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RESP > FINAL > Flashcards

FINAL Flashcards

1
Q

you see bulging fissure on CXR …

A

klebsiella (typical)

tx: Carbapenems

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2
Q

MCC of Typical pneumonia =

A

Strep pneumo

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3
Q

MCC of ATYPICAL pneumonia

walking pneumonia

A

Mycoplasma pneumoniae

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4
Q

Treatment drug choice for ATYPICAL pneumonia

A

Macrolides – Azithryomycin

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5
Q

Chest XRAY shoes interstial pattern, patient appears fine …

A

ATYPICAL Pneumonia

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6
Q

Atypical Pneumonia

Patient was recently in contact with birds, + Splenomegaly
DX?

A

Psittacosis

TX with MACROLIDES

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7
Q

Patient presents with muscle aches, diarrhea, and ataxia
Labs: Hyponatremia
Lives in the city and has been using his AC…

A

Legionella

TX: Macrolide/Floroquinolone

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8
Q

Patient has been in the hospital 48+ hours, has a normal CXR but has purulent bronchitits
What is the MCC of this pneumonia?

A

HAP = pseudomonas followed by S. aureus

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9
Q

Treatment of CAP

outpatient with no previous lung disease or risk factors …

A

azithromycin or clarithromycin or doxycycline

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10
Q

treatment of CAP

Outpatient WITH lung disease/risk factors

A

Beta lactam (Penicillin/cephalosporin) + Azithromycin or fluroquinolone

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11
Q

Treatment of CAP

INpatient with NO lung dz/risk factors

A

IV azithromycin or IV Fluroquinolone

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12
Q

Treatment of CAP

INpatient with comorbidities

A

Beta lactam + Azithromycin or Macrolide or DOXy

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13
Q

Piperacillin-Tazobactam can be used as treatment towards what pathogen?

A

HAP – Pseudomonas aeruginosa

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14
Q

Treating ACTIVE Tb

  1. Start on all 4 drugs: RIPE
A

Rifampin
Isoniazid
Pyrazinadmide
Ethambutol

2. Once pansensitive D/C E, after 2 mo D/C , use I/R for 6 mo total

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15
Q

What is the solution to TB drug resistance?

A

DOT = directly observed therapy

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16
Q

chronic airflow obstruction d/t chronic bronchitis and or pulm epmhysema

A

COPD

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17
Q

GOLD 1 = MILD
What is the FEV1 predicted

A

> 80 %

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18
Q

50% < FEV 1 < 80%

A

GOLD 2 = MODERATE

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19
Q

30% < FEV1 < 50%

A

GOLD 3 Severe

GOLD 4 = VErY SEVERE <30%

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20
Q

Treatment for MILD COPD

A

SABA

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21
Q

Treatment for GOLD 2

Moderate

A

LABA

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22
Q

treatment for GOLD 3

A

ICS

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23
Q

reduce incidence of community-acquired pneumonia

A

PPSV23

Patients <65 yo, FEV1 <40% predicted, with comorbidities

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24
Q

reduces pneumococcal disease in adults > 65

A

PCV13

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25
Q

fever, night sweats, hemoptysis

A

TB

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26
Q

TB immunity is mediated by

A

TH1 cells

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27
Q

A positive PPD is evidence of what type of immune response

A

Cell-mediated (Type IV) hypersensitivity

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28
Q

caseating granulomas ..,.

A

TB

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29
Q

combo of parenchymal lung lesion and nodal involvement is referred to as the …

A

Ghon Complex

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30
Q

sulfur granules
formation of multiple abscesses
draining sinus tracts

A

Actinomycosis

TB look alike

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31
Q

borad based budding

A

Blastomycosis

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32
Q

patient was recently in San Joaquin valley and presents with erthyema nodusum

A

Coccidiomycosis

Thick-walled, non-budding spherules
filled with endospores

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33
Q

2 bacterial TB look alikes =

A

Nocardia and Actinomcyetes

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34
Q

Carcinoid tumors arise from what type of organs or cells

A

neuroendocrine

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35
Q

most carcinoid tumors are found where?

A

GI tract

tracheobronchil tree/lungs

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36
Q

macroscopic pattern

masses that grow within the lumen of the bronchus
covered by intact mucosa
3-4cm

A

Central Tumors

Peripheral – outside the bronchioles collar button lesions

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37
Q

What type of carcinoid

organoid nests, rosettes, or a trabecular growth pattern of uniform cells – seperated by delicate fibrovascular stroma

A

Micropscopic morphology of TYPICAL carcinoids

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38
Q

“salt and pepper” appearance

nucleir with finely granular chromatin

A

Bronchial Carcinoid Tumors

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39
Q

systemic release of serotonin and other vasoactive substances

sx; flushing, diarrhea, bronchospasm

A

Carcinoid syndrome

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40
Q

growth of secondary tumors via lymphatic or hematogeneous dissemination

A

Metastatic Lung Tumors

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41
Q

preferential site for hematogenous metastsais

Non-small cell lung cx (NSCLC)

A

bone, adrenal glands, brain and liver

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42
Q

preferential site for hematogenous metastsais

Small cell lung canver (SCLC)

A

Bone, brain and liver

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43
Q

what symptoms should you be on the lookout for metastatic disease?

A

Mental/Neuro changes
Hepatomegaly
Bone pain/fractures

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44
Q

Solitary Fibrous Pleural Tumor

Pathogenesis:** Inversion of chromosome 12** and the subsequent fusing of two genes:

A

NAB2 and STAT6
drives pleural tumor growth

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45
Q

Solitary Fibrous Pleural Tumor

Morphology: rare, well-localized, round-oblong tumors with whorled appearances that arise from the pleura & are often attached to it by a?

A

pedicle

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46
Q

rare, malignant tumor of the thoracic cage affecting both layers of pleura

d/t exposure of ASBESTOS

A

Mesothelioma

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47
Q

Pathogenesis: homozygous deletion of tumor suppressor gene,

A

CDKN2A on chromosome 9

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47
Q

Pathogenesis: homozygous deletion of tumor suppressor gene,

A

CDKN2A on chromosome 9

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48
Q

What types of diets are recomennded for patients with asthma?

A

Anti Inflam Diet
* INC omega 3 fatty acids / DEC omega 6

Mediterranean diet

omega 3 – salmon, walnuts, chia seeds, sardines/flax

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49
Q

obesity is associated to:
while malnutrition is associated to:

A

Obesity – ASTHMA
Malnutrition – COPD

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50
Q

Vitamin and mineral supplement to compensate for inadequare oral intake:

A

VIT D, Ca2+, and antioxidants

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51
Q

What can indicate fluid deficit/fluid overload?

A

HYPERnatremia – fluid deficit
HYPOnatremia – fluid overload

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52
Q

What diet recomenddation do you give for a patient with COPD?

A

High Calorie / High Protein Diet

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53
Q

Individuals with CF also have difficulties absorbing what kind of vitamins?

A

ADEK

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54
Q

What nutritional intervention should be given to those with CF

A

INC Calorie and FAT intake
Maintain lean body mass

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55
Q

Intake of what vitamin may lead to reduction in the incidence of pneumonia?

A

VIT C

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56
Q

Hypermetabolism has an increased reliance on?

A

Gluconeogenesis

INC catbolism of muscle tissue

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57
Q

What is the best measure of energy requirements for the critcally ill?

A

Indirect Calorimetry

heat release calculated indirectly by measuring consumption of O2 a

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58
Q

enteral nutrition should be started within how many hours of admission of the critcally ill patient who is unable to eat?

A

24-48 hours

maintains normal gut pH/flora, inhibits opp bacterial overgrowth

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59
Q

What type of nutrition therapy is approtiate for patients with ARDS or acute lung injury?

A

Enteral nutrition

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60
Q

If pt is on propofol (which provides ??? kcal/ml), deduct those calories from energy requirements.

A

1.1

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61
Q

When to use exlcusive PN and supplemental PN?

A

exclusive – within 7 days (High nut. risk)
Supplmental – after 7-10 days

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62
Q

What is the second most common lung cancer which carries the best prognosis?

A

squamous cell carcinoma

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63
Q

What is an effective treatment for squamous cell carcinoma?

A

Bevacizumab

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64
Q

squamous cell carcinoma is associated to hyperarathyroidism and hypercalcemia which is associated to what syndrome?

A

Paraneoplastic syndrome

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65
Q

The most common lung cancer (60%) …

A

Adenocarcinomas

affects bronchioles and alveoli – more distal airways

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66
Q

What two common mutations are associated with adenocarcinomas?

A

EGFR and Kras

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67
Q

this mutation is a proto-oncogene which possibly is a cysteine receptor to turn gene off …

A

KRAS

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68
Q

What type of carcinoma has a strong association to smoking history, cannot be resected and has the worst prognosis?

A

Small Cell Carcinoma

arises in the proximal airways

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69
Q

Small cell carcinoma arises in the proximal airways from what type of cells? Associated with deletion on chrom 3

A

K-cells (Kulchistsky)

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70
Q

Small cell carcinoma secretes ectopic ACTH/ADH which is associated with which syndrome?

A

Paraneoplastic syndrome
ADH –> SIADH (too much ADH causes water retention/hypo-osmolarity)
ACTH – prod. excess glucocorticoids –> abdnormal fat deposition, HTN)

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71
Q

What biomarkers allow targeted therapies or immune checkpoints, without the use of cytotoxic chemo

A

EGFR, ALK, ROS, BRAF, NTRK

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72
Q

what increasses toxicity in squamous cell cancer

A

bevacizumab

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73
Q

Which two biomarkers respond to crizontinib?

A

EGFR TKI, EML4-ALK

74
Q

an apical lung tumor – damages nerves going up to the face, resulting in horners syndrome

A

Pancoast tumor

compression of sympathetic ganglion

75
Q

what is the triad of symptoms in horners syndrome?

A

Ptosis (eyelid drop) , Misosis (Constricted pupil) , anhidrosis

76
Q

most common benign primary lung tumor
CXR = coin lesions

A

Pulmonary hamartoma

77
Q

TTF-1 is a specific IHC marker and helpful for diagnosis of …

also shows intracytoplasmic mucin

A

adenocarcinomas

histology shows gland formation

78
Q

Which cell carcinoma expresses neuroendocrine markers chromogranin, synaptophysin, and CD56

A

Small Cell Carcinoma

releases hormones –> paraneoplastic syndromes

79
Q

Superior vena cava syndrome and Pancoast syndrome are most common with ?

A

Small Cell Lung Carcinoma

80
Q

Tuberculum impar

cell proliferation in medial tongue bud

No Tx needed, can use anti fungal wash

A

Median Rhomboid Glossitis

81
Q

cyst/swelling of the minor salivary glands

self resolves, crytotherapy

A

Mucocele

82
Q

retention cyst of sublingual gland duct

Tx: Marsupialization (puncture/drain)

A

RANULA

83
Q

caused by nervous biting
white, exophytic, hyperkeratotic, CANT be scraped OFF
Smoking, EtOH –> Sq. cell CA (pre malignant)

A

Leukoplakia

84
Q

Torus mandibularis = bony overgrowth of manible
What can this impinge?

A

Whartons Duct

at the base of the lingual frenulum

85
Q

acute necrotizing ginivits = trench mouth is caused by?

Treated with penicillin

A

Borella vincentii

86
Q

Aphthous stomatitis = canker sores usually occur where?

Tx: Anti-inflammatories/steroids

A

non-keratinized tissue

buccal mucosa, floor of mouth

87
Q

Herpe stomatitis = cold sores are due to HSV-1 and occur on what surfaces?

Tx: Acyclovir

A

Keratinized tissue

lips, gums

88
Q

Herpangina is most commonly caused by:

Canker like sores inside of mouth

A

Coxsackie virus A

Tx; Symptom relief

89
Q

Most common cause of ACUTE tonsillitis

A

viruses, group A Strep, H. Flu
EBV - hairy leukoplakia

Tx: bacterial – penicillin, augmentin/cephalosporins

90
Q

Tonsillolith is due to what?

A

stones of food getting stuck within the crypts of tonsils causing bad breath

91
Q

Ludwig Angina

invasion of mylohyoid muscle causing swelling where?

Sx; Pain, drooling, dysphagia, tongue protrusion

A

under the chin

Treat with IV antibiotic, steroids, tracheostomy

92
Q

3-5-7 Rule for tonsillectomy

A

3 infections/yr
5/2 years
7/3 years

93
Q

90% of oral cancer is ….

A

Squamous Cell

Most commonly found on the LOWER LIP

94
Q

Basal Cell Cancer is most commonly found where?

A

Upper Lip

95
Q

Tongue cancer is most commonly located

A

Anterior 2/3

likely to metastasize to posterior head/neck lymph nodes

96
Q

Buccal mucosa carcinoma is MC in Asia/Africa due to consumption of what?

A

BETEL NUT

spreads to floor of mouth

97
Q

Posterior cricothyroarytenoid muscle function =

A

ABduction

98
Q

Interarytenoid and Thyroarytenoid muscle functions =

A

ADduction

99
Q

Thryoglossal duct cyst is a remnant of foramen cecum which is found where?

A

MIDLINE – near pyramidal lobe of thyroid

moves with swallowing and tongue protrusion

100
Q

Goiters can occur due to WHAT?

A

Hypo or Hyperthyroidism

101
Q

Reinke’s edema presents as hoarseness due to what?

A

Overuse of smoking

102
Q

superior laryngeal nerve damage will cause

A

cricothyroid weakness

103
Q

Recurrent laryngeal nerve damage will cause

A

inter-laryngeal ab/adductor weakness

104
Q

if there is uneven elevation of uvula, what CN is damaged?

deviates AWAY from side of lesion

A

CN X

105
Q

eustachian tube drains mucus into

A

nasopharynx

106
Q

Why do children get ear infections?

A

Eustachian tube = more horizontal – drainage impaired

107
Q

If tympanometry shoes pressure less than -200,
Hearing Test shows conductive hearing loss or air-bone gap
You would suspect disease in what part of the ear?

A

Middle Ear Disease

108
Q

Medical management of acute otitis media includes:

A

Antibiotics: Amox/Ampicillin +/- clavulanic acid for B-lactamase coverage
Erythromycin, TMP/SMX, Cefamine
Nasal decongestants
Analgesics

109
Q

What surgical procedure will ventilate middle ear, used in CHRONIC OM

A

Tympanostomy

110
Q

What surgical procedure could be recomended for a child that has chronic or recurrent infections?

A

Adenoidectomy

111
Q

obliteration of the postauricular crease is a symptom most commonly seen in what middle ear disease?

A

Acute mastoiditis

IV antibiotics for 24-48 hrs, then oral abx for 2 weeks

112
Q

squamous cell growth where its not supposed to be, in middle ear =

Chronic OM -> poor ventilation -> INC neg press -> pocket/cyst w/squamou

A

Cholesteatoma

results in erosion of ossicles and destruction of mastoid cavity

113
Q

MCC of acute localized otitis externa (furnucle) =

A

Staph Aureus

114
Q

MCC of acute diffuse otitis externa (Swimmers Ear) =

A

Pseudomona aeruginosa

115
Q

LOW protein, LDH, and cholesterorl is inidcative of what type of pleural fluid?

HIGH Glucose, BASIC pH

A

TRANSUDATIVE

CHF, Liver cirrhosis, nephrotic syndrome

116
Q

Sleep is measured via what?

A

Polysomnography

117
Q

What waves do you see when someone is ALERT or when they are DROWSY?

A

Alert = Beta Waves
Drowsy = Alpha Waves

118
Q

What waves are seen during NREM sleep?

A

Theta Waves (N1-N2)
Delta Waves (N3 = deeper sleep)

119
Q

What stage of sleep shows K-complexes and sleep spindles?

A

N2 along with theta waves

120
Q

SAWTOOTH waves are indicative of what sleep stage?

A

REM sleep

121
Q

What type of neurotransmitters promote wakefulness and alertness

A

Monoamines

norepinephrine, histamine, serotonin and dopamine

122
Q

what NT comes from the Locus coeruleus nucleus and regulates wakefulness?

A

Norepinephrine

123
Q

what NT promotes REM sleep and wakefulness

A

Acetylcholine

promotes fast EEG rhytmns

124
Q

What regulates switching between wakefulness and sleep?

A

Orexin and Hypocretin

125
Q

What group promotes Sleep

A

Somnogens

Adenosine, cytokines, prostaglandin

126
Q

lookout for ascending paralysis, and rapid onset of muscle weakness following an infection/illness ….

A

Guillain Barre Syndrome

peripheral neuropathy to cause resp failure

127
Q

Guillain Barre Syndrome

cross-reactive immune attack on peripheral muelin sheaths due to molecular mimicry
typically caused by a GI infection by what?

A

campylobacter jejuni

muelin mimics capsular bacterial LPS

128
Q

How do you diagnose Guillain Barre Syndrome?

A

sural nerve biopsy with segmental demylineation present

129
Q

What diagnostic tests can be used to diagnose myasthenia gravis?

associated with thyomas

A

Edrophonium test – INC Ach at NMJ
Ice pack test – cooling improves neuromusclar tranmssion

130
Q

picornaviridae infection of motor cells (anterior horn) of spinal cord

A

Poliomyelitis

flaccid paralysis, unvaccinated, travel to endemic area

131
Q

irreversible, progressive neurodegenerative disease of motor neurons with significant paralysis and a poor prognosis of 2-5 years

A

Amyotrophic Lateral Sclerosis

132
Q

treatment for ALS

A

palliative care
Riluzole – extends life by 3-6 mo – inhibits glutamatergic transmission

133
Q

Most common pathogen of CAP in OUTPATIENTs

A
  1. Mycoplasma pneumoniae
  2. Resp viruses
  3. Strep pneumo
134
Q

Most common pathogen of CAP in INPATIENTs

A
  1. Strep pneumo
  2. Resp Viruses
  3. Mycoplasma pneumo
135
Q

Most common pathogens of CAP in INPATIENT

A
  1. Strep pneumo
  2. Legionella
  3. Gram Neg bacilli
136
Q

CURB 65

A

confusion
BUN > 20
RR > 30
BP < 90 / < 60
65 yo

137
Q

CURB 65 score of 0-1

A

treat as outpatient

30 day mortality = 0.7-2.1

138
Q

CURB Score of 2

A

treat as inpatient

30 day mortality = 9.2

139
Q

CURB 65 score of 3+

A

ICU

30 mortality rate 15-40

140
Q

1st choice treatment of CAP
healthy pt with no co morbities

A

Amoxicilin

doxy

141
Q

1st drug choice to treat CAP in patient with comorbities

A

amox/clavulanate plus doxy

142
Q

primary requirement for noninvasive ventilation

A

spontaneous breathing

least invasive = face mask / most = tracheal trube

143
Q

What is the ideal position for intubation

A

SNIFFING position
Extension at c1-c2
Flecion at C6-7

144
Q

in obese patients, the sniffing position is not good, instead you want external auditory meatus is in line with ?

A

sternal notch

145
Q

name the technique

posterior pressure applied to the cricoid cartilage to occlude esophagus

A

Sellevk maneuver

146
Q

ventilation w/simple nasal mask

provides a single set pressure throughout sleep
only forces air in (inspiration only)

A

CPAP

147
Q

ventilation with simple nasal mask

as two distinct pressure settings for inhalation and exhalation

A

BIPAP

148
Q

PT home exercise

A

bronchial drainage
draining with saline to decrease mucous and infections

149
Q

6 min walk test
desaturating during the test may occur in ….

A

interstital lung disease
PULM HTN
severe obstructive lung disease

150
Q

Resp Failure Type 1 vs Type 2

A

Type 1 = Hypoxemic
Type 2 = Hypercapnic/Ventilatory

150
Q

Resp Failure Type 1 vs Type 2

A

Type 1 = Hypoxemic
Type 2 = Hypercapnic/Ventilatory

151
Q

How to Calculate Anion Gap

A

(Na+ + K+) – (HCO3- + Cl-)

Normal = less than 12, abnormal = greater than 12

152
Q

is there compensation by the lungs

Winters Formula

A

PaCO2 = 1.5 X [ HCO3] + 8, plus or minus 2

153
Q

NON-ANION Gap Metabolic acidosis

USEDCRAP

A

Ureteric Diversion
Sigmoid Fistula
Excess Saline
Diarrhoea
Carbonic Anhydryase inhibitors
Addisons
Renal Tubular Acidosis
Pancreatic Fistula

154
Q

causes of high anion gap metabollic acidosis

CAT MUDPILES

A

CO
Aminoglycosidse
Teophylline
Methanol
Uremia
Diabetic ketoacidosis
Paractetamol
Iron
Lactic Acidosis
Ethanol
Saliclyci acid

155
Q

What non cardiac thoracic procedure would you suggest for a patient with severe COPD and poor resp mechanics?

FEV1 < 35%, end stage emphysema, able to do rehab

A

Lung Volume Reduction Surgery

EXCLUDE; Age > 75, FEV1 < 20%, on high dose steroids, hypercapnic

156
Q

Indications

Absolute: Enlarged Mediastinal LN
Relative: T2/3 Tumor
adeno/large cell CA
Stage 1 small cell
Vocal cord paralysis

A

Large Tumor Resection

157
Q

Most common mediastinal teratoma =

A

mediatstinal germ cell tumor

Three Types: Mature, Immature, Malignant

158
Q

post-op FEV1 value is estimated using Split Lung Function Test

pt. undergoes spirometry test and perfusion scan

A

Post-op FEV1 (predicted) = (pre-op FEV1) X (%perfusion)

Low Post op = HIGH Risk , High Post Op = LOW Risk

159
Q

H1 antihistamine drugs work via what pathway?

smooth muscle, endothelium

A

IP3-DAG pathway

hydrophobic – can cross BBB – sedation

160
Q

What antagonist part of antihistamines INCREASES appetite

A

Serotonin antagonist

ACh blocks – DEC level of awareness

161
Q

use of antihistamines

seasonal allergies

A

first gen H1
diphenhydramine

162
Q

use of antihistmines

allergic reactions

A

2nd gen HI = cetrizine, loratidine

163
Q

use of antihistamines

Promethazine, Cyclizine, Meclizine

A

MOTION sickness

164
Q

antihistamine toxicity can cause

espceically with CYP450 inhibitors like macrolides/azoles

A

QT prolongation –> Cardiac arrythimias

WORST = astemizole/terfenadine

165
Q

What drug is sometimes called OTC hypnotic

A

diphenhydramine

166
Q

what antihistamine has some dopamine anatgonistic effects

A

Promethazine

167
Q

What antihistamine has dual action mechanism
Blocks H1 receptors/Blocks mast cell release of histamine

A

AZELASTINE

168
Q

Which antihistamine is
Long Acting, LESS QT Prolongation

A

Desloratadine

169
Q

What antihistamine can be given with CYP450 inhibitors without QT prolongation

A

Fexofenadine

170
Q

What antihistmaine is more sefating, approved for infants < 6 mo

A

Cetirizine

171
Q

what antihistmaine drug antagonizes serotonin receptors

useful in Cushing syndrome, vasc. headache, and anorexia

A

Cyproheptadine

can treat anorgasmy = imparired sexual function

172
Q

Anterior vs. Posterior Epitaxis
Which is more common
Which is most server

A

MC = Anterior
Most servere = POSTERIOR

173
Q

During an anterior epistaxis, bleeding is from

A

Kiesselbach’s Plexus

174
Q

Posterior Epistaxis, bleeding is from

A

Woodruff’s plexus

175
Q

arteries associated with kiesselbach’s plexus

A

Anterior ethmoidal,
Posterior ethmoidal
Sphenopalatine
Greater palatine
Superior labial branch of facial artery

176
Q

arteries in Woodruffs plexus

A

sphenopalatine
ascedning pharyngeal
internal msxillary veins

177
Q

Classic Triad of Osler-Weber-Rendu Disease

A

Epistaxis + Mucocutaneous telangiectasia + family Hx

178
Q

adjuvant compressive therapy

anterior epistaxis treatment
Step 1 Part B = Meds

Part A = Compressive therapy (10-15 min)

A

Oxymetazoline nasal spray
Epinephrine

vasoconstriction via alpha receptors

179
Q

2nd Step

if compressive therepay failed in anterior epistaxis management, what can you do

A

CAUTERY

180
Q

What is the 3rd Step in anterior epistaxis management

A

Anterior Nasal Packing
Gauze, baloon, tampon for 48 hours

181
Q

Final step of anterior epistaxis management

A

Pack affected nares and contralateral nares

182
Q

Posterior Epistaxis Management

1st Step = Posterior Nasal Packing

A

Balloon catheter, foley catheter, or rubber catheter with cotton packing

2nd step = admit to hospital for ENT

RESP (3 decks)

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