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106 Cards in this Set
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- Back
- 3rd side (hint)
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A male 68 y/o pt presents to the ER with complaints of fatigue, coughing up reddish sputum and shortness of breath. He reports that he lives alone and the symptoms started 2 days prior. BP 160/86; P110; R40; Sats 82%. What is your diagnosis
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Community aquired pneumonia
HOw would the gram stain appear and what is the bug? |
Gram +
Lancet shapped Diplocicci Streptococcus pneumoniae |
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You have a gram positive lancet shaped diplococci organism growing in a culture. It is catalase negative. What is it most likely?
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Streptococcus pneumonia
What antibiotic would you treat the pt with? |
Beta lactams--Penicillin, 3rd generation cephalosporins
Erythromycin Quinolones |
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Streptococcus pneumoniae treatment
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Beta lactams- Penicillin, 3rd generation cephalosporins
Erythromycin Quinolones |
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A pt presents to the ER. She is rather disheveled and dirty appearing. On taking the history she reveals that she is homeless and that for nearly a week she has had shaking chills, increased fatique and is coughing up what looks like red currant jelly. What is a possible diagnosis.
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Pneumonia
Likely gram stain appearance and ID? |
Gram negative rods
Klebsiella pneumoniae |
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What is the virulence factor for klebsiella pneumoniae?
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Large polysaccharide capsule
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You have a gram positive lancet shaped diplococci organism growing in a culture. It is catalase negative. What is it most likely?
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Streptococcus pneumonia
What antibiotic would you treat the pt with? |
Beta lactams--Penicillin, 3rd generation cephalosporins
Erythromycin Quinolones |
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Streptococcus pneumoniae treatment
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Beta lactams- Penicillin, 3rd generation cephalosporins
Erythromycin Quinolones |
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A pt presents to the ER. She is rather disheveled and dirty appearing. On taking the history she reveals that she is homeless and reports that for nearly a week she has had shaking chills, increased fatique and is coughing up what looks like red currant jelly. What is a possible diagnosis.
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Pneumonia
Likely gram stain appearance and ID? |
Gram negative rods
Klebsiella pneumoniae |
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What is the virulence factor for klebsiella pneumoniae?
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Large polysaccharide capsule
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Youre placing a pt on a ventilator what ratio is used to measure the efficiency of oxygen diffusion between her alveoli and pulmonary ciruclation?
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A-a gradient
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You have pt with cystic fibrosis who has been on a ventilator in the ICU for 3 weeks. When a chest xray is performed there is a cloudy hazziness in the middle of the right lung field. What is the likely general diagnosis?
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Pneumonia
A culture is grown and shows thin gram negative rods that are oxidase positive. What is the likely microbe causing this infection? |
Pseudomonas aeruginosa
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What is the mechanism for cystic fibrosis
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Sodium chloride channel dysfunction
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A heroin addict reports to the ER with SOB, increased fatique, and a productive cough. He reports that he recently had the flu. You have a CXR performed an note a cloudy hazziness in the left lung. What does he most likely have?
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Community Aquired Pneumonia
What is the most likely bacterial cause and how would the gram stain look? |
Staphylococcus aureus
Gram positive, cocci, beta hemolytic, golden pigment on sheep blood agar. |
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Two likely bacterial causes of pneumonia in CF pts?
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Pseudomonas aeruginosa
Staphylococcus aureus |
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You have a pt who has been bed bound in the hospital. She is hypoxemic and you have not been able to wean her from the ventillator. In addition she begins to develop calf pain, swelling and edema. What do you suspect?
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Venous thromboembolism
Pulmonary embolism What do you order to confirm your diagnosis? |
Pulmonary angiogram
D-dimer |
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List three risk factors for venous thromboeboli
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Endothelial injury
Venous stasis Hypercoagulability What are these three things known as? |
Virchows triad
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List 4 conditions that cause aquired hypercoagulability.
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Cancer
Lupus Nephrotic syndrome Heparin induced thrombycytopenia |
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List 3 inherited conditions that can cause hypercoagulability.
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Factor V Leiden
Protein C/S deficiency Antithrombin III deficiency |
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A pt who has been immobilized due to surgery or trauma should be placed on anticoagulation therapy for how long?
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3 months
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A pt who has had a venous thromboemboli or pulmonary emboli with no known cause should be place on anticoagulation therapy for how long?
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3-6 months
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A pt with a history of recurrent VTE, PE, cancer, or a hypercoagulable state should be placed on therapy for how long?
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12 months to life
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A ten year old male with a 2 week history of gradual onset of noproductive cough, fever and headache reports to your office. What is your differential? What test would you use if you thought it might be bacterial in origin?
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Walking Pneumonia caused by either Mycoplasma pneumonia or chlamydia penumonia
Cold agglutinins test--if positive Mycoplasma pneumonia What is the DOC? |
Doxycycline or erythromycin
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A ten year old male with a 2 week history of gradual onset of noproductive cough, fever and headache reports to your office. What is your differential? What tests would you use to determine the bacterial cause?
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Mycoplasma pneumonia and chlamydia pneumponia
Cold agglutinins test--comes up negative Bacteria is able to be isolated with McCoy cell line What is your specific diagnosis and DOC? |
Chlamydia pneumonia- TWAR strain
Tetracycline |
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Viral vs bacterial Pneumonia
Pts appears well |
Viral
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Viral vs bacterial Pneumonia:
Sudden onset |
Bacterial
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Viral vs bacterial Pneumonia:
Gradual onset |
Viral
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Viral vs bacterial Pneumonia:
Productive cough |
Bacterial
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Viral vs bacterial Pneumonia:
Nonproductive cough |
Viral
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Viral vs bacterial Pneumonia:
Blood sputum |
Bacterial
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Viral vs bacterial Pneumonia:
mucoid sputum |
Viral
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Viral vs bacterial Pneumonia:
Nonproductive cough |
viral
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Viral vs bacterial Pneumonia
Temp 103-104 |
Bacterial
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Viral vs bacterial Pneumonia
Temp <103 |
Viral
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Viral vs bacterial Pneumonia
Consolidation |
Frequent with bacterial
Rare with viral |
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Viral vs bacterial Pneumonia
Gram stain- WBCs with + cocci |
bacterial
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Viral vs bacterial Pneumonia
Gram stain with mononuclear cells |
Viral
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Viral vs bacterial Pneumonia
WBC cells greater than 15000/mm3 |
bacterial
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Viral vs bacterial Pneumonia
Chest x ray with nondefined density |
Viral
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List a virus that can pass between mice feces and humans.
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Hantavirus
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A 30 y/o male pt presents at a WV hospital with what is confirmed to be hantavirus that he contracted when he recently traveled to Colorado. His wife his concerned about his health as well as their 2 month old baby contracting the disease. What can you tell her?
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Her husband has a 50% survival rate but the infant is not at risk b/c Hanta virus can not be passed between people.
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At an ER in New Mexico a pt presents with SOB. The pt reports that they felt like they had the flu that morning but the feel much worse now and are having trouble breathing. You order CXR and note pulmonary hemorrahge and pulmonary edema. What might they have?
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Hanta Pulmonary Syndrome
How did they get it? |
From mice feces
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What is the only LRTI that can cause alveolitis?
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Hanta virus
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A pt presents with a mild cough, fever, malaise, stridor, fever, cyanosis, and devleops dyspnea. You have a CXR taken and not a widened mediastinum. What is your differential diagnosis?
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Anthrax
Influenza Acute bacterial mediastinitis Mycoplasma pneumonia Legionaire’s disease What would a gram stain show if it was indeed anthrax? |
Bacillus anthracis has large gram positive rods
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What is the drug of choice for treating Bacillus anthracis
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Ciprofloxin
Doxycycline Penicillin |
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Define silhouette sign (and be able to recognize)
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The boarder of a normally visible structure is obscured by pathology
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Define airbronchogram
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Occurs when blood, pus or fluid fills the alveoli providing a background such that air within bronchi becomes visible
What is this hallmark for? |
Alveolar lung disease
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List antibiotics that are folate synthesis inhibitors.
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Sulfonamides- sulfamethoxazole
Trimethoprim |
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List the antibiotics that inhibit RNA polymerase.
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Rifampin
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Which antibiotics inhibit DNA gyrase?
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Fluoroquinolones- Ciprofloxacin
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Which antibiotics inhibit cell wall synthesis?
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Beta lactams- Penicillins, Carbapenems, Cephalasporins, Monobactams
Bacitracin Vancomycin Fosfomycin |
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Which antibiotics inhibit protein synthesis?
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Tretracyclines- doxycycline
Macrolines- Erythromycin aminoglycosides- Gentamycin |
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Which antibiotic inhibit cell membrane synthesis?
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Polymyxin
Daptomycin |
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Define post antibiotic effect.
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When bacterial growth is inhibited even after antibiotic concentrations have fallen below the MIC
What types of antibiotics are most likely to exhibit a post antibiotic effect? |
Bacterialcidal antibiotics
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The trachea has what type of epithelium?
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Respiratory
Which consists of what cell types? |
Pseudostratified ciliated columnar epithelium
-Ciliated cells -Goblet cells -Small granule cells -Brush cells -Basal cells |
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List the muscles used during normal inspiration.
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Diaphragm
External intercostals Internal intercostals Scalenes |
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Muscles of expiration
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Normal expiration is mainly the result of recoil
With forces expiration -Internal intercostals -Innermost intercostals -Abdominal obliques -Rectus abdominis -Transversus thoracis |
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A pt with COPD might have hypertrophy of which muscles?
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-Scalenes
-Pectorailis major -Pectorailis minor -Seratus anterior -Trapezius -Levator scapulae -Rhomboids |
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If something happens to compromise the chest wall and air is allowed to enter the pleural space what is this called?
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Pneumothorax
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what cells of the alveoli produce surfactant?
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Type II pneumocytes
What else do they produce? |
Type I and II pneumocytes
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What alveolar cells make up the greatest surface area?
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Type I pneumocytes
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What cells of the alveoli make up the majority of the cell population?
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Type II pneumocytes
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List the tissue layers of the trachea.
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Respiratory epithelium
Lamina propria- small glands and elastic tissue Muscularis Cartilage- C shaped hyaline Adventitia |
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List the three most common viral causes of URTI
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Rhinovirus > Coronavirus > Adenoviruses
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List 6 diseases associated with adenovirus
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Common cold
LRTI in children Acute respiratory disease of military recruits Pharygoconjuctival fever- swimming pools Epidemic keratoconjunctivitis Infantile gastroenteritis |
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Define antigenic drift
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Small gradual changes in hemaglutinin or nueramindinase at single antigenic determinants due to point mutations
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Define antigenic shift
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Abrupt change following dual infection. There is a major change in many or all antigenic determinants of hemagglutinin and/or neuraminidase, by:
-intragenomic recombination (crossover) -intergenomic recombination (segment exchange)between human and animal viruses. |
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Define sensitivit.
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Ability to detect positives that are really positives
How is it calculated |
true positives/(true positive + false negative)
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Define specificity
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Ability to detect negatives that are really negative
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true negative/ (true negative + false positive)
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What is the cause of symptoms of runny nose and congestion?
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Histamine- causes dilation of blood vessels and exudate
Prostaglandins- mucous gland secretion What is responsible for the muscle aches and sore throat associated with a cold |
Kinins- stimulation of nerve pain --> sore throat
Cytokines- headache, fever, chills, muscle aches |
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What is the function of the mucociliary transport system?
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-Functions to clear mucous and debris--this prevents infection and protects the LRT
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What antibody predominates in the upper airway?
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sIgA
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What antibody predominates in the lower airway?
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sIgG
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Which immune cell(s) can kill virus-infected respiratory epithelial cells?
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NK
Cytotoxic t cells |
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List some changes in the immune system that occur during aging.
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Immunoscenesance leading to a decrease in the following:
Immune cell activation Response to vaccines Mucociliary clearance Cough reflex Numbers of immune cells Immune cell function |
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List 5 1st generation H1 antagonists.
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Diphenhydramine
Meclizine Chlorpheniramine dimenhydranate Hydroxyzine |
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List 3 2nd generation H1 antagonists
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Loratinidine
Fexofenadine Cetririzine |
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Which generation of H1 antagonists has the longest duration?
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2nd generation
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Which generation of H1 antagonists has the strongest sedation effects?
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1st generation
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Which generation of H1 antagonists has the strongest anti-emetic/antimuscarinic effects?
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1st generation
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What is the most common viral LRT infection?
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Influenza
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What is the most serious sequalae of the flu?
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Bacterial pneumonia
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What is the most common LRT in enwborns/children?
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Respiratory syntial virus
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A 3 year old male pt presents with inspiratory stridor and barking cough. What is your DDx and the cause of each?
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Epiglotitis- haemophillus influenza type B
Laryngotracheobronchitis (croup)- parainfluenza virus, adenovirus, RSV Foreign body airway obstruction What would the first two diagnoses show on Xray? |
Epiglotitis- thumb sign
Croup- steeple sign |
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what is the most common cause of streptococcal pharyngitis?
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Group A beta hemolytic streptococci (streptococcus pyogenes)
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Why is it important to treat strep throat?
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To prevent
Rheumatic fever Glomerulonephritis Give 2 reasons treatment might fail |
Noncompliance
Beta lactamase producing bacterial flora |
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You are inspecting a 5 year old pt that started with a sore throat, and fever but later let to listlessness and swellign of the neck. Upon ausculatation you note a HR of 140 and also that the pt smells almost like garlic. When you examine the throat you see what appears to be a pseudomembrane. What is your diagnosis?
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Corynebacterium diptheriae
What would you see on gram stain? |
Gram positive club shaped bacteria that looks like chinese letters
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A 1 year old child presents with a paroxysmal cough that makes it gasp for air. What is the likely diagnosis/
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Bordetella pertussis
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What lesion of the lung is associated with TB?
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Ghon complex
In immunocompromised pts how is TB spread? |
hematogenous spread through the lymphatics to other organs--known as miliary TB
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Describe the size of a positive PPD?
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10 mm induration after 48 hours
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Describe the rule of 2s for poor control of asthma
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>2 uses of inhaler during the day/week
>2 uses of inhaler at night/month >2 canisters/ year |
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A pt with ashtma is experiencing daytime symptoms less htan or equal to 2 days a week or less than 2 times a month at night. What is the severity? What is the drug protocol?
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Mild intermitent
No daily drug needed |
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Describe the symptom characteristics of mild persistent asthma.
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Daytime symptoms more than 2x per week but not daily
Nighttime symptoms more than 2x per month |
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Describe the daily medication for mild persistent ashtma.
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Low does Inhaled corticosteroid
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Asthmatic with daily symptoms or symptoms more than 1 night a week would be classified as . . .
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Moderate persistant
Daily drug therapy? |
Low to medium dose inhaled corticosteroid and long acting beta 2 agonists
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A pt presents with cough associated with wheezing and fatigue several times a week. He denies fever or chills. The CXR shows hyperinflation and flattened diaphragms. When tested the FEV1/FVC ratio is < 70%. What is your next step?
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Test to see if there is a bronchodilator respnse.
If it is positive what is the condition? |
Asthma
What else could the FEV1/FVC ration have been? Greater than 80% |
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List 3 components of asthma.
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-Chronic inflammation of the airways
Hypersecreton of mucus glands Airway smooth muscle hyperrresonsiveness |
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Define status asthmaticus
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persistent attack despite nebulizer, oxygen and steroid therapy (an attack you cannot break)
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List 6 maintenance meds for asthma?
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Inhaled steroids
Long acting beta agonists Cromolyn Leukotriene modifiers Omalizumab Methylxanhines |
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List three medications that can exacerbate asthma.
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Short acting beta agonists
Anticholinergis Systemic corticosteroids What else should you avoid giving to ashmatics? |
Long acting beta agonists a monotherapy
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List four causes of hypoxemia
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Hypoventilation
Diffusion impairment Shunt V/Q inequality |
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Red hepatization is associated with . . .
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Early bacterial pneumonia
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Hemosiderin lade macrophages is associated with . . .
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Pulmonary congestion
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Curchman's spirals is associated with
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Bronchial asthma
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Ferrunginous bodies is associated with
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Asbestosis exposure
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Charcot-Leyden Crystals is associated with . .
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Bronchial asthma
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Granular PAS positive material is associated with . . .
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Alveolar porteinosis
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