Mac & Cheese
Mycobacterium tuberculosis primarily affects the lungs, but involves other organs ___ % of the time.
Mycobacterium tuberculosis primarily affects the lungs, but involves other organs _33__ % of the time.
Also affect 33% of the world population!
What is the difference between Acute Bronchitis and Chronic Bronchitis?
Acute Bronchitis: “a lower respiratory tract infection involving the large airways (bronchi), without evidence of pneumonia, that occurs in the absence of Chronic Obstructive Pulmonary Disease.”
Chronic Bronchitis: “a subtype of Chronic Obstructive Pulmonary Disease and is defined as a cough that lasts for at least three months in each of two successive years.”
What is the most common cause of a transudative pleural effusion?
What is the difference between an embolism and a thrombus?
BONUS: Name 2 types of emboli.
Thrombus = clot that forms in a vein (stationary)
Embolus = a piece of the clot that moves through the vein (mobile)
BONUS: blood, air, amniotic fluid, fat, parasite eggs, septic emboli, foreign bodies, tumors, right side of heart
What are the three phases of Pertussis?
BONUS: In which phase is the "whooping" cough present?
1) Catarrhal
2) Paroxysmal
3) Convalescent
BONUS: Paroxysmal
What is the scientific names for COVID-19?
COVID-19 = SARS-CoV-2
What are the four possible outcomes a person can have after they acquire TB?
1) Clear the bacteria
2) Immediate onset of dz (Primary Disease)
3) It goes dormant (Latent Disease)
4) It reactivates after a dormant period (Reactivation Disease)
What is the anatomical difference between Acute Bronchitis and Pneumonia?
Acute Bronchitis involves the bronchi.
PNA involved the lung tissue itself (parenchyma)
What are the two most common causes of exudative pleural effusions?
Pneumonia
Cancer
What are the components of Virchow's Triad?
BONUS: Why does this matter?
1) Venous Stasis
2) Endothelial Injury / Vascular Inflammation
3) Hypercoagulability
BONUS: These are the 3 main risk factors for acquiring a venous thromboembolism.
You have a 2 year old patient whom you suspect has Pertussis. His cough has been present for 3 weeks. What is the best way to confirm your diagnosis?
Sputum Cx and PCR
*Cx's sn will have declined at this point, but it is still recommended.
COVID-19 came from which animal?
Bats (& Wet Market)
What is the gold standard diagnostic for Tuberculosis?
BONUS: How many times must you do this?
Sputum Cx
BONUS: 3 consecutive morning sputum samples
A 25 year old female presents to your clinic complaining of wheezing, cough, and dyspnea for 1 week. Vital Signs: BP 110/87 mmHg, RR 22 bpm, HR 105 bpm, Temp 100.5F, SpO2 97% on room air. Which parts of her history would lead to you suspect PNA over Acute Bronchitis? (Hint: there are two)
Tachypnea & Tachycardia
Describe pleuritic chest pain.
Pain in chest when breathing in/out - pleura is irritated by the movement.
What sign is associated with a PE (even though it is rare) and explain what it is.
Homan's Sign:
You elicit calf pain when dorsiflexing the foot.
A 27 year old pregnant woman comes in her for routine pre-natal care. What vaccine should she receive? Any other recommendations you should provide her regarding this vaccine?
Tdap for her and family/close contacts
Histoplasmosis is commonly, and initially, misdiagnosed as which condition?
Community Acquired Pneumonia
Provide 3 risk factors for having complications from Influenza.
BONUS: Provide 2 possible complications.
Risk Factors:
- Asthmatic
- Healthcare facility residents
- 65 yo +
- Morbid obesity
- DM and other comorbid conditions
- Pregnancy
Possible complications:
- Secondary bacterial infxn
- MI
- CVA
- Szs
- Viral myocarditis and encephalitis
- Reye's Syndrome
You diagnose a pt with Acute Bronchitis and they ask you how long the virus lasts. What is your response?
7-21 days
You have a pt w/ a pleural effusion. What does a lateral decubitus CXR view help you distinguish?
If the fluid is free flowing or loculated.
What two criteria should you use to help you rule in/out a PE and in what order should you use them?
Well's Criteria/Score --> PERC
A 67 year old male with prostate cancer presents to the ED and is diagnosed with a Pulmonary Embolism. What is the best treatment to give him?
A. Low Molecular Weight Heparin
B. Rivaroxaban
C. Streptokinase
D. Alteplase
A. Low Molecular Weight Heparin
**Direct oral anti-coags are 1st line unless pt has cancer
Itraconazole is first line treatment for which of the following conditions (could be more than one answer)?
A. Blastomycosis
B. COVID-19
C. Cryptococcosis
D. Histoplasmosis
E. Pertussis
Histoplasmosis & Blastomycosis
Why is the flu so hard to vaccinate against? In other words, why does the vaccine "not always work"?
3 Types: A,B,C
A has subtypes: H1N1, H2N1, etc. (18 H, 11N) and A mutates quickly.
A 45 year old male presents to you clinic with signs and symptoms consistent with Acute Bronchitis. Before prescribing him dextromethorphan, what drug would you want to double check he is not taking?
Bonus: why?
An SSRI
Bonus: SSRI + DM = Serotonin Syndrome
You have a 38 year old male who presents to you clinic with signs and symptoms consistent with pneumonia. His chest x-ray shows a pleural effusion in addition to infiltrates. What type of effusion does he have?
A parapneumonic effusion.
Defn: An exudative effusion that accompanies bacterial PNA.
A 27 year old female presents to your clinic complaining of a cough and left calf soreness and swelling. She reports she just got back from a trip to London. Vital Signs: BP 117/89, HR 103, RR 20, Temp 98.6F, SpO2 98% on room air. Based on this knowledge alone, is she at a low, intermediate or high risk for a PE?
High risk!
Clinical s/sx of DVT = 3
Tachycardia = 1.5
Recent immobilization = 1.5
PE most likely dx = 3
Of the following classes of drugs, which class would make Abby the MOST upset if you give them to a pt with Acute Bronchitis?
Bonus: Why?
A. Antibiotics
B. Bronchodilators
C. Corticosteroids
D. Cough Suppressants
E. Lozenges
A. Antibiotics!
Bonus: > 90% of Acute Bronchitis cases are VIRAL!
According to the CDC, what are the two preferred therapies for COVID-19?
Ritonavir-boosted nirmatrelivir (Paxlovid)
Remdesivir