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172 Cards in this Set
- Front
- Back
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What are the 4 routes a pneumonia infection can occur?
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-inhalation of droplets,
aspiration of oropharyngeal contents, upper respiratory infection, hematogenous spread |
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What medical procedure often introduces pneumonia?
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intubation
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What are the 4 defense mechanisms of the pulmonary system?
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turbulence of air flow, cough reflex, cilia, alveolar macrophages and neutrophils
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What are the 2 types of pneumonia?
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community acquired, health care associated
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What organisms cause typical community acquired pneumonia (CAP)?
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Strep. pneumoniae,
Haemophilus influenzae, Morexella catarrhalis, Klebsiella pneumoniae, Staph aureus, Pseudomonas |
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Which organism is the most common cause of typical pneumoniae?
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Strep. pneumoniae
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Which bacteria cause atypical CAP?
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Mycoplasma pneumoniae, Legionella pneumophila, Chlamydia pneumoniae
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What viruses cause atypical CAP?
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Influenza A and B, RSV, Parainfluenza, Adenovirus
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RSV only causes pneumonia in what patients?
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children
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How does the cough present in CAP?
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dry, productive, hemoptosis
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What kind of sputum is seen in Pneumococcal pneumonia?
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rust colored
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Pneumonia caused by what bacteria causes “walking pneumonia”?
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mycoplasma
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What bacteria causes a pneumonia in older patients with comorbidities?
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Chlamydia
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What bacteria causes a pneumonia characterized by altered mental status?
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Legionella
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What bacterial pneumonia has the lowest morbidity?
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mycoplasma
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What bacterial pneumonia has the highest morbidity?
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legionella
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What are breath sounds like in pneumonia cases?
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harsh
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What sounds are heard in the lungs?
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crackles, rales
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What 4 signs of consolidation are noticed on a physical exam with pneumonia?
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-increased tactile fremitus
-dullness to percussion -positive egophony -positive whispered pectoriloquy |
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How does positive egophony sound?
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patient says “E” but it sounds like “A”
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How does whispered pectoriloquy sound in pneumonia?
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louder in areas of consolidation
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What is recommended for a diagnosis of CAP?
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chest xray
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What is seen commonly in xrays of CAP?
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lobar consolidation
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What is seen commonly in xrays in atypical CAP?
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bilateral infiltrates, thickened interstitial markings
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Secondary pleural effusion can be seen on xray in what bacterial pneumonia
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mycoplasma
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What lab test is difficult to obtain cleanly but diagnostic of pneumonia?
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sputum culture
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What severity index is used to determine inpatient vs. outpatient pneumonia cases?
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CURB-65
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What does this stand for?
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confusion, urea nitrogen, resp. rate, blood pressure, 65 years or older
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What medication is given to healthy pts that have not been on abx for 3 mo?
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azithromycin, clarithromycin
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What medication is used if pt has macrolide allergy?
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doxycycline
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What medications are used for pts with comorbidities or abx use in the last 3 mo?
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levofloxacin, moxifloxacin
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What medications can be used if fluroroquinolone allergy or if pregnant?
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augmentin or cefuroxime plus azithromycin/clarithromycin
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What medications are given for inpatient CAP?
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levofloxacin, moxifloxacin
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What IV meds are given if fluoroquinolone allergy or if pregnant?
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Ceftriaxone, ampicillin, cefotaxime
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What IV meds are given if fluoroquinolone allergy or if pregnant? ANSWER
-Ceftriaxone, ampicillin, cefotaxime What other meds are given with these? |
oral biaxin, oral azithromycin, or IV azithromycin
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What meds are given for ICU cases of CAP?
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ceftriaxone or cefotaxime
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What meds are given for ICU cases of CAP? ANSWER
-ceftriaxone or cefotaxime What other meds are given with these? |
-oral biaxin or
-oral azithromycin or -IV azithromycin or -IV levofloxacin or -IV moxifloxacin |
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What medications cant be used by pregos?
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doxycycline, levofloxacin, moxifloxacin
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How long is the average treatment with CAP medications?
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10-14 days
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What are 4 complications that can develop from CAP?
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pleural effusions, lung abscess, bacteremia, acute resp. distress syndrome
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What vaccines may reduce complications in CAP elderly pts?
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pneumococcal, influenza
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Nosocomial pneumonia is defined as?
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pneumonia occurring >48 hrs after admission to hospital
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Early onset nosocomial pneumonia is usually caused by what bacteria?
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Strep pneumoniae, Haemophilus influenzae, staph aureus
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Late onset nosocomial pneumonia is usually caused by what bacteria?
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MRSA, Pseudomonas aeruginosa
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When is the highest risk of ventilator acquired pneumonia?
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first 5 days of putting on ventilator
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What five types of bacteria usually cause ventilator acquired pneumonia?
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typical pathogens, pseudomonas, mrsa, acinetobacter, enterobacter
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What criteria list is used to diagnose VAP?
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clinical pulmonary infection score
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What parameter is most sensitive in this score?
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oxygenation
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What medications are given for non-MDR nosocomial pneumonia?
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ceftriaxone, moxifloxacin, levofloxacin, ciprofloxacin, unasyn
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What drug regimen is given for MDR nosocomial pneumonia?
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two drugs against pseudomonas and one drug against mrsa
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What drugs are used to treat pseudomonas?
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ceftazidime or cefepime
plus -gentamicin or tobramycin or ciprofloxacin or levofloxacin |
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What drugs are used to treat mrsa?
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linezolid or vancomycin
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Where is visual field loss first in glaucoma?
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peripheral field loss
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What is the only treatable risk factor in glaucoma?
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elevated eye pressure
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What is the normal pressure of the aqueous humor?
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16 mmHg
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What type of glaucoma is seen in 90% of cases?
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primary open-angle
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Posterior exam of the eye in glaucoma shows what?
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cupping of the optic nerve
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What test is done after findings of glaucoma on physical exam?
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formal visual field test
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What are the 2 goals of medical therapy for glaucoma?
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decrease aqueous production, increase aqueous outflow
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What beta blockers are used to reduce pressure by 30%?
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timolol, timoptic, betaxolol
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What patients should use caution when using beta blockers?
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asthmatics, bradycardics
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What are other cons to using beta blockers?
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decreases HDL, depression, impotence
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What a2 agonist is used to treat glaucoma?
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alphagan
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Alphagan is good for patients with what comorbidity?
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cardiovascular patients
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What are adverse reactions to alphagan?
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red eyes, conjunctivitis
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What 3 prostaglandin analogues are used for glaucoma?
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xalatan, travatan, lumigan
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What are adverse reactions to prostaglandin analogues?
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red eyes, long/full lashes, change in iris color
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What 3 carbonic anhydrase inhibitors are used for glaucoma?
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dorzolamide, brinzolamide, acetamazolamide
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What are adverse reactions to carbonic anhydrase inhibitors?
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kidney stones, weight loss, fatigue, aplastic anemia,
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Which patients must avoid carbonic anhydrase inhibitors?
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sickle cell patients
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What are the surgical options for glaucoma?
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trabectome, trabeculectomy
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What type of glaucoma is characterized by a sudden acute rise in pressure?
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angle-closure glaucoma
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What are 2 risk factors for angle-closure glaucoma?
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hyperopia, Asians
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What are the symptoms of angle-closure glaucoma?
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pain, redness, vision loss, nausea, headache
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What definitive surgical treatment is used in angle-closure glaucoma?
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laser peripheral iridotomy
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What is a cataract?
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opacification of lens
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Which way do cataracts grow?
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anterior-posterior direction
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What are patient complaints in cataracts?
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-blurred vision, difficulty driving/reading, glare, night vision problems, altered color perception
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What is the most common cataract?
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nuclear
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What kind of cataract shows spokes formation?
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cortical
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What kind of cataract is common in chronic steroid users and radiation therapy pts?
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posterior sub-capsular
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When should follow up appointments be made after cataract surgery?
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1 day, 1 week, 1 month later
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What complications from cataract surgery could arise?
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elevated intraocular pressure, infection, retinal detachment
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What medications are given after cataract surgery?
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antibiotic and steroid drops
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What kind of vision is the macula responsible for?
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detail, central and color vision
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What kind of vision is affected in age related macular degeneration (AMD)?
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gradual onset central vision loss
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What is the most common form of AMD?
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dry macular degeneration
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What is the characteristic exam finding in AMD?
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drusen
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How is dry AMD treated?
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exam and self monitoring, ocuvite, AREDS vitamins
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What causes wet AMD?
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vessels from choroid grow underneath the retina and bleed
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What kind of vision loss is seen in wet AMD?
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acute central vision loss
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How is wet AMD treated?
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laser therapy, lucentis injections
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How do these medication injections work?
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they are anti-angiogenics, cause regression of abnormal blood vessels
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What usually causes retinal artery occlusion?
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Hollenhorst plaque (embolus)
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How will the macula appear in a retinal artery occlusion?
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cherry red spot surrounded by retinal whitening
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What symptom precedes retinal artery occlusion?
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amaurosis fugax
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What is this (amaurosis fugax)?
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transient monocular blindness
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What serious complications are possible in patients with retinal artery occlusions?
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heart disease, stroke
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What are the risk factors in central retinal vein occlusions?
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diabetes, HTN, glaucoma, hypercoagulable state, hyperviscosity
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What are the stages of a TB infection?
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exposure, latent infection, active TB, disseminated TB
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What stage of TB infection would appear on a chest xray?
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active TB stage
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What stage of TB infection would cause a positive PPD?
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latent stage
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What type of TB presents with many tiny nodules in lungs seen on xray?
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Milliary TB
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What usually self-limiting TB infection is common in children <4 yrs?
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primary TB
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Latent and active TB cases are what type of TB infection?
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secondary
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Where are these infections usually located in the lungs?
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apical and posterior segments of upper lobes
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What are usual pulmonary symptoms of TB?
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cough > 3wks, hemoptysis
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Extrapulmonary symptoms of TB are seen often in what patients?
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HIV pts
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What 2 lesions are commonly seen in the lungs of TB pts?
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Ghon’s complexes, cavitations
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What is the size of induration in a positive PPD for a normal person?
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15 mm
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What blood test detects cell mediated immunity following a PPD?
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QuantiFERON-TB
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What are the 5 first line medications for TB?
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isoniazid, rifampicin, pyrazinamide, ethambutol, streptomycin
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What are the 5 second line medications for TB?
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aminoglycocides (kanamycin or amikacin), cycloserine, thioamides (ethionamide), para aminosalycilic acid, quinolones
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What meds are used initially for 2 months in TB?
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isoniazid, rifampin, and pyrazinamide
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What meds are used for 4 months after the first two months in TB?
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isoniazid, rifampin
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What meds are used if MDR TB is suspected?
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ethambutol and streptomycin for 2 months
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What side effects are seen in all TB drugs?
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nausea, vomiting
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BCG vaccination may minimize what complications of TB?
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TB meningitis, miliary TB
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Treatment is considered a failure when what tests are positive?
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sputum cx after 3 mo, AFB smear after 5 mo
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When can an influenza patient infect others?
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1 day before symptoms, up to 5 days after becoming sick
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What abrupt symptoms are seen in influenza?
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high fever, HA, cough, sore throat, nasal congestion, myalgias
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What serious complications can be seen in children, elderly or pregos?
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bacterial pneumonia, sinus infxn, otitis media, purulent bronchitis, dehydration, worsening of chronic conditions
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What complications can develop from primary viral pneumonia?
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pericarditis, myocarditis, toxic shock syndrome, thrombophlebitis
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What complication in children results in liver failure and encephalopathy?
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Reyes syndrome
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What medications are used for influenza?
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ribavirin, zanamivir, oseltamivir
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When do these meds, influenza, have to be given?
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within 48 hrs of onset
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What influenza med is contraindicated in asthma?
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zanamivir
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The flu vaccine is not recommended for people with what three things?
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egg allergies, guillain-barre syndrome, acute febrile illness
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What vaccine is approved for healthy, not prego pts age 2-49 years?
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nasal spray live attenuated virus
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What medications are H5N1 and swine flu resistant to?
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amantadine, rimantadine
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Swine flue is susceptible to what meds?
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oseltamavir, zanamivir
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What is the definition of acute bronchitis?
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<3 wks of cough
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What viruses cause bronchitis in pts < 1yr?
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RSV, parainfluenza, corona
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What viruses cause bronchitis in pts 1-10 yrs?
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parainfluenza, entrovirus, RSV, rhinovirus
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What viruses cause bronchitis in pts >10 yrs?
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influenza, RSV, adenovirus
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What symptoms of bronchitis are found on exam?
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fever, tachypnea, wheezing, rhonchi/rales, sputum production
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What protussive meds, for bronchitis, are used for treatment?
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terbutaline, amiloride, saline aerosols
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What antitussive meds, for bronchitis, are used for treatment?
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hydrocodone, dextromethorphan, codeine, carbetapentane, benzonate
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White side effect should be cautioned in antitussive meds?
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sedation
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This can lead to mastoiditis and it is most common in infants in children.
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Acute otitis media
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What are the etiological causes of Acute otitis media?
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Strep pneumo, H. flu, moroxella, strep pyogenes, Staph aureus
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What is a sign, upon examination, of acute otitis media?
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Bulging tympanic membrane from pressure.
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This is seen in Hx and Physical, pain, swelling, tenderness, and redness over the mastoid region, protrusion of the ear, fever and toxicity. The Dx can be confirmed by CT scan.
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Mastoiditis
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What is the first line treatment for mastoiditis?
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Amoxicillin 7-10 days
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What is the second line treatment for mastoiditis?
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Augmentin, quinolones may be used in adults.
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If there is a PCN allergy what drugs can you use to treat mastoiditis?
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Erythromycin, clarithromycin, sulfa, 2nd gen. cephalosporins, bactrim
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If mastoiditis is recurrent what is the tx?
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Tympanostomy with tube.
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80% of vertigo cases are?
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Peripheral
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What are the three most common types of vertigo?
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Benign paroxysmal positional vertigo (BPPV), vestibular neuritis, and Meniere's disease
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In this type of vertigo symptoms are brought on by positional changes or head movements. Canalolithiasis in posterior semicircular canal. It is more common in the elderly.
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Benign Paroxysmal Positional Vertigo
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What triggers BPPV?
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While laying in bed, rolling over will trigger it.
"it started in bed this morning when I woke up" |
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Are otalgia, hearing loss, and tinnitus involved in vertigo?
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No
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Excessive endolymphatic fluid of inner ear
Fluctuant hearing loss, roaring tinnitus, fullness Symptoms temporary but recurrent |
Meniere's Disease
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What does the endolymphatic fluid do in the inner ear?
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Helps to maintain balance
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What age is usually affected by Meniere's Disease?
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any age but usually 20-40
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What is usually the cause for Meniere's if it is happening in a child?
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It is usually due to a congenital inner ear malformation.
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Is meniere's unilateral?
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Yes
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Salt intake has been linked to what disease?
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Meniere's Disease
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What are the clinical features of Meniere's Disease?
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Episodic vertigo (a true spinning sensation that has an onset and an offset)
Sensorineural hearing loss - unilateral Tinnitus - unilateral |
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This is usually a viral disruption of the inner ear. It occurs after viral URI, infection of cochlea and labyrinth. Essentially, non-specific inflammation of labyrinthine system of the inner ear. Still a peripheral cause of vertigo.
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Labyrinthitis
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Trauma/Concussion that may not be from a direct blow. Vertigo, nausea, vomiting and imbalance are maximal at onset. This improves over days to months.
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Labyrinthine concussion
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What are the causes of central vertigo?
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MS, vertebrobasilar insufficiancy, CVA
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This is progressive, causing unilateral hearing loss/tinnitus, eventual damage to other CN and brain stem, leading to irreversible hearing loss.
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Acoustic neuroma (benign tumor of CN VIII)
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What type of nystagmus is concerning?
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Vertical
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What are the physical presentations in Vertigo?
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Eyes - Nystagums
Ear - Hearing acuity Cardiac - Carotid Bruits, arrythmia Neuro - Cerebellar function, CNs Dix-Hallpike for BPPV |
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What are the diagnostic tests used to diagnose causes of vertigo?
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Audiologic testing
ENG ABR CT MRI |
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What does the ENG test measure?
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Dizziness, it is a series of tests that tries to identify central vs. peripheral vertigo.
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What does the ABR test stand for, and test?
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Auditory Brainstem Response- If patient complains of unilateral hearing loss, this measures how fast the brain conduction is with hearing, can help detect neurofibromas as well.
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What is the Tx for BPPV?
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Avoid positional causes, but you can also give Meclizine if pat. is waiting for diagnosis, use only as needed.
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What is the Tx. for Meniere's Disease?
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Low salt diet and diuretics
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What is the Tx. for Labyrinthitis?
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Antivert, benadryl, valium
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What do you do if you find that the vertigo isn't due to anything ENT related?
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Call a neurology consult, or if it is based in cardiology make sure to correct cardiology problem.
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