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121 Cards in this Set

  • Front
  • Back
Most common bacterial cause of CAP?
step pneumoniae
Organism often causing alcoholic related aspiration pneumonia?
klebsiella
Empiric tx of CAP pneumonia (getting admitted)?
Azithromycin + ceftriaxone
Bacterial Cause of walking pnuemonia?
mycoplasma
Bacterial pneumonia associated with chronic cardiac or respiratory disease. Other sx include diarrhea and hyponatremia
Legionella
Common bacterial pneumonia seen in COPD patients?
Haemophilus
Bacteria commonly seen causing pneumonia in cystic fibrosis patients?
pseudomonas
Causes of atypical pneumonia?
Mycoplasma
Chlamydia
Legionela
Moraxella
Influenza A and B
Bacterial pneumonia associated with contaminated water droplets or cooling/ventilation systems?
Legionella
Tx of chlamydia pneumonia?
Tetracycline
Definition of hospital acquired pneumonia?
pneumonia that develops >48 hrs after admission
Most common organisms associated with hospital acquired pneumonia?
staph aureus, pseudomonas
PCP pneumonia appears in HIV pts with CD4 count of what?
< 200
Tx of PCP pneumonia?
Bactrim
+ Prednisone first if PaO2 <70
Blood test that is elevated in particular in PCP pneumonia?
LDH
Empiric tx for active TB?
INH, rifampin, pyrazinamide, and either ethambutol or streptomycin x 2 months
then
INH + rifampin x 4 months
Size of positive PPD induration in normal immunocompetent patients?
>15 mm
Multi drug resistant TB is resistant to what ABX?
isoniazid
rifampin
Dx: Extrapulmonary TB that affects the spine?
Pott disease
Diagnostic study for TB?
acid fast sputum smear and culture
x3 (quicker diagnosis)

PCR (more sensitive but takes longer)
Prophylaxis tx for contact with TB positive patient?
INH x 6-12 months
Monitor what lab tests in pt receiving TB treatment?
LFTs
Side effects of INH?
hepatitis
peripheral neuropathy
lupus like syndrome
Side effects of rifampin?
orange urine
hepatitis
hypersensitivity
Must monitor what lab test in pts taking pyrazinamide for TB?
uric acid
Red green vision loss is a side effect of what TB drug?
ethambutol
Location of reactivation TB in lung?
usually apical
Xray findings of healed primary TB infections?
ghon complexes
ranke complexes
Lung biopsy in TB may reveal what?
caseating granulomas
Most common cause of bronchiolitis?
RSV
Bacterial cause of epiglottitis?
Haemophilus influenzae B
Imaging of choice for epiglottitis?
lateral neck xray
Xray may reveal what in epiglottitis?
thumbprint sign
Tx of epiglottitis?
ceftriaxone or cefotaxime x 7-10d
Most common cause of croup?
parainfluenza virus
Croup findings on xray?
steeple sign (PA neck films)
Tx of severe croup?
steroids
humidified air or O2
nebulized epi
Lung cancer with early mets and aggressive course?
small cell
Types of non-small cell lung cancer?
squamous
adenocarcinoma
large cell
Most common cause of solitary pulmonary nodule?
infectious granuloma
Follow up imaging for solitary pulmonary nodule not likely to be cancerous?
CT every 3 months for a year
then every 6 months for 2 yrs
Dx: dyspnea, facial/arm swelling, cough, headache, pleural effusions, mental status changes
Superior vena cava syndrome
(70% from lung cancers)
Dx: apical lung mass causing pain in C8 or T1 distribution (pain in shoulder and ulnar nerve distribution of arm)?
Pancoast tumor
What syndrome is associated with pancoast tumor?
horners syndrome
(unilateral facial anhidrosis, ptosis, miosis)
Carcinoid tumors are capable of producing what?
serotonin
ACTH
ADH
MSH
Sx of serotonin syndrome caused by carcinoid mass?
tachycardia
flushing
bronchoconstriction
diarrhea
telangiectasias
What PFT findings indicate obstructive airway disease?
FEV1/FVC <75%
An increase in FEV1 of what % after bronchodilator tx indicates obstructive airway disease?
10%
Stages of asthma severity?
intermittent
mild persistent
moderate persistent
severe persistent
Sx of intermittent asthma?
sx <2d per week
nightime sx <2x per month
FEV1 >80% predicted
Tx for intermittent asthma?
prn SABA
Sx of mild persistent asthma?
sx >2d per week (but not daily)
night sx 3-4x per month
FEV1 > 80% predicted
Tx of mild persistent asthma?
SABA prn
+
Low dose ICS
Sx of moderate persistent asthma?
daily sx
night sx > 1 per week
60%< FEV1 predicted <80%
Sx of severe persistent asthma?
continual sx
extremely limited physical activities
night sx daily
FEV1 predicted <60%
Most common cause of congenital bronchiectasis?
cystic fibrosis
Rare cause of COPD in non smokers?
Alpha 1 antitrypsin deficiency
Spirometry finding consistent with COPD?
decreased FEV1/FVC ratio
Supplemental oxygen is warranted in what COPD patients?
PaO2 <55 mmHg
or SaO2 < 88%
In Asthma, Peak expiratory flow increases how much after bronchodilator?
>60 L/min
What is seen on methacholine challenge in asthma patient?
FEV1 decreases >20%
Condition causing asthama, eosinophilia, neuropathy, glomerulonephritis, and carditis?
churg-strauss syndrome
Blood levels elevated in churg-strauss syndrome?
IgE
RF
ANCA
PE finding in pneumomediastinum (subcu air)?
hammans crunch
Causes of transudate pleural effusion?
CHF
pericarditis
cirrhosis (hydrothorax)
nephrotic syndrome
Causes of exudative pleural effusion?
pneumonia
malignancy
PE
Pancreatitis
Churg-strauss, wegners
What is Lights criteria in pleural effusion?
exudate=
Total protein eff/serum >0.5
LDH eff/serum >0.6
or
LDH eff > 2/3 upper limit of serum LDH
Albumin ratio in exudative pleural effusion?
serum / effusion albumin gradient <1.2
TG >110 in pleural effusion indicates what?
chylothorax
(blocked thoracic duct from lymphoma or trauma)
Lab findings of complicated parapneumonic effusion requiring drainage?
+ gram stain or culture
pH <7.2
glucose <60
Pleural effusion of what size on Xray should be tapped?
> 1cm on decubitus films
Tx of choice for pertussis?
erythromycin
Chest xray used to evaluate for pneumothorax?
expiratory
What is virchows triad?
venous stasis
hypercoagulable state
vascular endothelial injury
What is wells criteria for PE?
-PE is a likely diagnosis, signs and symptoms of DVT
-HR >100
-Prior hx of DVT/PE
-Immobilization
-Hemoptysis
-Malignancy
Rare CXR findings with PE?
Hamptons hump (wedge shaped density)
Westermark sign (no vascular markings distal to PE)
A CTA should be performed with a wells score of what?
>4
Acute anticoagulation tx for DVT?
heparin 80 u/kg bolus
then
18 u/kg/hr

or

LMWH 1mg/kg BID
How long should coumadin be used after first DVT/PE?
at least 3 months
Pulmonary artery pressure in pulmonary hypertension?
>25mmHg at rest
>30 mmgHg with exertion
Gas inhalation associated with cherry red skin?
carbon monoxide
Gas inhalation associated with bitter almond odor and pink skin?
cyanide
Tx for methemoglobinemia induced respiratory failure (nitrate intoxication)?
methylene blue
Tx for cyanide induced respiratory failure?
hydroxycobalamin
What is CURB 65 score?
Rates severity of pneumonia:
-Confusion
-Uremia
-RR >30
-BP <90/60
-Age >65
What factors are involved in PORT score to determine pneumonia severity?
-Demographic: age, nursing home resident
-Coexisting medical problems
(malignancy, liver ds, CHF, CVA, CKD)
-Vital signs
-Labs
What findings indicate a adequate purulent sputum gram stain?
<10 squamous cells
>25 polys
Tx of choice for H1N1?
oseltamivir
Fungal infection found in central and SE US, river banks, associated with bird and bat droppings?
histoplasmosis
Fungal infection found in south west US?
coccidiomycosis
Fungal infection associated with marijuana use?
aspergillus
Fungal infection more common in HIV pts, may lead to meningitis?
cryptococcus
What hypercoagulability disorder increases risk of DVT/PE?
Factor V Leiden
Most common mediastial mass. Associated with myastenia gravis?
Thymoma
PE findings of pleural effusion?
-decreased breath sounds
-decreased diaphragmatic excursion
-decreased tactile fremitus
-dullness to percussion
-positive egophany
Type of pulmonary disease associated with decreased TLC, RV, but normal or increased FEV1/FVC ratio?
restrictive disease
Type of pulmonary disease associated with decreased FEV1/FVC ratio but an increased RV?
obstructive disease
What is a normal FEV1/FVC ratio?
>80%
Type of COPD associated with cyanosis, and right ventricular heart failure?
chronic bronchitits (blue bloater)
Diagnostic FEV1 in asthma?
increase >15%
Common restrictive lung diseases associated with inhalation of coal or mining dust?
pneumoconiosis
silicosis
asbestosis
Restrictive lung disease with small opacities in upper lung fields on CXR?
pneumoconiosis
Restrictive lung disease with insterstitial fibrosis, thickened pleura and calcified plaques on the lateral walls and diaphragms on CXR?
asbestosis
Diagnostic finding in tissue of sarcoidosis affected organs?
noncaseating granulomas
Lab values associated with sarcoidosis?
eosinophilia
^ ESR, Ca, ACE
Common CXR finding in sarcoidosis?
paratracheal lymphadenopathy
Which medications are useful only in influenza A?
amantadine
rimantadine
CXR findings in bronchiectasis?
tram-tracks
ring-like markings
(dilated and thickened bronchi)
CXR findings in pulmonary fibrosis?
ground glass infiltrates
Medications that may cause pulmonary fibrosis?
amiodarone
methotrexate
nitrofurantoin
CXR findings in ARDS?
Diffuse bilat infiltrates that spare costophrenic angles
3 most common causes of ARDS?
sepsis
trauma
aspiration
Preferred treatment for mild persistent asthma?
SABA
+
low dose inhaled corticosteroid
How does tiotropium and ipratropium work?
anticholinergic
relaxation of bronchial smooth muscle
decreased mucus secretion
What meds are leukotriene inhibitors?
montelukast
zafirlukast
What PaO2/FiO2 ratio indicates ARDS?
<200
Normal ABG findings?
pH: 7.35-7.45
PaO2: 80-100 mmHg
PaCO2: 35-45 mmHg
Bicarb: 22-26
Base excess: -3 to +3
Vasculitis associated with increased incidence of DVT/PE?
wegeners granulomatosis
Dx: sinusitis, pulmonary infiltrates/nodules, hematuria?
wegeners granulomatosis
Tx for wegeners granulomatosis?
cyclophosphamide
+
prednisone
then
methotrexate or azathioprine for maintenance
Blood test positive in wegeners?
c-ANCA