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87 Cards in this Set

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What is first line therapy in an acute asthma exacerbation?
beta agonists, usually in the form of albuterol.
In treating uncomplicated community acquired pneumonia in a 3 week old baby, what bugs should you cover, and what drugs should you use?
Listeria, E coli, group b strep, and consider herpes. Treat with ampicillin and gentamicin, plus/minus acyclovir.
If you need to intubate an asthamtic, what is a good choice of agent for induction?
Ketamine. It is a potent bronchodilator.
What is the appropriate antibiotic choice for uncomplicated community acquired pneumonia in a 45 year old man that you plan to send home?
If you are sending home a 3 year old with community acquired pneumonia, what antibiotic should you choose?
A beta lactam. The incidence of atypicals is rare in this population, so a macrolide is not appropriate.
In a patient with suspected PCP, when do you add steroids to bactrim therapy?
If the patient's sat is less than 90 or the PaO2 is less than 60.
What EKG findings should make you consider underlying pulmonary disease?
RVH, RBBB, or, most specifically, wandering atrial pacemaker or multifocal atrial tachycardia.
Which bacteria accounts for the most total mortality in pneumonia patients?
strep pneumo
a patient with pneumonia is a 55 year old smoker. He has altered mental status, hyponatremia, and elevated LFTs. What bug should you consider high on your differential?
Legionella, treated with macrolides or with macrolide plus rifampin.
A teenager has pneumonia. He has blisters or bubbles visible on his TMs when you do otoscopy. What is the likely diagnosis?
Mycoplasma, treated with macrolides.
An elderly patient has pneumonia. She recently had a lab-proven diagnosis of influenza A. She is hypotensive and toxic. What bug should you cover for?
Staph aureus.
The patient has a RML pneumonia. You can treat him with zithromax or a quinolone
This is an adult who has a fever, but otherwise normal vitals. How should you treat him?
Does the incidence of pneumonia increase or decrease with age?
what is the most common viral cause of pneumonia in the fall?
what is the most common viral cause of pneumonia in the winter?
what is the most common viral cause of pneumonia in the spring?
Which age group is characterized by bacteria as the leading cause of pneumonia?
Newborns because of aspiration of maternal genital organisms during labor and delivery
What is the recommended inpatient treatment for newborns with pneumonia?
Ampicillin plus cefotaxime or gentamicin
What is the recommended inpatient treatment for infants 1-24 months with pneumonia?
What is the most common bacterial cause of pneumonia in children 5-18 years of age? Treatment?
treat with macrolide
The best physical exam finding for ruling out pneumonia in an infant or child is:
Absence of tachypnea
What is the typical prodrome of pertussis?
1-2 weeks of coryza, conjunctivitis, and cough
Is there a male or female predominance in pediatric asthma?
Male in prepuberty then ratio equalizes during adolescence
What are the pediatric anatomic differences that put them at a higher risk for respiratory failure?
Increased rib cage compliance, immature diaphragm ÿ paradoxical
respiration, increased work of breathing, respiratory muscle fatigue
* Young lung tissue lacks elastic recoil, more prone to atelectasis
What are the typical CXR findings in children with asthma?
* hyperinflation
* flattened diaphragm
* increased AP diameter
* peribronchial cuffing
* atelectasis
When should steroids not be administered in the setting of an acute
asthma exacerbation?
* PEF > 50%
* immediate response to first nebulizer treatment
* exercise-induced attacks in well child
Is nocturnal asthma associated with a better or worse prognosis?
What is the typical triad of bronchiolitis?
* wheezing
* tachypnea
* chest retractions
What is the age group affected by bronchiolitis?
Less than 2 years old
What is the peak prevalence of bronchiolitis?
Late October to May
What is the most common cause of bronchiolitis?
RSV (50-70% of cases)
What is the most notable clinical finding in bronchiolitis?
Tachypnea (RR > 50-60)
What is the name of the monthly monoclonal antibody IM injections given as passive immunization against RSV in high-risk children?
What condition is most likely to be a precipitating factor for pneumothorax?
Cigarette smoking (>20:1 RR compared to non-smoker)
Which disease is most commonly associated with pseudocyanosis?
Which part of the body most reliably confirms the presence of cyanosis?
What are the Wells criteria? What are they used to assess?
Assess the pretest probability for PE

Wells criteria:
Suspected DVT = 3 points
An alternative dx is less likely than PE = 3 points
HR > 100 bpm = 1.5 points
Immobilization or surgery = 1.5 points
Previous H/O DVT and/or PE = 1.5 points
Hemoptysis = 1 point
Malignancy (on Tx, treated in past 6 months, or palliative) = 1 point

High-risk pts (score>6, 7% of total pts) had a mean probability of 66.7% for PE
Where do large cell lung cancers tend to present?
In the periphery of the lung
When are the risks of radiation exposure on the neurologic development of an embryo/fetus the highest?
8 to 15 weeks postconception
*hyperinflated lungs
*decreased vascular markings
*increased parenchymal lucency
*small cardiac silhouette
*flattened diaphragm
What does this CXR show?
When are fiberoptic bronchoscopes least helpful?
Bleeding in the airway
Excessive oral secretions
Air trapping on right (where a FB has been aspirated)

On exhalation, the FB obstructs outflow, leaving affected side relatively expanded when compared to the unaffected side
What is abnormal about this CXR of a 3-year old boy?
On PE, the boy is smiling, playful, with hint of wheezing on right that clears with coughing. VS are normal.
Nothing. The linear lucency at the right costophrenic angle is air trapped in between folds of adipose tissue in a
rather corpulent young lady.
What is abnormal about this CXR?
How is the clinical presentation of pneumonia different in elderly patients?
*Classic signs and symptoms of PNA are often absent in elderly or debilitated patients
*Elderly patients are often sicker and are in advanced stage of illness on initial presentation
Is pneumococcal bacteremia more common in young or elderly patients?
Pneumococcal bacteremia is 3x more common in elderly patients than in younger patients
Aspiration pneumonia caused by anaerobes is most common in which patient population?
How well do expectorated sputum cultures identify the causative organism in pneumonia?
Sputum cultures have low clinical utility due to higher rates of contamination from oropharyngeal colonization
Which lung lobes are most commonly affected in aspiration pneumonia?
The posterior segments of the upper lobes and superior segments of the lower lobes are the MC sites if recumbent, basal lower lobes (often RLL) if upright
Aspergillus fumigatus is commonly found in the sputum of which patient population?
Cystic fibrosis patients
The incidence of cystic fibrosis is highest within which ethnic group?
Highest incidence within white North Americans (1 in 3,000 live births)
Which organism is most commonly recovered from lung secretions in newly diagnosed CF patients?
Staph aureus and H.influenzae = MC in newly dx Pseudomonas = MC later on
What role does lung transplantation play in the treatment of cystic fibrosis?
It is the only potential treatment
How are viral and bacterial pneumonias differentiated in children?
Viral and bacterial pneumonias can seldom be differentiated in children because of overlap in clinical, radiographic, and lab findings
Is oral dexamethasone recommended in the treatment of mild croup in a previously healthy toddler?
Yes, it leads to quicker resolution of symptoms when compared with observation
Is cool mist recommended in the treatment of mild croup in a previously healthy toddler?
Although historically considered an important component of croup treatment, cool mist is probably clinically ineffective
What is the most common CXR finding in tuberculosis?
Lobar pna with hilar adenopathy
In the United States, the foreign-born patients with TB are most often from _____
Mexico, India, Vietnam, and the Philippines
In which patient population is miliary TB most commonly seen?
Miliary TB is seen in extremes of age and in immunocompromised patients
Why are Ghon complexes not commonly seen in transplant patients with TB?
Transplant pts have decreased cell immunity and therefore are less likely to be able to create Ghon complexes
What are the common physical exam findings in patients with TB?
There are no reliable physical exam findings in TB
Which organism is the most common cause of pneumonia in a patient with HIV infection and a CD4+ count of 850 cells/microliter?
Streptococcus pneumoniae

*The risk of acquiring opportunistic infections is more likely with lower CD4+ counts
*A CD4+ count < 200 increases the risk of infection with Pneumocystis jiroveci (formerly Pneumocystis carinii)
A cancerous etiology is more likely if the abscess develops in the posterior portion of the lung
A cancerous etiology is more likely if the abscess develops in the anterior portion of the lung
Anaerobic bacteria are more commonly found in immunocompromised patients than in immunocompetent patients
Aerobic bacteria are more commonly found in immunocompromised patients
In most cases, a lung abscess cavity communicates with a bronchiole
Infectious lung abscesses commonly occur in the superior segments of the lower lobes
Infectious lung abscesses commonly occur in the basal segments of the lower lobes
Surgical intervention is commonly necessary for lung abscesses
Surgical intervention is rarely required
What are the early radiographic findings of asbestosis?
Bilateral, irregular or linear opacities along the periphery of the lungs and in the lower lobes
What percentage of mesotheliomas metastasize?
About 50% of mesotheliomas metastasize, however these tumors are locally very invasive and death often occurs from local extension
Corticosteroids should be administered after completion of bronchodilator therapy in acute severe asthma
Corticosteroids should be used early in treatment
IV beta-agonists are more effective than nebulized beta-agonists in acute severe asthma
IV beta-agonists may produce worse outcomes compared to their nebulized counterparts
Magnesium administration results in an improvement of approximately 10% of predicted FEV1 in the treatment of acute severe asthma
Response to corticosteroids is age related in the treatment of acute severe asthma
There is no age-related response to steroids
A 22-yr old college basketball player presents with sudden-onset SOB. CXR reveals a 10% PTX. The patient has not had a prior episode of PTX. He is in no acute distress and his vital signs are normal. Without any intervention, approximately how long will it take for the pneumothorax to resolve on its own?
1 week

The intrinsic absorption rate of intrapleural air is 1-2% of total lung volume per day
Which of the following drugs is FDA approved for the treatment of intractable hiccups?

a.) Baclofen
b.) Chlorpromazine
c.) Metoclopramide
d.) Nifedipine
e.) Valproic acid

*Chlorpromazine and Reglan often abolish hiccups within 30 minutes
*Nifedipine, valproic acid, and baclofen exert their effect more gradually
In an asthmatic patient who requires intubation, inspiratory-to-expiratory ratio should be kept at 1:2
In an asthmatic patient who requires intubation, ketamine is the preferred paralytic agent
*Ketamine is the preferred induction agent bc of its bronchodilating properties
*Neuromuscular blocking agents (succinylcholine, rocuronium) should be used for paralysis
In an asthmatic patient who requires intubation, nasotracheal intubation is preferred over orotracheal
Nasotracheal intubation requires a smaller tube, which creates greater airway resistance
In an asthmatic patient who requires intubation, propofol can be used as a sedating agent
In an asthmatic patient who requires intubation, tidal volume should be kept at 10 cc/kg ideal body weight
Tidal volume should be kept at 6-8 cc/kg ideal body weight (prolongs expiration phase and reduces air trapping)
Regarding arterial blood gas measurements, air bubbles within the syringe lower the pH
Air bubbles elevate the pH and PO2 readings
Regarding arterial blood gas measurements, co-oximetry allows identification of sulfhemoglobin
Co-oximetry cannot differentiate between methemoglobin and sulfhemoglobin, for this reason cyanide is added to the blood sample (cyanide binds only to methemoglobin)
Regarding arterial blood gas measurements, excess heparin within the syringe affects only pH and PCO2
Excess heparin affects pH, PO2, PCO2, and Hb
Regarding arterial blood gas measurements, the blood gas analyzer warms the blood to 98.6F prior to analysis
Regarding arterial blood gas measurements, the conventional blood gas analyzer directly measures oxygen saturation
What is a common early lab finding in fat embolism?
What is Hamman crunch? In which patient position is it best heard?
*Adventitious, crackling sound on auscultation in patient with pneumomediastinum
*Left lateral recumbent position
ARDS might be associated with the use of which antiarrhythmic drug?