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173 Cards in this Set
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1. 70 y old acute shaking chills, increased fatigue, rust sputum, shortness of breath, O2 82%, BP 160/86, what is going on?
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strep pneumo
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1. 70 y old acute shaking chills, increased fatigue, rust sputum, shortness of breath, O2 82%, BP 160/86, what would the gram stain look like
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gram positive diplococci
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1. 70 y old acute shaking chills, increased fatigue, rust sputum, shortness of breath, O2 82%, BP 160/86, what antibiotic would you use?
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Beta Lactam (penicillin, cephalosporins
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what do beta lactams do?
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affect the cell wall.... this will destroy strep pneumo
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red currant jelly sputum
Gram stain? |
gram negative rod
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red currant jelly sputum
bacteria |
Klebsiella pneumoniae?
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red currant jelly sputum
virulence |
large polysaccharide capsule
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What tidal volume do you give on ventilation?
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6-8ml/kg
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what formula is used to meausre efficiency of o2 diffusion btw her lungs and pulmonary circulation?
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A-a gradient
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cystic fibrosis on vent for a week
gram stain? oxidase? |
gram negative rod
positve |
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cystic fibrosis on vent for a week
bacteria? |
pseudomonas
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heroin addict recovering from flu
bacteria? |
Staph Aureus
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underlying causes of cystic fibrosis
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Na channel dysfunciton
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oxidase of pseudomonas?
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positive
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if you had dental decay and inhaled it what would likely be the bacterial cause of pnuemonia
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anaerobes
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what do you order to evaluate VTE?
(2) what is the gold standard? [probably not on test] |
Pulmonary angiogram-Gold standard
d-dimer |
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what are the 3 risk factors for VTE
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stasis
hypercoaguability injury Virchows triad |
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acquired hypercoagualbility? 4
inherited? 3 |
Acquired: lupus, nephrotic syndrome, HIT, cancer
inherited: Factor Leiden V, protein C/S deficiency, antithrombin II deficiency |
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have DVT
secondary to immobilization surgery or trauma therapy time? |
3 months
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have DVT
first time therapy time? |
6 months
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have DVT
recurrent, cancer, hypercoagable state therapy time? |
lifetime coumadin
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despite serveral boluses of IV normal saline, she is not maintaining adequate perfusion. which pressures do you base the need for vasopressors on?
Diastolic, Systolic, or Mean Arterial? what does it have to be less than? |
mean arterial
<60mmHg |
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what 2 bacterial pneumonias are common in kids
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mycoplasma
chlamydia |
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does mycoplasma have a cell wall?
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NO
can't use beta lactam |
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what lab diagnosis you need for mycoplasma?
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cold agglutinins
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DOC for mycoplasma infection?
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doxycycline or erythromycin
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if you have a similar infection to mycoplasma with obligate intracellular parasites what do you have
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chlamydia
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what is the serotype of chalmydia pneumonia?
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TWAR
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know the bacterial vs Viral chart
onset rigor cough temp WBC CXR |
Onset- B: sudden V: gradual
Rigors- B:seen here V: not so much Cough B: productive V: non Temp B: higher V: lowar WBC- B: higher V: lower CXR B: lobar consolidation V: more diffuse |
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6 year old native american boy with flu like symptoms and short of breath. x ray with evidence of pulmonary edema
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hantavirus (remember mice)
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anthrax gram stain
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large gram positive rod
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DOC for anthrax?
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ciprofloxin
doxy penicillin |
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if you see widened mediastinum what should you think
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ANTHRAX
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To recognize for xray
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interstitial lung disease
alveolar lung disease silhouette sign air bronchogram lung segments/fissures COPD findings |
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why does an antibiotic fail?
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resistance
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acquired drug resistance mechanism? 3..which is major
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Altered DNA via:
--transduction: DNA of one bacteria introduced into another --transformation: DNA uptake from lysed bacteria Conjucation: gene transfer cell to cell plasmids, major mechanism |
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what is the post antibiotic effect?
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suppression despite drug levels below MIC
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viral URT infections most common causes?
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rhinovirus
adenovirus coronovirus |
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most common cause of common cold?
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rhinovirus
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what is the most common misuse of antibiotics?
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rhinovirus..common cold
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how is rhinovirus spread?
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resp droplit...esp hand to mouth (nose)
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besides rhinovirus what causes common cold
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adenovirus
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LRT disese in children can be caused by what?
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adenovirus
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what is antigenic shift
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large change
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what is antigenic drift
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small change, mutation
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what is the importance of the individual lobes within the right or left lung?
***** |
each get a single tertiatry bronchi and their own blood supply
so if someone gets pneumonia, you can just remove one segment! |
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at what passage way in the respiratory tract do you start to see respiratory epithelium?
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nasal cavity
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when do you start to see goblet cells in the resp tract?
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nasal cavity
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when do you stop seeing respiratory epithellium in the resp tract?
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Terminal bronchioles
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when do you stop seeing goblet cells in the resp tract?
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large bronchioles
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when do you start seeing clara cells in the resp tract?
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large bronchioles
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when do you stop seeing clara cells in the resp tract?
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respiratory broncioles
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when do you stop seeing smooth muscle in the resp tract?
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alveoli (so alveolar ducts is last place)
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when do you start seeing type 1 and 2 pneuomocytes in the resp tract?
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respiratory bronchioles
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what are the muscles usually involved during inspiration (5)
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Diaphragm
External intercostals Internal intercostals (parasternal portion) Scalene muscles Levator costarum (minor role) |
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what supplies blood to the respiratory tissues? (maintaining each segment)
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bronchial arteries
(blood from the right ventricle does not supply the respiratory tissues themselves) |
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what are the sympathetic innervations of the lung? (levels)
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T2-T7
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please list the rib borders of the inferior portion of the lung....
also list the rib boarders for the line of pleural reflection what is this good for? |
Inferior border of lungs
Anterior = 6th costal cartilage Lateral = 8th rib Posterior = 10th rib Line of pleural reflection Anterior = 8th costal cartilage Lateral = 10th rib Posterior = 12th rib use this info to know where to do a thoracocentisis so you don't puncture the lungs |
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Starting with the Nares and ending with the Alveoli, please list the order of the airways
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Nares
Vestibule Nasal Cavity Nasopharynx Oropharynx Larynx Trachea 1-3 Bronchi Large Bronchioles Terminal Bronchioles Respiratory Bronchioles Alveolar Ducts Alveoli |
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what is respiratory epithelium?
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pseudostratified ciliated columnar epithelium
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what is the most common cause of lower respiratory tract infection?
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Influenza virus
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what causes LRTI in children/newborns (most commonly)
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Respiratory Syncytial virus
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what is the only virus that actually invade the alveoli and cause alveolitis?
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Hantavirus
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what spreads parainfluenza leading to croup?
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Respiratory droplets
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What is preventative against infections in newborns and children?
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IgA antibodies
Secretory can be given in breast milk! |
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what are the types of strains of Respiratory Syncytial Virus? (RSV)
What population do these affect most? **** |
A and B
The major lower respiratory tract pathogen of infants worldwide (especially premature infants) |
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What type of process is inspiration, what is necessary for it?
**** |
It is an active process (energy is required) because muscles are contracting
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why type of process is expiration? what is necessary for it?
**** |
It is a passive process (energy is not required) because muscles are not contracting. Expiration only requires energy during strenuous exercise.
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describe how spriometry works?
what is it dependent on? what can it determine? what cant it determine ***** |
Air flow measurements via forced exhalation
(note: this is patient dependent, it can vary with their effort) used to determine presence or absence of airway obstruction can suggest restriction***** but not diagnose it!! |
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what is forced vital capacity?
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maximal amount of air that can be forcibly exhaled
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FEV1/FVC ratio of <70% suggests?
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obstruction
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FEV1/FVC ratio of 70-80% suggests?
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normal
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FEV1/FVC ratio of >80% suggests?
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restriction
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flow limitation is encountered during forced expiration, when the pleural pressure becomes positive relative to airway pressure, and the effect of any obstructive lesion in this region is accentuated...what flow volume loop does this describe
***** |
Variable Intrathoracic
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if you suspect asthma, but spirometry comes up normal, what test should you try?
**** |
methacholine challenge
look for "The PC20 was reached" |
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Spirmoetry alone cannot diagnose _______
**** |
restrictive lung diseases
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what test measures ventilated and unventilated segments of the lung?
What is this good for? **** |
Plethesmography
good for showing COPD (versus restrictive) |
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Chemotherapeutic drug
*** |
Any chemical used in the treatment, relief, or prophylaxis of a disease
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Prophylaxis
*** |
Use of a drug to prevent imminent infection of a person at risk
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Narrow spectrum
*** |
Antimicrobials effective against a limited array of microbial types. Targets a specific cell component found only in certain microbes – for example, a drug effective mainly on gram-positive bacteria
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Broad spectrum
*** |
Antimicrobials effective against a wide variety of microbial types. Targets cell components common to most pathogens – for example, a drug effective against both gram-positive and gram-negative bacteria
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Post antibiotic effect (PAE) is ?
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Persistent inhibition of bacterial growth following exposure to an ABX
meaning that growth is inhibited even though drug levels have dropped below the MIC |
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when do you want to use a bactericidal agent?
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when the immune system is depressed
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what are 3 general mechanisms of drug resistance?
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The drug does not reach its target: (decreased uptake OR increased efflux)
The drug is not active: -increased rate of inactivation -limited formation of active form of drug The target is altered: -target deleted -target modified -acquisition of a resistant form of native, susceptible target |
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what is vertical acquired resistance?
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Mutation and selective pressure (vertical)
Mutation and ABX selection of a resistant mutant are the molecular basis of resistance to: streptomycin --ribosomal mutation quinolones --gyrase or topoisomerase gene mutation linezolid --ribosomal RNA mutation |
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what is horizontal acquired resistance?
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Gene Transfer (horizontal)
Transduction -DNA of one bacteria introduced into another ... phage mediated ... same species -Important in the transfer of resistance among strains of S. aureus |
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what is Conjugation?
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Gene transfer through direct cell-to-cell contact
a form of horizontal acquired resistance |
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what is the major mechanism of resistance transfer?
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Conjugation: Gene transfer through direct cell-to-cell contact
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there are 3 general therapies with antibiotics... what are they?
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empirical therapy:
-organism not yet identified -broad spectrum agent used definitive therapy -organism and susceptibilities known -narrow spectrum agent used prophylactic therapy -prevent initial or recurrent infection -spectrum of agent depends on situation |
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What is a superinfection and what causes it? What gives you a greater chance of getting a superinfection
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drug resistant microorganisms may emerge
Superinfection is due to removal of normal microflora The broader the spectrum of drug and the longer the period of treatment, the greater the chance for superinfection |
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LRT in children is most often caused by
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adenovirus
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Infantile gastroenteritis is most often caused by?
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adenovirus
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what are the 2 pneumonia virus vaccines and what populations are they used in
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Pneumovax: Adults/post hospital stay
Prevnar: kids |
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6. Which generation of H1 antagonist has longest duration
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2nd generation
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Which generation of H1 antagonist has largest sedation effect?
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1st generation
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8. Which generation of H1 antagonists have strongest anti-emetic/anti-muscarinic
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1st
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9. Most common viral LRT infection?
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influenza
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10. Most serious sequalae of flu?
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a. 2ndary bacterial pneumonia
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11. Most common LRT infection in newborns?
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a. Respiratory syncytial virus (RSV)
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12. 3 year old boy with inspiratory stridor and barking cough could have what two major things?
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Epiglottitis
Laryngotrachobronchitis (CROUP |
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Cause of Epiglottitis?
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1. Haemophilus influenza type B
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prevention for Epiglottitis?
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Hib vaccine
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cause of Laryngotrachobronchitis (CROUP)
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1. Parainfluenza virus
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if you see the Steeple sign what should you think? 2
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epiglottitis, or CROUP
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a. Cause of strep pharyngitis?
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i. Strep pyogenes (group a beta hemolytic streptococci)
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b. Sequalae of strep infection
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i. Rheumatic Fever ---> glomerulonephritis
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c. Treatment failure of strep pharyngitis? 2
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i. Non-compliance
ii. Beta lactamase producing bacterial flora |
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if you see Toxin mediated, pseudomembrane you think?
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a. Corynebacterium diphteriae
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16. Paraoxysmal cough
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a. Bordetella pertussis
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b. Whooping cough
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Bordetella pertussis
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why is whooping cough on the rise?
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i. People aren’t getting vaccinated
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17. 45 year old poor immigrant, night sweats, weight loss, dyspnesa, released from 3 months immigration detention…you think what?
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TB
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18. Organism of TB? important characteristic of wall
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a. Mycobacterium tuberculosis
b. Acid fast bacteria |
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19. What is the lesion associated with TB
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a. Ghon complex
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20. Immunocompromised patients develop what with TB? what does this do
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a. Miliary TB
i. Hematogeonuos spread to other organisms |
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21. Positive PPD?
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a. 10mm induration>48
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b. Will immunocompromised have positive PPD?
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nope
think miliary |
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this TB drug is a potent CYP450 inducer
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b. Rifampin
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this TB drug turns your urine red
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b. Rifampin
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this TB drug causes hepatitis, CNS toxicity, and peripheral neuropathy
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c. Isonizade
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this TB drug causes Hepatotoxicity, hyperuricemia
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d. Pyrazinamide
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Optic neuritis, impaired red-green vision, hyperuricemia are all side effects of what TB drug
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e. Ethambutol
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23. Why use 4 TB drugs
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a. Resistance
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24. what do you use for the treatement of Latent infections of TB?
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a. Isoniazid or rifampin
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25. 12 year old with cough associated with wheezing and fatigue, for several weeks, no fever or chills, CXR shows hyperinflation, flattened diaphragms, what does he have
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a. Asthma
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b. Will a pt with asthma have a bronchodilator response?
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yes
|
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c. FEV1/FVC ratio for asthma? what kind of disease is this?
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Less than 70
obstructive |
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26. FEV1/FVC Ratio for restrictive disease
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>80
|
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27. 3 components of asthma
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a. Chronoic inflammation of the airways
b. Hypersecretion of mucus glands c. Airway smooth muscle hyperresponsiveness |
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28. Status asthmaticus?
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a. Persistent attack despite nebulizer, 02 and steroid therapy
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29. Maintenance meds for asthma? 6
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a. Inhaled steroid
b. Long acting beta agonists c. Cromolyn d. Leukotriene modifiers e. Omalizumab f. Methylxanthines |
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30. Asthma exacerbation meds? 3
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a. Short acting beta agonist
b. IV: steroids (systemic) c. Anticholinergics |
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if you see:
Red hepatization you should think... |
a. Early bacterial pneumonia
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if you see:
Hemosiderin laden macrophages you should think... |
a. Pulmonary congestion
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if you see:
Curschman’s spirals you should think... |
a. Bronchial asthma
|
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if you see:
Charcot-leyden crystals you should think... |
a. Bronchial asthma
|
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if you see:
Granular PAS positive material you should think... |
a. Alveolar proteinosis
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READ: clinical findings of hospital acquired pneumonia according to Leech
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i. Terminally ill patients
ii. Acquired in the course of a hospital stay iii. Patients already ill from another disease process; Patients with severe underlying disease, immunosuppression, prolonged antibiotic therapy, or invasive access devices (catheter) iv. Patients on mechanical ventilation are at a particularly high risk v. Bronchiolitis |
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i. Patchy (non-continuous) consolidation of the lung centered around bronchi or bronchioles (terminal and respiratory bronchioles) is associated with what?
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hospital acquired pneumonia (bronchopneumonia)
|
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most common organisms causing hospital acquired pneumonia?
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gram negative rods (ex. Pseudomonas) and S.aureus; Klebsiella
|
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when your immune system is down, what normal flora is increased?
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gram negative bacteria (these are mostly anerobic)
this can lead to aspiration pneumonia |
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i. Acute bacterial infection resulting in fibrinosuppurative consolidation usually producing virtually total lobar consolidation
ii. Uniform consolidation this describes? |
lobar pneumonia
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what is the main difference between lobar and hospital acquired pneumonia ?
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lobar: uniform consolidation
HAP: patchy consolidation |
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iii. Most common causative agent of lobar pneumonia
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Streptococcus pneumonia
|
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what are the 4 stages of inflammation seen in lobar pneumonia
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Congestion
Red Hepatization Grey Hepatization Resolution |
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1. Characterized by massive confluent exudation with neutrophils, red cells, and fibrin filling the alveolar spaces; extensive neutrophil exudation into the alveoli
2. Grossly, the lobe appears distinctly red, firm, and airless, with a liver-like consistency this describes what stage of what disease |
Red Hepatization
lobar pneumonia |
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1. Lung is heavy, boggy, and red
2. Characterized by vascular engorgement, intra-alveolar fluid with few neutrophils, and often the presence of numerous bacteria this describes what stage of what disease |
Congestion
lobar pneumonia |
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1. Progessive disintegration of red cells and the persistence of a fibrinosuppurative exudate
2. Transformation of exudates to fibromyxoid masses/macrophages and fibroblasts 3. Gross appearance is grayish brown, dry surface this describes what stage of what disease |
Grey hepatization
lobar pneumonia |
|
1. Consolidated exudates within the alveolar spaces undergoes progressive enzymatic digestion to produce granular, semi-fluid debris that is resorbed, ingested by macrophages, expectorated, or organized by fibroblasts growing into it
this describes what stage of what disease |
iv. Resolution (final stage)
lobar pneumonia |
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describe pneumonia in the immuno-compromised patient
|
chronic pneumonia that can expand over the lung
can make a caseous center and irregular cavity that is poorly walled off by fibrous tissue |
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how do you get miliary tuberculosis? what happens with this
|
TB when you are immunocompromised
can spread throughout lymphatics to multiple organs |
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what is the current theory for development of chronic obstructive pulmonary disease
|
Protease-antiprotease theory
Aided by oxidant-antioxidant imbalance Theory – alveolar wall destruction due to imbalance between proteases (mainly elastase) and antiproteases/in the lung too much destruction of elastic tissue (done by elastase) leading to alveolar collapse |
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if you see golden-brown rods with a translucent center in the lung what are you looking at?
|
asbestos bodies
|
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Diffuse pulmonary interstitial fibrosis due to a previous exposure to a pathogen is a typical finding of what?
|
asbestosis
|
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what are the 2 forms of asbestosis?
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1. Serpentine: curly, flexible fibers
2. Amphibole: straight, stiff, brittle fibers |
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what is the most common manifestation of asbestos exposure? located where?
|
Pleural plaques
iii. Most frequently on anterior and posterolateral aspects of the parietal pleura and over the domes of the diaphragm |
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if you see i. Elevated eosinophil count in the peripheral blood
ii. Eosinophils, Curschmann spirals, and Charcot-Leyden crystals in the sputum iii. Mucus plug what should you think |
asthma
|
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a. Most prevalent occupational disease in the world?
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acute silicosis
|
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d. Accumulation of lipoproteinaceous material within alveoli is associated with?
|
acute silicosis
|
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c. Intra-alveolar, granular, pink precipitate; alveoli filled with a smooth, floccular, pink material is a microscopic finding of what?
|
pulmonary congestion/edema
|
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a. Early ambulation in postoperative and post partum patients
b. Elastic stockings; graduated compression stockings for bedridden patients c. Anticoagulation for high-risk individuals are used to prevent what? |
PE
|
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insertion of a filter (“umbrella”) into the inferior vena cava is a possible preventative treatment of what?
|
PE
|
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primary pulmonary hypertension is b. Most frequently secondary to ______
|
structural cardiopulmonary conditions
|
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discuss the genetics of primary pulmonary HT
|
e. Less than 10% has genetic component
|
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b. Loss of bilateral costophrenic angle on CXR is due to?
|
bilateral pleural effusion
|
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_____ is characterized by loculated, yellow-green, creamy pus composed of masses of neutrophils admixed with other leukocytes
|
Empyema
|
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Empyema is an example of what type of plueral effusion?
this card sucks. just read it. |
purulent (infalmmatory pleural effusion)
|
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iii. Exudate =
|
inflammatory extravascular fluid
1. High protein content/concentration 2. Cellular debris 3. Specific gravity >1.020 |
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if you see tumor cells or sanguineous inflammatory exudates what should you be thinking?
|
iv. Hemorrhagic pleuritis
|
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i. Transudate =
|
fluid with low protein content (mostly albumin); specific gravity < 1.012
|
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iv. Chylothorax
|
lymph fluid inbetween pleura
usually on the left side |
|
hemothorax?
|
blood caused
due to 1. Aortic aneurysm 2. Vascular trauma 3. Can be fatal |