CMN 568 - UNIT 2 – ALL Questions With Complete Solutions(Guaranteed Success)

CMN 568 - UNIT 2 – ALL Questions With Complete Solutions(Guaranteed Success) After exposure to toxic fumes, a pt gradually develops cough and dyspnea, he most likely has: - correct answer...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 - correct answer...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 - correct answer...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. - correct answer...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. - correct answer...Risk factors for HCAP Three factors distinguish nosocomial pneumonia from CAP: - correct answer...(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. - correct answer...pharynx; stomach Within ___ hours of admission, ___% of seriously ill hospitalized patients have their upper airway colonized with organisms from the hospital environment. - correct answer...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. - correct answer...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 - correct answer...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 - correct answer...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. - correct answer...True ____________ alone is inadequate treatment for anaerobic pleuropulmonary infections because an increasing number of anaerobic organisms produce B-lactamases - correct answer...PCN Neutropenia and impaired granulocyte function predispose to infections from S aureus, Aspergillus, gram-negative bacilli, and Candida. - correct answer...... Knowledge of the underlying immunologic defect and the time course of infection provides clues to the etiology of pneumonia in immunocompromised patients. - correct answer...... 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. - correct answer...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. - correct answer...Bacterial; viruses; fungi Substances with potential to embolize to the pulmonary circulation - correct answer...air, amniotic fluid, fat, foreign bodies, parasite eggs (schistosomiasis), septic emboli, tumor cells, thrombus (most commond) Risk factors for PE and DVT - correct answer...Venous stasis, injury to the vessel wall, and hypercoagulability -- VIRCHOW TRIAD Causes of venous stasis... - correct answer...Immobility, hyperviscosity (polycythemia), increased CVP (low CO, pregnancy) Causes of hypercoagulability... - correct answer...Oral contraceptives, HRT, malignancy/surgery, inherited gene defects (Factor V Leiden) Massive pulmonary thrombus may cause... - correct answer...Right Ventricular Failure T or F: Common S/S of PE are specific to the disorder. - correct answer...False 3 S/S seen in most pts presenting with PE... - correct answer...Dyspnea, CP with breathing, tachypnea. 2 Common ECG changes with PE: - correct answer...ST and nonspecific ST & T wave changes. Profound_______ with a normal_____in the absence of preexisting lung disease is highly suspicious for PE. - correct answer...Hypoxia, CXR A D-Dimer < __________ provides strong evidence against PE. - correct answer...500 ng/ml Initial diagnostic study used for suspected PE: - correct answer...Helical CT pulmonary angiography Radiolabeled microaggregated albumin is injected into the venous system, allowing the particles to embolize to the pulmonary capillary bed. - correct answer...Perfusion Scan Patient breathes a radioactive gas or aerosol while the distribution of radioactivity in the lungs is recorded. - correct answer...Ventilation Scan ___% of pts with PE will have a DVT on eval. - correct answer...70 Test of choice to detect proximal DVT - correct answer...Venous U/S On a venous U/S, what is diagnostic of first-episode DVT in symptomatic pts? - correct answer...Inability to compress the common femoral or popliteal veins. What is the reference (gold) standard for the diagnosis of DVT? - correct answer...Contrast Venogram - although venous U/S remains diagnostic procedure of choice. What is the reference (gold) standard for the diagnosis of PE? - correct answer...Pulmonary Angiography The v/q scan is useful for pts who are not able to udergo CTA, for example... - correct answer...Pts with renal failure. If the PE Dichotomous Clinical Probability Assessment score = 4, what is your next step in the algorithm? - correct answer...Order a Rapid quantitative ELISA D-dimer If the D-dimer comes back positive, what is your next step in the PE algorithm? - correct answer...Order helical CT-PA If the CT-PA is unable to confirm nor exclude a PE, what is your next step in the PE algorithm? - correct answer...Order LE U/S or PA T or F: Anticoagulation is a definitive form of therapy for VTE. - correct answer...False - It is a form of secondary prevention. In young, otherwise healthy individuals,___________is usually caused by viral respiratory infections or pneumonia. - correct answer...Pleuritis Treatment of pleuritis consists of treating the underlying disease and what for pain relief and to control cough associated with pleuritic CP if retention of airway secretions is not a likely problem? - correct answer...Indomethacin, 25 mg po 2-3 times/day Codeine, 30-60 mg po q 8 hours. Atypical presentation or failure of an effusion to resolve as expected warrants _____________. - correct answer...Thoracentesis ____________atelectasis may cause bronchial breath sounds and egophony just above the effusion. - correct answer...Compressive