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121 Cards in this Set
- Front
- Back
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Most common bacterial cause of CAP?
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step pneumoniae
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Organism often causing alcoholic related aspiration pneumonia?
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klebsiella
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Empiric tx of CAP pneumonia (getting admitted)?
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Azithromycin + ceftriaxone
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Bacterial Cause of walking pnuemonia?
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mycoplasma
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Bacterial pneumonia associated with chronic cardiac or respiratory disease. Other sx include diarrhea and hyponatremia
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Legionella
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Common bacterial pneumonia seen in COPD patients?
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Haemophilus
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Bacteria commonly seen causing pneumonia in cystic fibrosis patients?
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pseudomonas
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Causes of atypical pneumonia?
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Mycoplasma
Chlamydia Legionela Moraxella Influenza A and B |
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Bacterial pneumonia associated with contaminated water droplets or cooling/ventilation systems?
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Legionella
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Tx of chlamydia pneumonia?
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Tetracycline
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Definition of hospital acquired pneumonia?
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pneumonia that develops >48 hrs after admission
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Most common organisms associated with hospital acquired pneumonia?
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staph aureus, pseudomonas
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PCP pneumonia appears in HIV pts with CD4 count of what?
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< 200
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Tx of PCP pneumonia?
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Bactrim
+ Prednisone first if PaO2 <70 |
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Blood test that is elevated in particular in PCP pneumonia?
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LDH
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Empiric tx for active TB?
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INH, rifampin, pyrazinamide, and either ethambutol or streptomycin x 2 months
then INH + rifampin x 4 months |
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Size of positive PPD induration in normal immunocompetent patients?
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>15 mm
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Multi drug resistant TB is resistant to what ABX?
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isoniazid
rifampin |
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Dx: Extrapulmonary TB that affects the spine?
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Pott disease
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Diagnostic study for TB?
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acid fast sputum smear and culture
x3 (quicker diagnosis) PCR (more sensitive but takes longer) |
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Prophylaxis tx for contact with TB positive patient?
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INH x 6-12 months
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Monitor what lab tests in pt receiving TB treatment?
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LFTs
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Side effects of INH?
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hepatitis
peripheral neuropathy lupus like syndrome |
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Side effects of rifampin?
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orange urine
hepatitis hypersensitivity |
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Must monitor what lab test in pts taking pyrazinamide for TB?
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uric acid
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Red green vision loss is a side effect of what TB drug?
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ethambutol
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Location of reactivation TB in lung?
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usually apical
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Xray findings of healed primary TB infections?
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ghon complexes
ranke complexes |
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Lung biopsy in TB may reveal what?
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caseating granulomas
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Most common cause of bronchiolitis?
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RSV
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Bacterial cause of epiglottitis?
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Haemophilus influenzae B
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Imaging of choice for epiglottitis?
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lateral neck xray
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Xray may reveal what in epiglottitis?
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thumbprint sign
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Tx of epiglottitis?
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ceftriaxone or cefotaxime x 7-10d
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Most common cause of croup?
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parainfluenza virus
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Croup findings on xray?
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steeple sign (PA neck films)
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Tx of severe croup?
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steroids
humidified air or O2 nebulized epi |
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Lung cancer with early mets and aggressive course?
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small cell
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Types of non-small cell lung cancer?
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squamous
adenocarcinoma large cell |
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Most common cause of solitary pulmonary nodule?
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infectious granuloma
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Follow up imaging for solitary pulmonary nodule not likely to be cancerous?
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CT every 3 months for a year
then every 6 months for 2 yrs |
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Dx: dyspnea, facial/arm swelling, cough, headache, pleural effusions, mental status changes
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Superior vena cava syndrome
(70% from lung cancers) |
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Dx: apical lung mass causing pain in C8 or T1 distribution (pain in shoulder and ulnar nerve distribution of arm)?
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Pancoast tumor
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What syndrome is associated with pancoast tumor?
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horners syndrome
(unilateral facial anhidrosis, ptosis, miosis) |
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Carcinoid tumors are capable of producing what?
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serotonin
ACTH ADH MSH |
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Sx of serotonin syndrome caused by carcinoid mass?
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tachycardia
flushing bronchoconstriction diarrhea telangiectasias |
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What PFT findings indicate obstructive airway disease?
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FEV1/FVC <75%
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An increase in FEV1 of what % after bronchodilator tx indicates obstructive airway disease?
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10%
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Stages of asthma severity?
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intermittent
mild persistent moderate persistent severe persistent |
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Sx of intermittent asthma?
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sx <2d per week
nightime sx <2x per month FEV1 >80% predicted |
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Tx for intermittent asthma?
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prn SABA
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Sx of mild persistent asthma?
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sx >2d per week (but not daily)
night sx 3-4x per month FEV1 > 80% predicted |
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Tx of mild persistent asthma?
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SABA prn
+ Low dose ICS |
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Sx of moderate persistent asthma?
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daily sx
night sx > 1 per week 60%< FEV1 predicted <80% |
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Sx of severe persistent asthma?
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continual sx
extremely limited physical activities night sx daily FEV1 predicted <60% |
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Most common cause of congenital bronchiectasis?
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cystic fibrosis
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Rare cause of COPD in non smokers?
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Alpha 1 antitrypsin deficiency
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Spirometry finding consistent with COPD?
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decreased FEV1/FVC ratio
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Supplemental oxygen is warranted in what COPD patients?
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PaO2 <55 mmHg
or SaO2 < 88% |
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In Asthma, Peak expiratory flow increases how much after bronchodilator?
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>60 L/min
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What is seen on methacholine challenge in asthma patient?
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FEV1 decreases >20%
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Condition causing asthama, eosinophilia, neuropathy, glomerulonephritis, and carditis?
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churg-strauss syndrome
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Blood levels elevated in churg-strauss syndrome?
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IgE
RF ANCA |
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PE finding in pneumomediastinum (subcu air)?
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hammans crunch
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Causes of transudate pleural effusion?
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CHF
pericarditis cirrhosis (hydrothorax) nephrotic syndrome |
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Causes of exudative pleural effusion?
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pneumonia
malignancy PE Pancreatitis Churg-strauss, wegners |
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What is Lights criteria in pleural effusion?
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exudate=
Total protein eff/serum >0.5 LDH eff/serum >0.6 or LDH eff > 2/3 upper limit of serum LDH |
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Albumin ratio in exudative pleural effusion?
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serum / effusion albumin gradient <1.2
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TG >110 in pleural effusion indicates what?
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chylothorax
(blocked thoracic duct from lymphoma or trauma) |
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Lab findings of complicated parapneumonic effusion requiring drainage?
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+ gram stain or culture
pH <7.2 glucose <60 |
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Pleural effusion of what size on Xray should be tapped?
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> 1cm on decubitus films
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Tx of choice for pertussis?
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erythromycin
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Chest xray used to evaluate for pneumothorax?
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expiratory
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What is virchows triad?
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venous stasis
hypercoagulable state vascular endothelial injury |
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What is wells criteria for PE?
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-PE is a likely diagnosis, signs and symptoms of DVT
-HR >100 -Prior hx of DVT/PE -Immobilization -Hemoptysis -Malignancy |
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Rare CXR findings with PE?
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Hamptons hump (wedge shaped density)
Westermark sign (no vascular markings distal to PE) |
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A CTA should be performed with a wells score of what?
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>4
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Acute anticoagulation tx for DVT?
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heparin 80 u/kg bolus
then 18 u/kg/hr or LMWH 1mg/kg BID |
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How long should coumadin be used after first DVT/PE?
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at least 3 months
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Pulmonary artery pressure in pulmonary hypertension?
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>25mmHg at rest
>30 mmgHg with exertion |
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Gas inhalation associated with cherry red skin?
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carbon monoxide
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Gas inhalation associated with bitter almond odor and pink skin?
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cyanide
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Tx for methemoglobinemia induced respiratory failure (nitrate intoxication)?
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methylene blue
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Tx for cyanide induced respiratory failure?
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hydroxycobalamin
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What is CURB 65 score?
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Rates severity of pneumonia:
-Confusion -Uremia -RR >30 -BP <90/60 -Age >65 |
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What factors are involved in PORT score to determine pneumonia severity?
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-Demographic: age, nursing home resident
-Coexisting medical problems (malignancy, liver ds, CHF, CVA, CKD) -Vital signs -Labs |
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What findings indicate a adequate purulent sputum gram stain?
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<10 squamous cells
>25 polys |
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Tx of choice for H1N1?
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oseltamivir
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Fungal infection found in central and SE US, river banks, associated with bird and bat droppings?
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histoplasmosis
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Fungal infection found in south west US?
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coccidiomycosis
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Fungal infection associated with marijuana use?
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aspergillus
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Fungal infection more common in HIV pts, may lead to meningitis?
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cryptococcus
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What hypercoagulability disorder increases risk of DVT/PE?
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Factor V Leiden
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Most common mediastial mass. Associated with myastenia gravis?
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Thymoma
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PE findings of pleural effusion?
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-decreased breath sounds
-decreased diaphragmatic excursion -decreased tactile fremitus -dullness to percussion -positive egophany |
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Type of pulmonary disease associated with decreased TLC, RV, but normal or increased FEV1/FVC ratio?
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restrictive disease
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Type of pulmonary disease associated with decreased FEV1/FVC ratio but an increased RV?
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obstructive disease
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What is a normal FEV1/FVC ratio?
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>80%
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Type of COPD associated with cyanosis, and right ventricular heart failure?
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chronic bronchitits (blue bloater)
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Diagnostic FEV1 in asthma?
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increase >15%
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Common restrictive lung diseases associated with inhalation of coal or mining dust?
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pneumoconiosis
silicosis asbestosis |
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Restrictive lung disease with small opacities in upper lung fields on CXR?
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pneumoconiosis
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Restrictive lung disease with insterstitial fibrosis, thickened pleura and calcified plaques on the lateral walls and diaphragms on CXR?
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asbestosis
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Diagnostic finding in tissue of sarcoidosis affected organs?
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noncaseating granulomas
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Lab values associated with sarcoidosis?
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eosinophilia
^ ESR, Ca, ACE |
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Common CXR finding in sarcoidosis?
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paratracheal lymphadenopathy
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Which medications are useful only in influenza A?
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amantadine
rimantadine |
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CXR findings in bronchiectasis?
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tram-tracks
ring-like markings (dilated and thickened bronchi) |
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CXR findings in pulmonary fibrosis?
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ground glass infiltrates
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Medications that may cause pulmonary fibrosis?
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amiodarone
methotrexate nitrofurantoin |
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CXR findings in ARDS?
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Diffuse bilat infiltrates that spare costophrenic angles
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3 most common causes of ARDS?
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sepsis
trauma aspiration |
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Preferred treatment for mild persistent asthma?
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SABA
+ low dose inhaled corticosteroid |
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How does tiotropium and ipratropium work?
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anticholinergic
relaxation of bronchial smooth muscle decreased mucus secretion |
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What meds are leukotriene inhibitors?
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montelukast
zafirlukast |
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What PaO2/FiO2 ratio indicates ARDS?
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<200
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Normal ABG findings?
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pH: 7.35-7.45
PaO2: 80-100 mmHg PaCO2: 35-45 mmHg Bicarb: 22-26 Base excess: -3 to +3 |
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Vasculitis associated with increased incidence of DVT/PE?
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wegeners granulomatosis
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Dx: sinusitis, pulmonary infiltrates/nodules, hematuria?
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wegeners granulomatosis
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Tx for wegeners granulomatosis?
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cyclophosphamide
+ prednisone then methotrexate or azathioprine for maintenance |
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Blood test positive in wegeners?
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c-ANCA
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