Respiratory_ Exam 1 Review_ Wahl

Front 1

70 yr old living at home in ER with acute episode of shaking chills, increased fatigue, productive cough with *RUST COLORED SPUTUM* and shortness of breath x 2 days

What is this?

Back 1

Strep. pneumoniae

Front 2

You have a patient with pneumonia caused by Strep. pneumoniae. What will a gram stain of sputum show?

Back 2

gram +

lancet shaped diplococci

**streptococcus pneumoniae**

Front 3

What drugs would you use to treat Strep. pneumoniae infection?

Back 3

Beta lactam (penicillin, 3rd gen cephalosporins)

erythromycin, quinolones--> if allergic to pen.

Front 4

What is the most common cause of Community Acquired Pneumonia?

Back 4

Strep. pneumoniae

Front 5

You see a patient that is homeless, drinks a fifth a day and produces “red currant jelly” sputum. What are you thinking?

Back 5

Klebciella pneumoniae

Front 6

Klebciella pneumoniae gram stain?

Back 6

Gram -

Rods

Front 7

Klebciella pneumoniae virulence factor?

Back 7

Large polysaccharide capsule

Front 8

A patient is in acute respiratory failure and you intubate her.

What tidal volume do you order?

Back 8

6-8 ml/kg

Front 9

What formula is used to measure the efficiency of O2 diffusion between lungs and pulmonary circulation

Back 9

A-a gradient

Front 10

You have a patient with Cystic Fibrosis that has been on a ventilator for 3 months. Chest x-ray indicates infiltrates in the lungs. What are you thinking?

Back 10

Pseudomons aeruginosa

Front 11

Pseudomons aeruginosa

Gram stain? Oxidase?

Back 11

Gram negative rods

Oxidase +

Front 12

Underlying cause of cystic fibrosis

Back 12

Sodium/chloride channel dysfunction

Front 13

You are treating a heroin addict (IV drug use) recovering from the flu. What bacteria are you thinking?

Back 13

Staph Aureus

Front 14

You have a patient that is difficult to wean and develops left calf pain, swelling and edema
What do you suspect and what do you order?

Back 14

Pulmonary Embolism

Order a Pulmonary Angiogram (GOLD STANDARD)

Order D-dimer

Front 15

Three risk factors for Venous Thrombolotic Events

Back 15

VIRCHOW'S TRIAD

endothelial injury, venous stasis, hypercoagulability

Front 16

What are some causes of Acquired Hypercoagulability?

Back 16

lupus, nephritic syndrome, HIT, cancer , birth control pills

Front 17

What are some causes of Inherited Hypercoagulability?

Back 17

Factor V leiden , protein C/s deficiency, antithrombim III deficiency

**blood test to check for these before using anticoagulants**

Front 18

Your patient has had a VTE due to Immobilization: surgery, trauma. How long do you treat with anticoagulants?

Back 18

3 months

Front 19

Your patient has had a VTE for the first time with no obvious cause. How long to you treat with anticoagulants?

Back 19

3-6 months

Front 20

Your patient has had reccurent VTEs Cancer, Hypercoagulable state. How long do you treat with anticoagulants?

Back 20

12 months to LIFE

Front 21

Despite several boluses of IV normal saline, your pt. is not maintaining adequate perfusion. Which pressures do you base the need for vasopressors?

Back 21

Mean Arterial Pressure < 60 mmHg

Front 22

First line vasopressor for sepsis?

First line vasopressor for everything else?

Back 22

NE= sepsis

Dopamine= everything else

Front 23

10 year old male with a 2 week history of a gradual onset of a non productive cough, fever, headache, and fatigue. Fluffy infiltrate in CXR. What are you thinking?

Back 23

Could be viral, but...

Bacterial = mycoplasma pneumonia

Front 24

Best lab test for mycoplasma pneumonia?

Back 24

Cold Agglutins

Front 25

Does mycoplasma pneumonia have a cell wall?

Back 25

NO CELL WALL

Front 26

10 year old male with a 2 week history of a gradual onset of a non productive cough, fever, headache, and fatigue. Fluffy infiltrate in CXR.

You see obligate intracellular parasites on biopsy. What are you thinking?

Back 26

Chlamydia pneumoniae

Front 27

What serotype of Chlamydia pneumoniae causes respiratory infections and pneumonia?

Back 27

TWAR strain

Front 28

**Bacterial vs. Viral**


-Onset – ?
-Rigors- ?
-Cough- ?
-Temp- ?
-mucous- ?
-CXR-?

Back 28

-Onset – gradual if viral, acute if bacterial

-Rigors- present in bacterial

-Cough- productive if bacterial

-Temp- high grade for bacterial

-mucous- purulent (bloody) in bacterial , non-purulent in viral

-CXR- consolidation

Front 29

•6 yr old native American from SW Colorado home from school with flu-like symptoms, becomes acutely SOB, x ray shows pulmonary hemorrhage and edema.

Back 29

HANTA Virus

**Spread by mouse droppings**

Front 30

23 year old postal worker who works night shift at a hide processing plant with mild cough, fever, malaise develops acute dyspnea, stridor, fever, cyanosis. CXR shows a widened Mediastinum

Back 30

Anthrax

Front 31

You have a patient that presents with flu-like symptoms and a widened mediastinum on CXR. What's up?

Back 31

Anthrax

Front 32

Gram stain of Anthrax?

Back 32

Large, Gram + rods

Front 33

Why does an antibiotic fail?

Back 33

Noncompliance
Resistance to drugs
Drug-drug interactions

Front 34

What is the post antibiotic effect?

Back 34

Still have suppression despite drug levels below Minimum IC

**Concentration-dependent drugs**

Front 35

This Virus causes:
-LRT diseases in CHILDREN
-Acute respiratory dz of military recruits
-Pharngoconjunctival fever- swimming pools
-Epidemic keratoconjuctivitis
-Infantile gastroenteritis
-Common cold

Back 35

Adenovirus

Front 36

**Flu Virus**

Antigenic drift- ?

Antigenic Shift- ?

Back 36

*Antigenic drift* - small changes in hemagglutinin and/or neuraminidase single antigenic determinants. Due to mutation.

*Antigenic shift* - major change in most all antigenic determinants of
hemagglutinin and/or neuraminidase. Intragenomic or intergenomic recombination (segment exchange, reassortment) between human and animal viruses.

Front 37

Some muscles will grow abnormally large when a patient has forced respiration due to conditions like COPD or Emphysema. Other muscles that would not normally be involved in breathing are recruited to assist. What are these muscles?

Back 37

-Scalenes --> elevate 1st & 2nd ribs

-Pectoralis minor and major --> Can elevate anterior ribcage if arms are abducted and scapula is fixed.

-Serratus anterior --> Can elevate lateral ribcage if scapula is fixed.

-Trapezius, Levator scapulae, Rhomboids --> Stabilize (fix) the scapula so that other muscles can then work on the ribcage

Front 38

Why does an antibiotic fail?

Back 38

Noncompliance

Drug interactions

Resistance

Front 39

What's this?

Back 39

Steeple Sign

Front 40

What is sensitivity regarding lab results?

Back 40

Sensitivity is the % of true positives that are really positive by the gold standard

Front 41

What is specificity regarding lab results?

Back 41

Specificity is the % of true negatives that are really negative by the gold standard

Front 42

What causes symptoms of runny nose and congestion?

Back 42

Our own immune system

Front 43

what are PAMPS?

What receptors do they bind?

Back 43

Pathogen Associated Molecular Patterns

Bind to TLRs --> immune response

Front 44

Activation of what causes the release of pro-inflammatory mediators from cells?

Back 44

NFKB

Front 45

How does secretory IgA stop infection?

Back 45

Neutralizes pathogens and toxins

Front 46

Naso-oropharynxnasal hairs and mucus. Conducting
airways- about half of the cells are ciliated. Clears pathogens, dust, ect. from respiratory tract.

Back 46

Mucocilliary Clearance

Front 47

What is the most common viral LRT?

Back 47

influenza

Front 48

What produces the most serious sequelae of flu?

Back 48

Bacterial Pneumoniae

Front 49

What is the most common LRT infection in kids/newborns?

Back 49

Respiratory syncytial virus (RSV)

Front 50

3 yo boy with inspiratory stridor and barking cough comes in to the clinic. Tests reveal that the child has a viral infection. What's the virus?

Back 50

Parainfluenza Virus

**Viral Croup**

Front 51

3 yo boy with inspiratory stridor and barking cough comes in to the clinic. Tests reveal that the child has a bacterial infection. What is it?

Back 51

haemophilus influenza type B (G-)

Staph. aureus (G+)

Front 52

3 yo boy with inspiratory stridor and barking cough comes in to the clinic. The cause is not viral or bacterial infection. What is going on?

Back 52

Foreign body airway obstruction

Front 53

Cause of strep pharyngitis?

Back 53

Group A beta-hemolytic streptococci (s. pyogenes)

Front 54

Sequelae of strep infection?

Back 54

Rheumatic fever

Glomerulonephritis

Front 55

Bacterial URT Treatment failure? (2)

Back 55

noncompliance

beta lactamase producing bacterial flora (co-pathogens in the throat)

Front 56

Toxin mediated, pseudomembrane bacteria?

Back 56

Corynebacterium diphtheria

-damages tissue through "A- toxin", and it develops a pseudomembrane

Front 57

Bacterial URT that causes paroxysmal cough?

Back 57

Bordella pertussis

Front 58

45 yr old Laotian male released from 3 mos immigration detention with night sweats, wt, loss, hemoptysis and dyspnea (cavitation on x ray). What are you thinking?

Back 58

Mycobacterium tuberculosis

Front 59

Gram stain of Mycobacterium tuberculosis ?

Back 59

Won't gram stain!

Acid-Fast membrane full of lipids

Front 60

Lesion seen in TB?

Back 60

Gohn Complex

Front 61

What does a positive PPD test look like?

Back 61

10 mm induration after 48 hrs

Front 62

Immunocompromised patient infected with Mycobacterium tuberculosis. What does this cause? Why is it bad?

Back 62

Miliary TB

**SYSTEMIC INFECTION**

Front 63

Why use 4 drugs to treat TB?

Back 63

we use four drugs to try to keep a pharmalogical therapy that works.

If we use just one drug, more likely to develop resistance to that drug.

Front 64

Rifampin Side effects

Back 64

Potent CYP450 inducer

hepatic toxicity

Front 65

Isoniazid side effects:

Back 65

CYP 34a inducer
Hepatitis
CNS toxicity
peripheral neuropathy ----> give Vitamin B6

Front 66

Pyrazinamide side effects:

Back 66

hepatotoxitcity

hyperuricemia

Front 67

Ethambutol side effects:

Back 67

optic neuritis-->impaired red green vision

hyperuricemia

Front 68

Tx for Latent TB infections?

Back 68

Isoniazide/rifampin

Front 69

Tx for Isoniazide TB infections?

Back 69

Ethambutol + Rifampin + Pyrazinamide
for 6 months

Front 70

A 12 year old with cough associated with wheezing and fatigue several times a week. No fever/chills. CXR swhows hyperinflation and flattened diaphragms

Back 70

ASTHMA

Front 71

FEV1/FVC ratio in asthma?

Back 71

FEV1/FVC ratio will be <70%

Front 72

Is there a bronchodilator response in asthma?

Back 72

yes

Front 73

**Asthma**

Rule of 2's to asses asthma control

Back 73

>2 uses of inhaler per week

>2 uses at night/month

>2 canisters/year=poor control

**Yes to any of these and you have poor control**

Front 74

What are the three components of asthma?

Back 74

Chronic inflammation of the airways

Hypersecretion of mucus glands

Airway smooth muscle hyperresponsiveness

Front 75

What is Status Asthmaticus?

Back 75

Persistent attack despite nebulizer, O2, and steroid therapy

Front 76

Back 76

Front 77

What are the 4 causes of hypoxemia?

Back 77

Hypoventilation

Diffusion impairment

Shunt

V/Q Inequality