Review pulmonary

Question 1

outpatient CAP

Answer 1

S. pneumoniae, Mycoplasma pneumoniae, H. influenza, Chlamydia pneumoniae, RSV

Question 2

inpatient CAP

Answer 2

S. pneumoniae, M. pneumoniae, C. pneumoniae, H. influenza, legionella, aspiration, RSV

Question 3

inpatient ICU CAP

Answer 3

S. pneumoniae, S. aureus, legionella, gram-negative, H. influenza

Question 4

CAP-alcoholics

Answer 4

anaerobes, Klebsiella pneumoniae

Question 5

COPD/smoking CAP

Answer 5

H. influenza, psuedomonas aeruginosa,

Question 6

Lung abscess CAP

Answer 6

CAP-MRSA, oral anaerobes, fungal pneumoniae, M. TB, atypical myocobacteria

Question 7

HIV/AIDS CAP

Answer 7

M. TB, pneumocystsis jiroveci, cryptococcus, histoplasmosis, aspergillus, atypical myocobacteia, H. influenza, Pseudomonas aeruginosa

Question 8

influenza CAP

Answer 8

influenza, S. pneumoniae, S. aureus, H. influenza

Question 9

cough CAP

Answer 9

bordetella pertusis

Question 10

Category 1 (outpatient, no cardiopulm disease)

Answer 10

S. pneumoniae, M. pneumoniae, RSV

Antibiotics: macrolide plus doxycycline

Question 11

category 2 outpatient, cardiopulm disease or risk factors: COPD, DM

Answer 11

S. pneumoniae, M. pneumoniae, Chlamydia pneumoniae

antibiotics: fluoroqionolone or beta-lactam + macrolide or doxycycline

Question 12

category 3 inpatient, non-ICU

Answer 12

S. pneumoniae, M. pneumoniae, Chlamydia pneumoniae

antibiotics: beta-lactam + macrolide, or fluoroquinolone

Question 13

category 4A (inpatient ICU)

Answer 13

S. pneumoniae, legionella, H. infleunza

antibiotics: beta-lactam + macrolide OR fluoroquinolone

Question 14

category 4B (inpatient ICU, RF for pseudomonas ) and consider MRSA risk factor

Answer 14

S. pneumoniae, legionella, H. infleunza, pseudomonas aeruginosa, CA-MRSA

antibiotics: anti-pseudomonal beta-lactam + aminoglycoside AND atypical coverage PLUS vancomycin or Linezolid

Question 15

Light’s criteria for exudate

Answer 15

pleural fluid protein/Serum Protein: >.5 (3)
Pleural fluid LDH/Serum LDH: >.6 (200)
Pleural fluid LDH/upper limit normal serum LDH: >.66 (>2/3) (0-240)

Question 16

light’s criteria for transudate

Answer 16

pleural fluid protein/Serum Protein: <.66 (2/3) (0-240)

Question 17

pediatrics CAP: <1 month

Answer 17

G group B strep
E. coli
L. monocytogenes
CMV
HSV

Question 18

pediatrics CAP: 1-3 months

Answer 18

virus
S. pneumoniae
afrebile pneumonitis pathogens
S. aureus

Question 19

pediatrics CAP: 3months- 5 years

Answer 19

virus
S. pneumoniae
S. aureus

Question 20

pediatrics CAP: school age

Answer 20

virus
M. pneumoniae
S. pneumoniae
C. pneuomoniae

Question 21

HAP

Answer 21

penumoniae that develops <48 hours after admission that as not present on admission

Question 22

VAP

Answer 22

pneumoniae that develops >48 hours after endotracheal intubation

Question 23

HCAP

Answer 23

hospitalized for >1 day within 90days of admission
long-term nursing facilities
recent IV abx chemotherapy or wound care within 30 days
attended hospital or hemodialysis clinic

Question 24

A-a gradient exceeds expectations?

Answer 24

diffusion impairment is present

Question 25

a sat of 90% expect PaO2

Answer 25

60

Question 26

normal PaO2 is approx

Answer 26

5X FiO2

Question 27

on room air (21% FiO2) normal PaO2

Answer 27

is approx 100 normal PaO2: FiO2 on RA 100/.21= 475 every 1 liter is about 3% increase

Question 28

ARDS severity: mild

Answer 28

PaO2/FiO2: 200-300

Question 29

ARDS severity: moderate

Answer 29

PaO2/FiO2: 100-200

Question 30

ARDS severity: severe

Answer 30

PaO2/FiO2: <100

Question 31

what could an increased V/Q mean

Answer 31

PE

Question 32

what could a decreased V/Q mean

Answer 32

Shunt emphysema (non-functional alveoli) fibrosis (poor diffusion of air) secretions (blocks diffusion of air)

Question 33

extrapulmonary shunt

Answer 33

right to left cardiac shunts | example: T of F

Question 34

intra-pulmonary shunt

Answer 34

blood is transported through the lungs without taking part in gas exchange example: atelectasis, pneumoniae, hepatopulmonary syndrome, AVM

Question 35

diagnostic FEV1/FVC ratio

Answer 35

less than 70%

Question 36

chronic respiratory failure is defined by

Answer 36

PaO250 mmHg while breathing air at sea level

Question 37

stage I Mild COPD

Answer 37

FEV1/FVC 80%

Question 38

stage II moderate COPD

Answer 38

FEV1/FVC <.7, FEV1 50-79%

Question 39

stage III severe COPD

Answer 39

FEV1/FVC <.7, FEV1 30-49%

Question 40

stage IV very severe COPD

Answer 40

FEV1/FVC <50% with chronic respiratory failure present