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34 Cards in this Set

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Community aquired pneumonia (CAP) is usually which bacteria?

Nosocomial pneumonia is usually which bacteria?
CAP = Strep Pneumoniae

Nosocomial = gram-negative rods and Staph Aureus
pneumoniae in alcoholics
klebsiella pneumoniae
Legionella pneumoniae is common in which groups?
organ transplant recipients, pts with renal failure, chronic lung disease, smokers
Typical VS Atypical community aquired pneumoniae

SYMPTOMS
Typical:
-Acute onset of fever and shaking chills
-Cough productive of thick, purulent sputum
-pleuritic chest pain (suggests pleural effusion)
-Dyspnea

Atypical:
-insidious onset: headache, sore throat, fatigue, myalgia
-Dry cough (no sputum production)
-fevers (chills are uncommon)
PULSE-TEMP dissociation (normal pulse in the setting of high fever)

both: rhonchi, crackles
How do you Dx pneumoniae?
PA and lateral Chest X-ray (CXR)
If vital signs are normal, what is the probability of pneumoniae in outpatients?
<1% If vital signs are normal
A quick, cheap way to test for legionella pneumoniae?
Urinary antigen assay
-however the antigen persists in urine for weeks, even after treatment has started
(there are other ways to test for it though)
What is empyema?
Empyema is caused by an infection that spreads from the lung and leads to an accumulation of pus in the pleural space. The infected fluid can build up to a quantity of a pint or more, which puts pressure on the lungs, causing shortness of breath and pain.
Lung abscesses can be complications of ____, _____, ____, and _____
1. Aspiration of organisms (especially oropharyngeal contents or food)
2. Acute necrotizing pneumoniae (gram-negative rods)
3. Hematogenous spread of infection from distant site
4. Direct inoculation with contiguous spread
Main risk factor for Lung Abscesses
predisposition to aspiration. This may be seen in pts with alcoholism, drug addiction, CVA (cerebrovascular accident), seizure disorders, general anesthesia, or a nasogastric or endotracheal tube)
Lung Abscesses - The most likely part of the lungs to be infected by aspirated contents are?
The dependent zones of the lungs: the posterior segments of the upper lobes and superior segrments of the lower lobes.

Aspirated material is most likely to affect the right lung because of the angle of the right main stem bronchus
What is Ghon's complex? Ranke's complex?
Radiographic findings in primary TB:

Ghons complex- calcified primary focus

Ranke's complex: calcified primary focus and calcified hilar lymph node
Tx for TB
four drug regimen: Streptomycin,INH,pyrazinamide,rifampin, ethambutol (SPIRE)

take this for 2 months followed by 4 months of INH and rifampin
Tx for the flu
largely supportive. Amantadine and Rimantadine decrease the duration of symptoms
Cause of Acute Bacterial Meningitis in:

Neonates
Group B strep > E Coli > Listeria monocytogenes
Cause of Acute Bacterial Meningitis in:

Children (>3 months)
Neisseria meningitidis > Strep pneumoniae > H influenza
Cause of Acute Bacterial Meningitis in:

Adults (Age 18 - 50)
Strep pneumoniae > N meningitidus > H influenza
Cause of Acute Bacterial Meningitis in:

Elderly (>50)
Strep pneumoniae > N meningitidis > L monocytogenes
Cause of Acute Bacterial Meningitis in:

Immunocompromised
L. monocytogenes > gram negative bacilli > Strep pneumoniae
What are
Kernig's Sign and Brudzinski's sign

for Meningitis
Kernig's sign: inability to fully extend knees when patient is supine with hips flexed

Brudzinski's sign - flexion of legs and thighs that is brought on by passive flexion of neck
WBC count

Normal
Bacterial Meningitis
Aseptic Meningitis
Normal - <5
Bacterial Meningitis - >1000(1000-20000)
Aseptic Meningitis - <1000
WBC differential

Normal
Bacterial Meningitis
Aseptic Meningitis
Normal - all lymphocytes or monocytes. No PMNs

Bacterial Meningitis - Mostly PMNs

Aseptic Meningitis - Mostly lymphocytes and monocytes
Glucose

Normal
Bacterial Meningitis
Aseptic Meningitis
Normal - 50-75
Bacterial Meningitis - low
Aseptic Meningitis - normal
Protein

Normal
Bacterial Meningitis
Aseptic Meningitis
Normal - <60
Bacterial Meningitis - high
Aseptic Meningitis - moderate elevation
Diagnosis of meningitis - CSF should be sent for
CSF should be sent for ccell count, chemistry (protein, glucose), Gram stain, culture (inc. AFB), and cryptococcal antigen or India ink
WBC count

Normal
Bacterial Meningitis
Aseptic Meningitis
Normal - <5
Bacterial Meningitis - >1000(1000-20000)
Aseptic Meningitis - <1000
WBC differential

Normal
Bacterial Meningitis
Aseptic Meningitis
Normal - all lymphocytes or monocytes. No PMNs

Bacterial Meningitis - Mostly PMNs

Aseptic Meningitis - Mostly lymphocytes and monocytes
Glucose

Normal
Bacterial Meningitis
Aseptic Meningitis
Normal - 50-75
Bacterial Meningitis - low
Aseptic Meningitis - normal
Protein

Normal
Bacterial Meningitis
Aseptic Meningitis
Normal - <60
Bacterial Meningitis - high
Aseptic Meningitis - moderate elevation
Diagnosis of meningitis - CSF should be sent for
CSF should be sent for ccell count, chemistry (protein, glucose), Gram stain, culture (inc. AFB), and cryptococcal antigen or India ink
Diff Dx in pts with FEVER & ALTERED MENTAL STATUS
Infection: Sepsis, UTI/urosepsis, pneumonia, bacterial meningitis, intracranial abcess, subdural empyema

Medication: Neuroleptic malignant syndrome (haloperidol, phenothiazines), Delerium tremens

Metabolic: Thyroid storm
What virus is associated with Cryoglobulinemia? What is cryoglobulinemia?
Hepatitis C
ryoglobulins are single or mixed immunoglobulins that undergo reversible precipitation at low temperatures.
Hepatitis E is particularly prevalent in which countries?
India, pakistan, southeast asia, and parts of africa
Symptoms of Acute Hepatitis:
Jaundice (look at sclera)
Dark colored urine (conjugated hyperbilirubinemia)
RUQ pain
nausea and vomiting
Fever and malaise
Hepatomegaly