random tidbits! Flashcards
(108 cards)
1
Q
most common cause of acute bronchiolitis?
A
RSV
2
Q
most common cause of croup?
A
parainfluenza virus
3
Q
most common cause of acute epiglottitis?
A
haemophilus influenza type B
4
Q
most common cause of pertussis?
A
brodatella
5
Q
most common cause of TB?
A
mycobacterium spp. except avian complex
6
Q
most common cause of pneumonia (healthy)?
A
strep pneumonia
7
Q
most common cause of pneumonia (COPD)?
A
haemophilus influenza
8
Q
most common cause of pneumonia (AIDS)?
A
staph aureus
9
Q
most common cause of pneumonia (alcoholics)?
A
klebsiella
10
Q
most common cause of pneumonia (cystic fibrosis)?
A
pseudomonas
11
Q
most common cause of pneumonia (teenagers)?
A
mycoplasma pneumonia/chlamydia pneumonia
12
Q
most common cause of pneumonia (air conditioners)?
A
legionella
13
Q
5 causes of TYPICAL pneumonia
A
strep pneumonia, h. influenza, staph aureus, klebsiella, pseudomonas
14
Q
5 causes of ATYPICAL pneumonia
A
mycoplasma, legionella, influenza, RSV, adenovirus
15
Q
3 causes of acute bronchitis
A
rhinovirus, coronavirus, RSV
16
Q
how do we treat an infant with hyaline membrane disease?
A
exogenous surfactant via endotracheal tube
17
Q
when is hyaline membrane disease most likely to occur?
A
shortly postpartum, usually lasts 2-3 days
18
Q
what is the most common cause of death in the first month of life?
A
hyaline membrane disease
19
Q
where will you see cephalization of vessels towards the head? (more prominent vessels up high)
A
ARDS
20
Q
what disease is characterized by a “white out” on the x-ray, sparing the costophrenic angles?
A
ARDS
21
Q
what disease is characterized by this mechanism: event occurs->cytokines are released which recruit pro-inflammatory mediators->large WBC traffic (NEUTROPHILS!)->proteins aggregate and hyaline membrane forms->alveolar edema ensues
A
ARDS
22
Q
is ARDS responsive to 100% O2?
A
NO (refractory hypoxemia)
23
Q
how do we treat ARDS?
A
mechanical ventilation CPAP w/ full face mask, PEEP to prevent airway collapse @ end of inspiration
24
Q
where do we want to keep O2 in ARDS?
A
over 55 mmHg but under 60 to prevent oxygen toxicity
25
what is the carrico dex? what should it normally be? what is bad?
measure of hypoxia; looks at ratio at how much oxygen you can hold vs. amount of O2 you need to breathe
normal: 380
ARDS:
26
which technique takes a substernal approach?
mediastinoscopy
27
which technique takes a parasternal approach?
mediastinotomy
28
what is a thoracotomy?
open procedure, using rib separators
29
when will DLCO be low?
restrictive diseases
30
what is happening during acidosis?
our enzymes don't work, we have high CO2, we're barely even breathing. could be respiratory failure
31
when do you not order a D-dimer?
after surgery, it will be high!
32
what is a typical FEV1/FVC ratio in restrictive & obstructive lung disease?
above 70% in restrictive, lower than 70% in obstructive
33
best measurement of obstruction?
FEV1/FVC ratio
34
best measurement of restriction?
decreased lung volume
35
when may DLCO also be low (aside from restrictive lung diseases)?
ANEMIA! less opportunity for CO affinity because less hemoglobin
36
what is another term for fine crackles? where do we see this?
rales; alveolar disease & fibrosis (velcro-like)
37
what is another term for course crackles? where do we see this?
rhonchi; seen with secretions (bronchitis, consolidation)
38
what do diminished breath sounds signify?
COPD, pneumothorax
39
what is the cough like in restrictive diseases?
dry, unproductive
40
what two signs do obstructive diseases usually present with?
hacking and wheezing
41
where is hemoptysis most common?
BRONCHITIS (viral)
42
what is the mechanism behind spontaneous/primary pneumothorax?
rupturing of apical blebs
43
how do we treat primary pneumothorax? tension pneumothorax?
primary: aspiration or chest tube if it doesn't spontaneously remit
tension: mechanical ventilation/resuscitative effort
44
what is our sclerotic agent? what does it do?
TALC; it is painful and results in virtual elimination of the pleural space due to adhesion
45
what is the treatment of a malignant or large pleural effusion?
PLEURX; catheter that works unidirectionally to drain fluid out without fluid going in
46
how do typical effusions appear on XRAY?
homogenous & white in color (not splotchy!)
47
how do we treat an empyema?
surgical drainage AND antibiotics
48
what is a clue for a transudative congestive heart failure?
more fluid in RIGHT side of chest than LEFT; elevated BNP
| -fluid across the diaphragm
49
where does the root lie in transudate effusions?
SYSTEMICALLY; not local to lung
50
where does the root lie in exudate effusions?
LOCAL to lung
51
how will we distinguish between transudate vs. exudate?
thoracentesis; compare pleural fluid protein & LDH with serum protein & LDH
52
you do a thoracentesis and notice the fluid is milky. what is the likely cause? what is this fluid high in?
chylothorax! high triglyceride count >100
53
is malignancy a transudate or exudate effusion?
exudate
54
is pulmonary embolism a transudate or exudate effusion?
exudate
55
what is the mechanism behind pleurisy?
it has roots in irritated nerve fibers along the parietal pleura (rooted in the chest wall)
56
what does beryllium typically mimic? how do you distinguish?
sarcoidosis! there will be granulomas with LESS lymphadenopathy than seen in sarcoidosis
57
which of our occupational diseases has a genetic component?
beryllium
58
which of our occupational diseases mimics COPD/chronic bronchitis?
coal workers pneumoconiosis
59
which of our occupational diseases affect the upper lobes? which affect the lower?
upper: coal-workers pneumoconiosis, silicosis
lower: asbestosis
60
what will XRAY of silicosis look like?
3-5 mm nodules (MANY!!), some calcification, swollen lymph nodes, fibrosis
61
what may silicosis put you at a higher risk of developing?
TB, connective tissue disorders (RA, scleroderma)
62
which of our occupational diseases will most commonly present with an effusion?
asbestosis! same with mesothelioma
63
where will we see a "candle dripping" pattern of calcification?
asbestosis
64
you are noticing pleural plaques & thickening of the diaphragm...likely diagnosis?
asbestosis
65
when will we see a ground-glass appearance on CT?
hypersensitivity pneumonitis
66
when will we see reticulonodular, poorly defined infiltrates on XRAY (sparing the apices)?
hypersensitivity pneumonitis
67
describe the acute pattern of hypersensitivity pneumonitis
flu-like symptoms, cough, fever, chills, malaise, dyspnea within 4-8 hours of exposure
68
describe the subacute pattern of hypersensitivity pneumonitis
cough, dyspnea within weeks. hospitalization may be necessary, but typically resolve
69
describe the chronic pattern of hypersensitivity pneumonitis
look more like pulmonary fibrosis, symptoms are coughing, weight loss, malaise, dyspnea
70
how do we treat hypersensitivity pneumonitis?
avoidance, steroids, not much for chronic
71
will we see respiratory failure in hypersensitivity pneumonitis?
we can! some may have dyspnea even with oxygen dependence
72
what is the mechanism behind hypersensitivity pneumonitis?
invasion of neutrophils into the alveoli & small airways, T-cell mediated granuloma formation
73
what type of hypersensitivity is hypersensitivity pneumonitis?
type 4; gell & coombs cell-mediated
74
where is hypersensitivity pneumonitis ultimately affecting?
the alveoli and terminal airways!
75
how do we differentiate between CAP and bronchitis?
bronchitis is typically viral, won't have infiltrates on chest XRAY, their entire chest will make harsh, crackly sounds (not just one spot like pneumonia)
76
how do we differentiate between CAP and pulmonary embolism?
dyspnea WITHOUT infiltrate is classic of PE
77
what is an increased risk of bladder cancer (2-4x) associated with?
tobacco! be weary if a patient comes in with blood in their urine (50% men, 40% women)
78
what is the most effective adherence treatment to TB?
DOT!
79
what is the hallmark of TB?
disease of the UPPER LOBES--chest xray will show infiltrates and CAVITIES
80
what are infiltrates?
collections of fluid & cells in lung tissues
81
what is the easiest/most cost efficient way to diagnose TB?
have them cough into sterile container; get a few specimens
82
what are additional ways to test for TB?
if initial fails:
1) do induced sputum (have patient inhale saline)
2) bronchoscopy (instrument passed through nose or mouth into lung to obtain secretion)
3) gastric washing (often with children; tube inserted through nose into stomach to obtain gastric secretions that MAY contain sputum)
83
why is quantiferon gold better than a PPD?
requires single visit; results in 24 hours, doesn't cause booster phenomenon, more accurate readings, BCG vaccine doesn't affect results
84
what level of induration will an IVDU likely have on PPD?
10 mm
85
what level of induration will a 3 year old likely have on PPD?
10 mm
86
what is the leading cause of death for people with HIV/AIDS?
TB
87
which disease is consistent with SEVERE lymphocytosis?
pertussis; WBC count may be up to 50,000!
88
what is the major limitation to pertussis management?
ABX will have no effect on duration of illness, it will only decrease contagiousness
89
what is the DOC for pertussis?
macrolides
90
what are pneumonia, otitis media, and seizures complications of?
pertussis
91
what are the three phases of pertussis?
1) catarrhal phase: URI symptoms for 1-2 weeks
2) paroxysmal phase: severe coughing fits with inspiratory whooping (^ to 6 weeks)
3) convalescent phase: resolving of cough and emesis
92
when will you see dysphagia, drooling, and distress?
acute epiglottitis
93
what are two give-aways for acute epiglottitis?
tripoding and thumbprint sign on XRAY
94
how do we treat epiglottitis?
dethamexasone to reduce swelling, tracheal intubation to protect airway, 2/3rd generation cephalosporin
95
in what age group is croup most common?
6 mo-6 years (15% of kids get it)
96
what disease is associated with hoarseness, a barking cough and "seal-like" stridor on inspiration AND expiration?
croup
97
what will xray of croup show?
steeple sign! though DX is usually made clinically
98
how to treat croup? what if severe?
oral steroids give GREAT relief. give nebulized epinephrine if severe!
99
what disease is characterized by proliferation & necrosis of the bronchial epithelium, producing obstruction from sloughed epithelium?
acute bronchiolitis
100
along with obstruction with sloughed epithelium, what two other factors lead to airway narrowing in acute bronchiolitis?
increased mucus plugging, submucosal edema
101
who is most at risk for developing acute bronchiolitis?
infants under 2 years old with exposure to cigarettes, not-breastfed, and premature
102
how is bronchiolitis spread?
HIGHLY contagious; transmitted by direct contact with secretions & self-inoculation
103
what are the two most common complications with bronchiolitis?
otitis media with strep pneumo most common ACUTELY; asthma most common later in life
104
how will we diagnose bronchiolitis?
NASAL WASHINGS using monoclonal antibody test
-CXR will show hyperinflation, peribronchial cuffing
105
what is the single best predictor of bronchiolitis in kids?
pulse ox
106
how do we treat acute bronchiolitis?
humified O2, mechanical ventilation if necessary. medications play LIMITED role and steroids ad NOT indicated
107
how many we prophylax for bronchiolitis in high risk groups?
palivizumab prophylaxis
108
how will a patient with acute bronchiolitis present?
fever, URI 1-2 days preceding-->respiratory distress (wheezing, tachypnea, nasal flaring, cyanosis, rales, retractions)
