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Undeleted > Exam 2 Clinical > Flashcards

Exam 2 Clinical Flashcards

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1
Q

Pneumonia sputum types and bug causing it

A

rust colored- strep pneumo
currant jelly-klebsiella
scant,watery-mycoplasma
foul smelling-anaerobic

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2
Q

CXR and findings/bug causing it

A 
lobar-bacterial
diffuse-viral/legionella/pneumocystis
interstitial-mycoplasma
multiple nodules-staph aureus
cavitation-staph aureus
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3
Q

Abnormal labs with legionnaires disease

A

hyponatremia

hypophosphatemia

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4
Q

Mycoplasma pneumo demographic

A

college students

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5
Q

Nosocomial acquired pneumonia definition

A

after 48hrs of being admitted

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6
Q

Risks for acquiring pseudomonas pneumonia

A

structural lung disease
steroids
recent broad spectrum antibiotics

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7
Q

Use of pneumovax

A

over 65 y/o

2-64 y/o with chronic illness

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8
Q

Use of influenza vaccine

A

over 50 y/o
6mo-64 yrs with chronic illness
pregnancy with flu season

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9
Q

Pattern of idiopathic pulmonary fibrosis damage

A

usual interstitial pneumonia

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10
Q

Sx of idiopathic pulmonary fibrosis

A

progressive respiratory failure (3-8yrs)
velco rales
paroxysmal cough

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11
Q

CXR with idiopathic pulmonary fibrosis

A

honeycombing

infiltrates at base of the lung

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12
Q

Cause of desquamative interstitial pneumonitis

A

inhaled stimulants

dense macrophages in airspace

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13
Q

Demographics for sarcoidosis

A

blacks

females

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14
Q

Abnormal labs with sarcoidosis

A

hypercalcemia

increased ACE levels in serum

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15
Q

Tx for sarcoidosis

A

corticosteroids

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16
Q

Cause of hypersensitivity pneumonitis

A

repeated exposure to organic dust

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17
Q

Cause of increased TB since the 1980’s

A

AIDS

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18
Q

Tuberculin skin test

A

type IV hypersenitivity

48-72hrs

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19
Q

TST positivity and pt

A

> 5mm for AIDS/immunosuppressed/abn CXR
10mm for healthcare/under 4 yrs/foreign born or increased risk (silicosis/DM/cancer)
15mm for healthy people

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20
Q

Dx of TB

A

culture is gold standard (7wks)

interferon-gamma for latent TB (BCG does not effect)

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21
Q

1st line tx for TB

A 
RIPE(S)
Rifampin
Isoniazid
Pyrazinamide
Ethambutol
Streptomycin
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22
Q

Immune reconstitution inflammatory syndrome

A

AIDS pt with TB
antivirals reactivate immune system
causes pt to have sx of illness

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23
Q

Abnormal labs seen in miliary TB

A

pancytopenia

hyponatremia

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24
Q

Selecting tidal volume for a pt

A

6-8cc of air/kg

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25
What is SIMV in regards to ventilation?
synchronous intermittent mechanical ventilation used for weaning pts off the ventilator is uncomfortable for pt
26
Best way to wean pt off ventilator
pressure support | helps pt open alveoli during initial inspiration
27
What is automatic flow on ventilators?
computer continually finds most optimal tidal volume pattern for pt
28
Problems arising from ventilators
``` overdistention of lung (birds beak on flow/volume) flow starvation (decreased airway pressure) ineffective triggering (wasted efforts) ```
29
Use of peak end expiratory pressure and possible problem with it
Keep alveoli open at end of expiration | air trapping/increased FRC
30
Drug used for rapid awakening
propofol
31
Drugs used for acute agitation
lorazepam/diazepam
32
Adverse effects of propofol
lactic acidosis renal failure decicated line needed pancreatitis (monitor TG's)
33
Lung adenocarcinoma location/risk
peripheral location metastasizes to brain most common type
34
Lung SSC location/lab finding
central location | hypercalcemia
35
Small cell lung carcinoma location/findings
central location SIADH Eaton-Lambert syndrome
36
Bronchalveolar cell carcinoma
``` lepidic growth (along alveoli) peripheral location ```
37
Limitations of CT/PET scans for cancer of the lung
must be over 1cm false (-) with diabetics false (+) with infection
38
Management of nodules under 8mm in lung for low risk pts
under 4mm-no follow up 4-6mm-follow up CT in 1 yr 6-8mm-follow up CT 6-12mo and 18-24mo over 8mm-CT at 3,9 and 24 mo, bx
39
Management of nodules under 8mm in lung for high risk pts
under 4mm-CT in 12 mo 4-6mm-CT 6-12mo, then 18-24 mo 6-8mm-CT 3-6mo, then 9-12, then 24mo over 8mm-CT 3,9,24mo, bx
40
Findings with cystic fibrosis
decreased FEV1/FEV ratio
41
Best tx for cystic fibrosis
``` tobramycin (pseudomonas) human DNase (decrease mucus thickness) hypertonic saline (increase hydration) ```
42
Worst bug for cystic fibrosis
Burkholderia cepacia cannot get rid of once acquired low survival
43
Goal antibiotic use in CF
eradicate pseudomonas early
44
Contraindication for lung transplant with CF
Burkholderia cepacia infection
45
What can cause false readings on pulse oximetry?
carboxyhemoglobin | methemoglobin
46
Measurement of oropharyngeal airway
center of mouth to angle of mandible
47
Measurement of nasopharyngeal airway
nostril to pts ear lobe
48
Bag valve mask ventilation flow/timeframe
oxygen flow at 12L/min | ventilation every 5 seconds
49
Rapid sequence induction
for pts with intact gag reflex lidocaine pretx succinylcholine + versed (or etomidate if hypotensive)
50
Endotracheal size/depth for peds
age/4 + 4mm | depth is 3x size in cm
51
Surgical airway procedure
not for children under 12 y/o | piece the cricothyroid cartilage
52
Endotracheal intubation in peds requirement
only use Miller blade
53
Tension pneumothorax tx
decompression: 2nd midclavicular intercostal space | chest tube in 4/5th mixaxillary intercostal space
54
Tx for open pneumothorax
airtight dressing taped on 3 sides (flutter valve)
55
Sx seen with cardiac tamponade
Kussmaul's sign pulsus paradoxus Beck's Triad
56
Tx for cardica tamponade
pericardiocentesis | 1-2cm inf xiphoid on L at 45 degree angle toward scapula
57
Common site for aortic disruption
ligamentum arteriosus
58
Cause of transudate in pleura space
cardiac/renal/liver problems
59
What needs to be done on all fluid analysis?
cell count/differential culture chemistry cytology
60
Crackles in the lung
from opening of alveoli | inspiration
61
Rhonchi in the lung
excess secretions in large airways | inspiration and expiration
62
Wheezes in the lung
from narrowing of small airways musical/high pitched expiration mostly
63
Pleural friction rub in the lung
harsh/scratching sound | inspiration and expiration
64
Stridor in the lungs
stenosis of the large airways high pitched inspiration only

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