Resp: Test 2 : 23. Wahl : Review

Front 1

what character bacteria is commonly on the skin?

Back 1

G+

Front 2

what character bacteria is commonly in the GI?

Back 2

G-

Front 3

PCNs are bacterial_____

Back 3

cidal

Front 4

which component of PCN binds to PBP?

Back 4

b-lactam ring

Front 5

Be able to Identify the structure of a B-lactam and the bond..

Back 5

Front 6

• The attack point of the beta-lactamases such as penicillinase is the?

Back 6

o B-lactam ring

Front 7

• Which PCNS are effective with methicillin sensitive staph A (besides methiciliin)

what are they collectively known as?

Back 7

o Naf, ox, clox, diclox

Antistaph pens

Front 8

• Which is the drug of choice for MSSA

Back 8

o Nafcillin

Front 9

• What are the functional Hemoglobins

Back 9

o A and F

Front 10

• Extended spectrum PCNs that are used for some gram negatives?

Back 10

o Amp and amox

Front 11

• DOC against listeria

Back 11

o Ampicillin

Front 12

which of the extended spectrums have better oral availability?

Back 12

amoxicilin

Front 13

• What are the antipseudomonal PCN

Back 13

o Ticar,piper

Front 14

• Which gen of ceph has more gram neg cov, 1st or 3rd?

• Better CSF penetration?

• More B-lactamase resistance?

Back 14

All are 3rd gen

Front 15

• Name a carbapenem

Back 15

o Imipenem

Front 16

• Can you use cefipime in a pt who had an anaphylactic rxn to amoxicillin?

Back 16

NO

Front 17

• Can you use aztreonam in a pt who had an anaphylactic rxn to a penicillin?

Back 17

yes!

Front 18

What kills almost ALL bacteria?

Back 18

Carbapenem

Front 19

MOA for carbapenem?

Back 19

similar to cephs

Front 20

Carbapenems:

Effective against pseudomonas?

Back 20

YES

Front 21

Carbapenems:

o Does it have a significiant post bacterial effect?

Back 21

Yes

Front 22

Carbapenems:

o Is it effective against MRSA?

Back 22

NO

Front 23

Carbapenems:

o Used with this medication to extend duration by blocking action of renal enzymes

Back 23

Cilastatin

Front 24

• Name a monobactam

Back 24

o Aztreonam

Front 25

• What is a MAGIC bullet for gram negs?

Back 25

o Aztreonam

Front 26

pt is in ICU for 6 weeks, have a ton of resistance, ton of infections..what do you want to use?

Back 26

this is a resistant G- infection

so Aztreonam

Front 27

Aztreonam:

MOA?

Back 27

Only binds PBP in G-

Front 28

Aztreonam:

o Does it have cross sensitivity with PCN/Cephs?

Back 28

NO

Front 29

• Vancomyicn spectrum limited to?

Back 29

G+

Front 30

vancomyocin is toxic to what 2 systems?

Back 30

Renal (nephrotoxic)
Auditory (ototoxic)

Front 31

adverse side effect of vancomycin with rapid infusion?

Back 31

Red man syndrome

Front 32

• What is the drug of choice for methicillin resistant staph A MRSA

Back 32

o Vancomycin

Front 33

DOC for psuedomembranous colitis?

Back 33

o Metronidozle and Vancomyocin

Front 34

Bug associated with:

• Southwest Desert

Back 34

o Coccidiodes immitis

Front 35

Bug associated with:

• Cutaneous Lesions

Back 35

o Blastomyces dermatites

Front 36

Bug associated with:

• Neutropenic

Back 36

o Aspergillus fumigatus

Front 37

Bug associated with:

• Ohio River Valley

Back 37

o Histoplasma capsulatum

Front 38

Bug associated with:

• Sporulating Organisms

Back 38

o Coccidioides immitis

Front 39

Bug associated with:

• Filamentous branching hyphae

Back 39

o Aspergillus fumigatus

Front 40

Bug associated with:

• CT “Snowstorm” pattern

Back 40

Histoplasma capsulatum

Front 41

Bug associated with:

Halo Sign

Back 41

Aspergillus

Front 42

Bug associated with:

Slimy black mold?

Back 42

o Stachybotrys chartrum

Front 43

• Evaluation of tumors of specific nerve is best achieved with?

Back 43

MRI- Tissue and nerve

Front 44

• What makes small cell carcinoma have an increased sensitivity to chemotherapy

Back 44

o Its rapid doubling time
o If something is a slow growing cancer, chemo doesn’t really do much, so this is good for small cell

Front 45

• Why is small cell Ca not amenable to surgery

Back 45

o Metastasizes via blood stream early, 80% disseminated at diagnosis
o So you can’t cut it out before it has already spread like wild

Front 46

• CT suspicious for lung cancer…next step to diagnosis?

Back 46

o Biopsy and bronchoscopy (must do this b4 diagnosing ca)

Front 47

• What are the associated paraneoplastic syndrome with small cell Ca

Back 47

o SIADH

Front 48

• Harmatomas are similar to pneumonias or coin lesions on xray?

Back 48

o Single pulmonary nodules (coin lesions)

Front 49

• Why may an apical lung tumor cause hoarseness

Back 49

o Right recurrent laryngeal nerve

Front 50

• In TNM classification what does each letter stand for and what must M be to signify stage IV

Back 50

o T- Tumor
o N- Nodes
o M- metastitis
o M must be at least 1

Front 51

• Which type of pneumothorax involves a mediastinal shift

Back 51

o Tension

Front 52

• Trauma, distant heart sounds, in shock describes?

Back 52

o Cardiac tamponade

Front 53

treatment of cardiac tamponade in order?

Back 53

IV fluids,
O2,
pericardiocentesis (drain that fluid)

Front 54

• A pancoast tumor can invade the cervical sympathetic chain and brachial plexus causing what syndrome?

Back 54

Horners

Front 55

What are the symptoms of Horner's syndrome? what can cause this?

Back 55

Miosis, ptosis, shoulder pain, and motor sensory deficits in the arm

Pancoast tumor

Front 56

what do you suspect if you see a

Milky pleural effusion?

Bloody?

Back 56

o Milky: Lymphoma
o Bloody: malignancy

Front 57

• 69 y/o male, smoker, with ant chest pain, shocky, and hoarse

Back 57

o Dissecting aortic aneurysm

Front 58

• Tumors-locations:

o Pleural

Back 58

Mesothelioma (fibrous plaques)

Front 59

• Tumors-locations:

Central

Back 59

Sqaumous Cell

Small Cell

Front 60

• Tumors-locations:

Peripheral

Back 60

Adenocarcinoma (glands involved)

Front 61

what type of cancer has ill defined cell boarders?

Back 61

small cell

Front 62

what type of cancer is Glandular with mucin?

Back 62

o Adenocarcinoma

Front 63

what type of cancer is Well differentiated, gray-white tissue

Back 63

o Squamous cell

Front 64

• Which carcinoma is associated with paraneoplastic syndromes (low Na, etc)

Back 64

o Small cell

Front 65

• Most common syndromes associated with small cell cancer?

Back 65

o SIADH
o Cushings (moon facies, hyper weight gain, hyper cortisol)

Front 66

• Which carcinoma is caused by asbestos

Back 66

o Mesothelioma

Front 67

• Leading cause of cancer-related deaths

Back 67

o Lung Cancer

Front 68

Major risk factor of cancer related deaths?

Back 68

Smoking

Front 69

• Most aggressive cancer?

Back 69

o Small cell

Front 70

please outline fetal circulation starting with the umbilical vein and finishing at the umbilical arteries

Back 70

Umbilical vein

ductus venosis

liver

inferior vena cava

RA

Foramen ovale

Latrium

Left ventricle

Ascending aorta

Descending aorta

Placenta

Front 71

where does blood go to first in fetal circulation?

Back 71

LIVER

(glucose and AAs for fetus)

Front 72

what part of fetal circulation has the highest concentration of "good stuff"

Back 72

umbilical vein

Front 73

what causes constriction of the pulmonary arteries?

Back 73

*Acidotic & Hypoxic blood causes Hypoxic Pulmonary Vasoconstriction *

Front 74

90% of Deoxygenated blood shunts through Prostaglandin induced _____ _____ ______ bypassing pulmonary arteries.

Back 74

Patent Ductus Arteriosus

Front 75

3 organs with preferred circulation in Fetal Circulation

Back 75

Liver

Heart

Brain

Front 76

what gets 1st dibs at O2 rich blood in fetal circulation?

Back 76

coronary arteries

brain gets second dibs

Front 77

o Pathology in meconium aspiration?

Back 77

Chemical irritation

(that is all she said but he asid the fetus gets stressed, hypoxic etc, causing decreased sympathetic tone, leading to pooping the womb. this poo is then inhaled as a chemical irritant, baby comes out looking like shit...hahaha i mean, all blue and having trouble breathing)

Front 78

o When does surfactant production begin?

Back 78

28 weeks

Front 79

o What initiates surfactant release

Back 79

physical stretch

Front 80

what stimulates the production of surfactant?

Back 80

cortisol

Front 81

at what age are lungs matured?

Back 81

34 weeks

Front 82

• Transient tachypnea of the newborn most common in? why?

Back 82

o C section (no thoracic squeeze)

Front 83

• Earliest preemie age for longer survival

Back 83

25 weeks

(i remember him saying 23 is when the type I pneumocytes develop, and that is the earliest age...but this is what she said in lecture)

Front 84

o Ground glass X ray in neonate....

Back 84

Hyaline Membrane disease (ugh what is the other name for this respiratory distress syndrome)

Front 85

o Patchy infiltrate X ray in neonate....

Back 85

Neonatal pneumonia

Front 86

o Spongy airless area base of left lung on X ray in neonate....?

Back 86

Pulmonary sequestration

Front 87

• Most common structural lung lesion in neonates?

Back 87

o Congenital lobar emphysema

Front 88

• Which malacia is mild albeit noisy?

Back 88

o Laryngo

Front 89

• Conjunctivitis and staccato cough?

tx?

Back 89

o Chlamydia (erythromycin/macrolide is Tx)

Front 90

• Most common neonatal infecting agent?

Back 90

o CMV

Front 91

• Primary newborn screening for CF?

Back 91

o Immunoreactive trypsinogen

Front 92

if you screen a kid for CF (using what again?) and it is positive... what do you do next?

Back 92

o Immunoreactive trypsinogen

next step: Refer them to CF center, and get sweat test

Front 93

What is the genetics behind CF?

Back 93

Autosomal recessive

so need to know how to calculate this if they tell you one parent is a carrier etc

Front 94

o Lung transplant parameters?

Back 94

baseline FEV1 < 40% of expected
increasing frequency of severe pulmonary exacerbations requiring hospitalization
progressive O2 need
emergence of organisms resistant to multiple anti-biotics


ok so this was something she said to know...i didn't see it in his handout but this is what i remember from lectuer:

it is tough to get a lung transplant, so you want to get on the list early (before you need one)

also you can get parts from mom/dad

Front 95

o Most common Bacteria in CF

Back 95

Pseudomonas

Front 96

Most dangerous bacteria in CF?

Back 96

Burkholderia cepacia

associated with worsening lung function, makes for worse outcome, isolate them from other CF pts because it can rock their shit

Front 97

Kid comes into your office w/ CHRONIC COUGH, APATHETIC, past Hx of SEVERAL INFECTIONS, & is SMALLER than other classmates...what should you do? why

Back 97

o Look at STOOL – check for malabsorption & order SWEAT TEST

they might have CF

Front 98

what is a J receptor? What can be detrimental to its activity? What population is this seen in?

Back 98

J receptor is what senses stretch of the lungs and makes you exhale

RSV can stop this receptor's activity

this is seen in kids and can lead to stopping of breathing!

Front 99

Why are neonates more susceptible to O2 toxicity?

Back 99

Premature babies get toxicity from oxygen and inflammation bc they *do not have Free Radical Scavengers* to fight off free radicals

--thus they cannot turn off the inflammatory response

Front 100

what is the most important lung volume?

Back 100

FRC (Functional Residual Volume)

Front 101

what stops atelectasis besides closely packed alveoli and surfactant?

Back 101

Functional Residual Volume

Front 102

How do you tx an asthmatic or COPD to get relief? (this had *TQ next to it...which makes me think test question)

Back 102

Restore FRC!

Make it easier for them to breathe.
-Giving O₂ doesn’t treat the WOB. Their lungs are already too full (blood, edema,pus, mucus)

Front 103

Please discuss the progression of infant immunity

Back 103

IgG passes from mother to fetus in *3rd Trimester*

-A TERM baby has mom’s immunity for a couple months, it then goes down for a bit while IgG, IgA & IgM are learned

Front 104

Thickened Alveolarmembrane
*Neutrophilic infiltration
*Decreases Oxygenation
*Increases Work of Breathing

describes?

Back 104

• Respiratory Distress Syndrome (RDS) or Hyaline Membrane Disease

Front 105

what is the major problem (cause) of Respiratory Distress Syndrome (RDS) or Hyaline Membrane Disease

Back 105

lack of surfactant leads to alveolar collapse

Front 106

treatments for RDS? 3

Back 106

1. Perinatal Steroids
2. 4 mL/kg Surfactant injection into Lungs
3. Support (O2, antibiotics….)

Front 107

What is considered a positive sweat test for CF?

Back 107

values of chloride greater than 60 mEq/L

Front 108

aside from the lungs, what is another major organ that has its function diminished in CF?

Back 108

pancreas

can't secrete as well, and what it does is less effective

Front 109

what can improve digestion and intestinal absorption problems seen in CF?

Back 109

supplemental pancreatic enzyme therapy