CMN 568 - UNIT 2 – ALL: QUESTIONS AND ANSWERS
After exposure to toxic fumes, a pt gradually develops cough and dyspnea, he
most likely has: Right Ans - Acute Bronchiolitis
Risk factors for development of bronchiolitis in the adult pt include:
a. exposure to toxic fumes
b. viral infection
c. organ transplant
d. systemic lupus erythematosus
e. all of the above Right Ans - e. all of the above
Connective tissue disease (SLE)
Treatment for a pt with proliferative bronchiolitis includes________________ for
___-___ months, then tapered to 20-40 mg/day Right Ans - Prednisone
1mg/kg/day for 1-3 months
T or F: When narrowing the dif. dx of causes of pna in the
immunocompromised adult, remember - Defects in humoral immunity
predispose to bacterial infections; defects in cellular immunity lead to
infections with viruses, fungi, mycobacteria, and protozoa. Right Ans - True
- Antibiotic therapy in the preceding 90 days.
- Acute care hospitalization for at least 2 days in the preceding 90 days.
- Residence in a nursing home or extended care facility.
- Home infusion therapy, including chemotherapy, within the past 30 days.
- Long-term dialysis within the past 30 days.
- Home wound care.
- Family member with an infection involving a multiple drug-resistant
pathogen.
- Immunosuppressive disease or immunosuppressive therapy. Right Ans -
Risk factors for HCAP
Three factors distinguish nosocomial pneumonia from CAP: Right Ans - (1)
different infectious causes.
(2) different antibiotic susceptibility patterns, specifically, a higher incidence
of drug resistance.
(3) the patients' underlying health status that puts them at risk for more
severe infections.
,Colonization of the ________ and possibly the ________ with bacteria is the most
important step in the pathogenesis of nosocomial pneumonia. Right Ans -
pharynx; stomach
Within ___ hours of admission, ___% of seriously ill hospitalized patients have
their upper airway colonized with organisms from the hospital environment.
Right Ans - 48; 75%
Patients with anaerobic pleuropulmonary infection usually present with
constitutional symptoms such as fever, weight loss, and malaise, dentition is
often poor, however, rarely edentulous; if so, an
________ ________ ________is usually present. Right Ans - obstructing bronchial
lesion
Representative material for culture of anaerobic organisms can be obtained
only by
a. transthoracic aspiration
b. thoracentesis
c. bronchoscopy with a protected brush.
d. all of the above Right Ans - d. all of the above
Expectoration is inappropriate.
This anaerobic pleuropulmonary infection appears as a thick-walled solitary
cavity surrounded by consolidation.
a. Empyema
b. Necrotizing pna
c. Lung abscess
d. A and C Right Ans - c. Lung abscess
T or F: Refer all pts with CXR findings consistent with anaerobic
pleuropulmonary infection for hospital admission, IV abx, and most likely a
chest tube. Right Ans - True
____________ alone is inadequate treatment for anaerobic pleuropulmonary
infections because an increasing number of anaerobic organisms produce B-
lactamases Right Ans - PCN
,Neutropenia and impaired granulocyte function predispose to infections from
S aureus, Aspergillus, gram-negative bacilli, and Candida. Right Ans - ...
Knowledge of the underlying immunologic defect and the time course of
infection provides clues to the etiology of pneumonia in immunocompromised
patients. Right Ans - ...
In the immunocompromised patient a __________ pneumonia is often caused by
bacterial infection, whereas an _________ pneumonia is more apt to be caused
by viral, fungal, protozoal, or mycobacterial infection. Right Ans -
Fulminant; insidious
Pneumonia occurring within 2-4 weeks after organ transplantation is usually
__________, whereas several months or more after transplantation P jiroveci,
__________and _______ are encountered more often. Right Ans - Bacterial;
viruses; fungi
Substances with potential to embolize to the pulmonary circulation Right
Ans - air, amniotic fluid, fat, foreign bodies, parasite eggs (schistosomiasis),
septic emboli, tumor cells, thrombus (most commond)
Risk factors for PE and DVT Right Ans - Venous stasis, injury to the vessel
wall, and hypercoagulability -- VIRCHOW TRIAD
Causes of venous stasis... Right Ans - Immobility, hyperviscosity
(polycythemia), increased CVP (low CO, pregnancy)
Causes of hypercoagulability... Right Ans - Oral contraceptives, HRT,
malignancy/surgery, inherited gene defects (Factor V Leiden)
Massive pulmonary thrombus may cause... Right Ans - Right Ventricular
Failure
T or F: Common S/S of PE are specific to the disorder. Right Ans - False
3 S/S seen in most pts presenting with PE... Right Ans - Dyspnea, CP with
breathing, tachypnea.
, 2 Common ECG changes with PE: Right Ans - ST and nonspecific ST & T
wave changes.
Profound_______ with a normal_____in the absence of preexisting lung disease is
highly suspicious for PE. Right Ans - Hypoxia, CXR
A D-Dimer < __________ provides strong evidence against PE. Right Ans - 500
ng/ml
Initial diagnostic study used for suspected PE: Right Ans - Helical CT
pulmonary angiography
Radiolabeled microaggregated albumin is injected into the venous system,
allowing the particles to embolize to the pulmonary capillary bed. Right
Ans - Perfusion Scan
Patient breathes a radioactive gas or aerosol while the distribution of
radioactivity in the lungs is recorded. Right Ans - Ventilation Scan
___% of pts with PE will have a DVT on eval. Right Ans - 70
Test of choice to detect proximal DVT Right Ans - Venous U/S
On a venous U/S, what is diagnostic of first-episode DVT in symptomatic pts?
Right Ans - Inability to compress the common femoral or popliteal veins.
What is the reference (gold) standard for the diagnosis of DVT? Right Ans -
Contrast Venogram - although venous U/S remains diagnostic procedure of
choice.
What is the reference (gold) standard for the diagnosis of PE? Right Ans -
Pulmonary Angiography
The v/q scan is useful for pts who are not able to udergo CTA, for example...
Right Ans - Pts with renal failure.
If the PE Dichotomous Clinical Probability Assessment score = 4, what is your
next step in the algorithm? Right Ans - Order a Rapid quantitative ELISA D-
dimer
After exposure to toxic fumes, a pt gradually develops cough and dyspnea, he
most likely has: Right Ans - Acute Bronchiolitis
Risk factors for development of bronchiolitis in the adult pt include:
a. exposure to toxic fumes
b. viral infection
c. organ transplant
d. systemic lupus erythematosus
e. all of the above Right Ans - e. all of the above
Connective tissue disease (SLE)
Treatment for a pt with proliferative bronchiolitis includes________________ for
___-___ months, then tapered to 20-40 mg/day Right Ans - Prednisone
1mg/kg/day for 1-3 months
T or F: When narrowing the dif. dx of causes of pna in the
immunocompromised adult, remember - Defects in humoral immunity
predispose to bacterial infections; defects in cellular immunity lead to
infections with viruses, fungi, mycobacteria, and protozoa. Right Ans - True
- Antibiotic therapy in the preceding 90 days.
- Acute care hospitalization for at least 2 days in the preceding 90 days.
- Residence in a nursing home or extended care facility.
- Home infusion therapy, including chemotherapy, within the past 30 days.
- Long-term dialysis within the past 30 days.
- Home wound care.
- Family member with an infection involving a multiple drug-resistant
pathogen.
- Immunosuppressive disease or immunosuppressive therapy. Right Ans -
Risk factors for HCAP
Three factors distinguish nosocomial pneumonia from CAP: Right Ans - (1)
different infectious causes.
(2) different antibiotic susceptibility patterns, specifically, a higher incidence
of drug resistance.
(3) the patients' underlying health status that puts them at risk for more
severe infections.
,Colonization of the ________ and possibly the ________ with bacteria is the most
important step in the pathogenesis of nosocomial pneumonia. Right Ans -
pharynx; stomach
Within ___ hours of admission, ___% of seriously ill hospitalized patients have
their upper airway colonized with organisms from the hospital environment.
Right Ans - 48; 75%
Patients with anaerobic pleuropulmonary infection usually present with
constitutional symptoms such as fever, weight loss, and malaise, dentition is
often poor, however, rarely edentulous; if so, an
________ ________ ________is usually present. Right Ans - obstructing bronchial
lesion
Representative material for culture of anaerobic organisms can be obtained
only by
a. transthoracic aspiration
b. thoracentesis
c. bronchoscopy with a protected brush.
d. all of the above Right Ans - d. all of the above
Expectoration is inappropriate.
This anaerobic pleuropulmonary infection appears as a thick-walled solitary
cavity surrounded by consolidation.
a. Empyema
b. Necrotizing pna
c. Lung abscess
d. A and C Right Ans - c. Lung abscess
T or F: Refer all pts with CXR findings consistent with anaerobic
pleuropulmonary infection for hospital admission, IV abx, and most likely a
chest tube. Right Ans - True
____________ alone is inadequate treatment for anaerobic pleuropulmonary
infections because an increasing number of anaerobic organisms produce B-
lactamases Right Ans - PCN
,Neutropenia and impaired granulocyte function predispose to infections from
S aureus, Aspergillus, gram-negative bacilli, and Candida. Right Ans - ...
Knowledge of the underlying immunologic defect and the time course of
infection provides clues to the etiology of pneumonia in immunocompromised
patients. Right Ans - ...
In the immunocompromised patient a __________ pneumonia is often caused by
bacterial infection, whereas an _________ pneumonia is more apt to be caused
by viral, fungal, protozoal, or mycobacterial infection. Right Ans -
Fulminant; insidious
Pneumonia occurring within 2-4 weeks after organ transplantation is usually
__________, whereas several months or more after transplantation P jiroveci,
__________and _______ are encountered more often. Right Ans - Bacterial;
viruses; fungi
Substances with potential to embolize to the pulmonary circulation Right
Ans - air, amniotic fluid, fat, foreign bodies, parasite eggs (schistosomiasis),
septic emboli, tumor cells, thrombus (most commond)
Risk factors for PE and DVT Right Ans - Venous stasis, injury to the vessel
wall, and hypercoagulability -- VIRCHOW TRIAD
Causes of venous stasis... Right Ans - Immobility, hyperviscosity
(polycythemia), increased CVP (low CO, pregnancy)
Causes of hypercoagulability... Right Ans - Oral contraceptives, HRT,
malignancy/surgery, inherited gene defects (Factor V Leiden)
Massive pulmonary thrombus may cause... Right Ans - Right Ventricular
Failure
T or F: Common S/S of PE are specific to the disorder. Right Ans - False
3 S/S seen in most pts presenting with PE... Right Ans - Dyspnea, CP with
breathing, tachypnea.
, 2 Common ECG changes with PE: Right Ans - ST and nonspecific ST & T
wave changes.
Profound_______ with a normal_____in the absence of preexisting lung disease is
highly suspicious for PE. Right Ans - Hypoxia, CXR
A D-Dimer < __________ provides strong evidence against PE. Right Ans - 500
ng/ml
Initial diagnostic study used for suspected PE: Right Ans - Helical CT
pulmonary angiography
Radiolabeled microaggregated albumin is injected into the venous system,
allowing the particles to embolize to the pulmonary capillary bed. Right
Ans - Perfusion Scan
Patient breathes a radioactive gas or aerosol while the distribution of
radioactivity in the lungs is recorded. Right Ans - Ventilation Scan
___% of pts with PE will have a DVT on eval. Right Ans - 70
Test of choice to detect proximal DVT Right Ans - Venous U/S
On a venous U/S, what is diagnostic of first-episode DVT in symptomatic pts?
Right Ans - Inability to compress the common femoral or popliteal veins.
What is the reference (gold) standard for the diagnosis of DVT? Right Ans -
Contrast Venogram - although venous U/S remains diagnostic procedure of
choice.
What is the reference (gold) standard for the diagnosis of PE? Right Ans -
Pulmonary Angiography
The v/q scan is useful for pts who are not able to udergo CTA, for example...
Right Ans - Pts with renal failure.
If the PE Dichotomous Clinical Probability Assessment score = 4, what is your
next step in the algorithm? Right Ans - Order a Rapid quantitative ELISA D-
dimer
