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48 Cards in this Set
- Front
- Back
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1. What is the gold standard for diagnosis of pneumonia?
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a. The presence of infiltrates on CXR
b. However, a normal x-ray does not exclude the diagnosis c. X-rays may be normal early in the course of disease and a patient who is dehydrated may not demonstrate infiltrate until the patient is adequately rehydrated. |
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2. Pneumonia vs. Pneumonitis?
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a. Pneumonia is infection of lung parenchyma caused by agency bacteria, viruses, fungi, and parasites
b. Pneumonitis inflammation of the lungs from a variety of noninfectious causes such as chemicals, blood, radiation, and autoimmune processes. |
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3. What is the most common mechanism triggering pneumonia
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a. Upper airway colonization by potentially pathogenic organisms that are subsequently aspirated
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4. What is the most common bacterial cause of community acquired pneumonia?
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a. Streptococcus pneumoniae (Pneumococcus)
b. Other common bacterial etiologies include: 1. Haemophilus influenzae 2. Moraxella catarrhalis |
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5. Classic Presentation of pneumococcal pneumonia?
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a. Illness of acute onset with cough productive of RUST-coloured sputum!
b. Fever c. Shaking chills d. Bulbar infiltrates on radiograph |
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6. In whom is Haemophilus pneumonia often seen?
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a. Patients with COPD
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7. Presentation of atypical pneumonia on radiograph (compared to typicals)?
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a. Tend to cause bilateral, diffuse infiltrates
b. Rather than focal, lobar infiltrates |
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8. Atypical pneumonia causes (3 listed)?
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1. Mycoplasma pneumoniae
2. Chlamydia pneumoniae 3. Legionella pneumoniae b. Also several different viruses |
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9. In whom do the typical vs. Atypical pneumonias commonly occur?
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a. Typical pneumonia: the very young and very old
b. Atypical pneumonia: more common in adolescent or young adult patients. |
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10. Pneumonia with radiographic findings of bilateral, ground-glass appearing infiltrate, think?
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a. Pneumocystis jiroveci pneumonia
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11. Pneumonia with apical consolidation, think?
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a. TB
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12. Pneumonia caused by aspiration of gastrointestinal contents, the seen where?
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a. Right lower lobe pneumonia.
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13. How can Legionella be identified?
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a. Urinary antigen testing
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14. Empiric Treatment of pneumonia in otherwise healthy persons?
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a. The macrolide: Clarithromycin or azithromycin
b. Or c. Doxycycline |
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15. Empiric Treatment of pneumonia in otherwise healthy persons in the areas with high rates of macrolide resistance?
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a. Treatment with a newer fluoroquinolone (levofloxacin, moxifloxacin)
b. Or c. A combination of a beta-lactam plus a macrolide |
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16. Treatment of hospitalized patients with community acquired pneumonia who do not require ICU?
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a. IV beta-lactam (eg, cefuroxime, cefotaxime, ceftriaxone, or ampicillin – sulbactam)
b. + c. IV macrolide (erythromycin or azithromycin) d. NIV fluoroquinolone activity against S pneumoniae can be substituted. |
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17. Why are early follow-up chest x-rays mandatory in those who fail to show clinical improvement at 5 to 7 days?
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a. Because bronchogenic carcinoma can present the picture of a typical pneumonitis
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18. Duration of Streptococcus pneumonia treatment?
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a. Should continue until the patient is afebrile for at least 72 hours.
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19. Duration of pneumonia treatment if caused by S aureus, Pseudomonas aeruginosa, Klebsiella, anaerobes, M pneumoniae, C pneumoniae, or Legionella species?
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a. A minimum of 2 weeks of therapy is appropriate
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20. When may be necessary to perform a thoracentesis with Gram stain and culture of pleural fluid with pneumonia?
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a. It's more than a minimal amount of fluid is present, as evidenced by significant blunting of the costophrenic angles on radiograph.
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21. For whom is the pneumococcal vaccine recommended?
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1. All persons 65 and older
2. All adults with chronic cardiopulmonary diseases 3. All immunocompromised patients b. Consider revaccination every 5 years in patients known to have a rapid decline in anybody titres, such as those with nephritic syndrome or renal failure. |
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22. Drug of choice for pneumonia caused by Legionella and S aureus?
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a. Erythromycin
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23. Drug of choice for Streptococcus pneumonia?
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a. Penicillin
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24. Drug of choice for pneumonia caused by Haemophilus?
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a. Cefuroxime
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25. Complete
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25. Complete
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1. What type of birth control is recommended for breast-feeding women?
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a. The progestin only “minipill” as combined hormonal contraceptives can interfere with milk supply.
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2. Endometritis?
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a. A polymicrobial infection of the endometrium of the uterus, usually caused by ascending infection from the vagina.
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3. Lochia?a. Yellow – white discharge, consisting of blood cells, decidual cells, and fibrous products, that occurs following delivery.
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a. Yellow – white discharge, consisting of blood cells, decidual cells, and fibrous products, that occurs following delivery.
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4. In women who are not breast-feeding, when does menstruation usually restart?
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a. By the 3rd month postpartum
b. Anovulation persists for longer periods of time were exclusively breast-feeding their babies |
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5. What is the most common cause of postpartum hemorrhage?
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a. Uterine atony.
b. Failure in the uterus to contract adequately resulting in continued bleeding from uterine vasculature |
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6. Risk factors for Uterine atony?
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a. Prolonged labor
b. Prolonged use of oxytocin during labor c. Large baby d. Grand multipara (5 or more previous children) |
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7. Initial management of uterine atony?
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a. IV oxytocin
b. Bimanual massage |
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8. Secondary management of uterine atony if the above does not control bleeding?
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a. IM methylergonovine (Methergine)
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9. Contraindication to administration of IM methylergonovine (Methergine)?
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a. Hypertension, as it may cause an abrupt increase in blood pressure
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10. 3rd line treatment of uterine atony if the above fails?
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a. Prostaglandin F2α (Hemabate) IM or intramyometrially
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11. In whom is Prostaglandin F2α (Hemabate) contraindicated?
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a. Patients with asthma
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12. Was another option which is given orally or rectally to control uterine bleeding?
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a. Misoprostol (Cytotec).
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13. Postpartum fever, especially if associated with uterine tenderness and foul-smelling lochia is often the sign of?
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a. Endometritis
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14. 3 other causes of fever in the postpartum period (esp in women w/c-sections)?
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a. Identical to causes of fever in postsurgical patients:
1. Atelectasis 2. Wound Infection 3. Venous thromboembolic disease |
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15. Maternity or baby blues?
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a. Occurs in 30 to 70% of women.
b. This condition develops within the 1st week after delivery typically resolves 510 postpartum day. c. Sx: i. Tearfulness ii. Sadness iii. Emotional mobility |
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16. First-line therapy for postpartum depression?
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a. SSRIs because of the efficacy and safety.
b. They are also considered safe in breast-feeding |
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17. Postpartum psychosis?
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a. A rare but potentially devastating complication following pregnancy.
b. Manic or frankly delusional behaviours be present in a few days to a few weeks afte delivery in up to 1 in 1000 postpartum patients. |
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a. A rare but potentially devastating complication following pregnancy.
b. Manic or frankly delusional behaviours be present in a few days to a few weeks afte delivery in up to 1 in 1000 postpartum patients. |
a. Frequent position changes
b. Alternating breasts during feedings c. Application of lanolin |
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19. Pathophys of mastitis?
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a. Results from obstruction of milk glands sometime secondarily infected with bacteria.
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20. Treatment of mastitis?
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a. Treated by increased nursing or breast pumping
b. Oral antibiotics, such as cephalexin or dicloxacillin should not result in discontinuation of nursing. |
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21. How long after delivery should non-breast-feeding women wait to start combined OCPs?
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a. 3 weeks, as the risk of thromboembolic disease is higher in those earlier times
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22. How long after delivery should you wait to place an IUD?
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a. 6 weeks
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23. Note: lactation induced amenorrhoea provides a high level of natural contraception in the 1st 6 months postpartum. Women who breast-feed exclusively and are amenorrheic have a 98% contraceptive protection for 6 months.
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23. Note: lactation induced amenorrhoea provides a high level of natural contraception in the 1st 6 months postpartum. Women who breast-feed exclusively and are amenorrheic have a 98% contraceptive protection for 6 months.
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