CMN 568 - UNIT 2 - study guide questions
and answers
After exposure to toxic fumes, a pt gradually develops cough and dyspnea, he most likely has: -
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 - 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 - 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. - 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. - ANS Risk factors for HCAP
Three factors distinguish nosocomial pneumonia from CAP: - 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. - ANS pharynx; stomach
Within ___ hours of admission, ___% of seriously ill hospitalized patients have their upper
airway colonized with organisms from the hospital environment. - 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. - 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 - 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 - 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. - ANS True
____________ alone is inadequate treatment for anaerobic pleuropulmonary infections because
an increasing number of anaerobic organisms produce B-lactamases - ANS PCN
Neutropenia and impaired granulocyte function predispose to infections from S aureus,
Aspergillus, gram-negative bacilli, and Candida. - ANS ...
Knowledge of the underlying immunologic defect and the time course of infection provides clues
to the etiology of pneumonia in immunocompromised patients. - 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. - 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. - ANS Bacterial; viruses; fungi
Substances with potential to embolize to the pulmonary circulation - ANS air, amniotic fluid,
fat, foreign bodies, parasite eggs (schistosomiasis), septic emboli, tumor cells, thrombus (most
commond)
, Risk factors for PE and DVT - ANS Venous stasis, injury to the vessel wall, and
hypercoagulability -- VIRCHOW TRIAD
Causes of venous stasis... - ANS Immobility, hyperviscosity (polycythemia), increased CVP
(low CO, pregnancy)
Causes of hypercoagulability... - ANS Oral contraceptives, HRT, malignancy/surgery,
inherited gene defects (Factor V Leiden)
Massive pulmonary thrombus may cause... - ANS Right Ventricular Failure
T or F: Common S/S of PE are specific to the disorder. - ANS False
3 S/S seen in most pts presenting with PE... - ANS Dyspnea, CP with breathing, tachypnea.
2 Common ECG changes with PE: - ANS ST and nonspecific ST & T wave changes.
Profound_______ with a normal_____in the absence of preexisting lung disease is highly
suspicious for PE. - ANS Hypoxia, CXR
A D-Dimer < __________ provides strong evidence against PE. - ANS 500 ng/ml
Initial diagnostic study used for suspected PE: - ANS Helical CT pulmonary angiography
Radiolabeled microaggregated albumin is injected into the venous system, allowing the particles
to embolize to the pulmonary capillary bed. - ANS Perfusion Scan
Patient breathes a radioactive gas or aerosol while the distribution of radioactivity in the lungs is
recorded. - ANS Ventilation Scan
___% of pts with PE will have a DVT on eval. - ANS 70
Test of choice to detect proximal DVT - ANS Venous U/S
On a venous U/S, what is diagnostic of first-episode DVT in symptomatic pts? - ANS
Inability to compress the common femoral or popliteal veins.
What is the reference (gold) standard for the diagnosis of DVT? - ANS Contrast Venogram -
although venous U/S remains diagnostic procedure of choice.
What is the reference (gold) standard for the diagnosis of PE? - ANS Pulmonary
Angiography
and answers
After exposure to toxic fumes, a pt gradually develops cough and dyspnea, he most likely has: -
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 - 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 - 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. - 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. - ANS Risk factors for HCAP
Three factors distinguish nosocomial pneumonia from CAP: - 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. - ANS pharynx; stomach
Within ___ hours of admission, ___% of seriously ill hospitalized patients have their upper
airway colonized with organisms from the hospital environment. - 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. - 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 - 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 - 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. - ANS True
____________ alone is inadequate treatment for anaerobic pleuropulmonary infections because
an increasing number of anaerobic organisms produce B-lactamases - ANS PCN
Neutropenia and impaired granulocyte function predispose to infections from S aureus,
Aspergillus, gram-negative bacilli, and Candida. - ANS ...
Knowledge of the underlying immunologic defect and the time course of infection provides clues
to the etiology of pneumonia in immunocompromised patients. - 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. - 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. - ANS Bacterial; viruses; fungi
Substances with potential to embolize to the pulmonary circulation - ANS air, amniotic fluid,
fat, foreign bodies, parasite eggs (schistosomiasis), septic emboli, tumor cells, thrombus (most
commond)
, Risk factors for PE and DVT - ANS Venous stasis, injury to the vessel wall, and
hypercoagulability -- VIRCHOW TRIAD
Causes of venous stasis... - ANS Immobility, hyperviscosity (polycythemia), increased CVP
(low CO, pregnancy)
Causes of hypercoagulability... - ANS Oral contraceptives, HRT, malignancy/surgery,
inherited gene defects (Factor V Leiden)
Massive pulmonary thrombus may cause... - ANS Right Ventricular Failure
T or F: Common S/S of PE are specific to the disorder. - ANS False
3 S/S seen in most pts presenting with PE... - ANS Dyspnea, CP with breathing, tachypnea.
2 Common ECG changes with PE: - ANS ST and nonspecific ST & T wave changes.
Profound_______ with a normal_____in the absence of preexisting lung disease is highly
suspicious for PE. - ANS Hypoxia, CXR
A D-Dimer < __________ provides strong evidence against PE. - ANS 500 ng/ml
Initial diagnostic study used for suspected PE: - ANS Helical CT pulmonary angiography
Radiolabeled microaggregated albumin is injected into the venous system, allowing the particles
to embolize to the pulmonary capillary bed. - ANS Perfusion Scan
Patient breathes a radioactive gas or aerosol while the distribution of radioactivity in the lungs is
recorded. - ANS Ventilation Scan
___% of pts with PE will have a DVT on eval. - ANS 70
Test of choice to detect proximal DVT - ANS Venous U/S
On a venous U/S, what is diagnostic of first-episode DVT in symptomatic pts? - ANS
Inability to compress the common femoral or popliteal veins.
What is the reference (gold) standard for the diagnosis of DVT? - ANS Contrast Venogram -
although venous U/S remains diagnostic procedure of choice.
What is the reference (gold) standard for the diagnosis of PE? - ANS Pulmonary
Angiography
