41 Questions
What is the typical duration of time it takes for anaerobic bacteria to overwhelm host defenses and form a walled off area of infection?
7-14 days
What is the typical radiographic finding in patients with lung abscess?
A fluid-filled space with an air-fluid level amid a pulmonary consolidation
What is the primary mechanism by which anaerobic bacteria enter the lower airway?
Aspiration of anaerobic bacteria from the oropharynx or stomach
What is the typical treatment for lung abscess, and what antibiotic is commonly used?
Treatment with antibiotics, such as ampicillin-sulbactam, is generally curative
What evaluation is recommended for patients at risk of aspiration to prevent recurrent aspiration?
A full speech and swallow evaluation
What is a common risk factor for aspiration, aside from impaired cough or gag reflex?
Advanced age, poor dentition, and esophageal dysmotility
What is the approximate incidence of cardiotoxicity with trastuzumab monotherapy?
5%
How does beta blocker toxicity affect contractile myocytes?
Reduced cAMP levels decrease the release of calcium, which decreases contractility.
What is the primary goal of supplemental oxygen therapy in pregnant patients with asthma?
To maintain SaO≥95%
What is the treatment of choice for refractory bronchoconstriction in acute asthma exacerbations?
Intravenous magnesium sulfate or terbutaline
What is the effect of glucagon on beta blocker toxicity?
It acts by directly increasing cAMP via activation of glucagon receptors, bypassing the blocked adrenergic receptors.
Why is it important to control asthma exacerbations during pregnancy?
Poorly controlled asthma is strongly linked to maternal and fetal mortality, premature birth, and low birth weight.
What is the role of systemic corticosteroids in acute asthma exacerbations?
They are administered especially in patients who have an incomplete response to bronchodilators, high-risk asthma features, or a breakthrough acute exacerbation.
How does anthracycline-associated cardiotoxicity differ from trastuzumab-associated cardiotoxicity?
Anthracycline-associated cardiotoxicity may not be reversible after treatment discontinuation due to myocyte necrosis, destruction, and replacement by fibrous tissue.
What is the result of reduced cAMP levels in pacemaker cells?
Decreased slope of phase 4 depolarization (due to impaired activity of the HCN 'funny' channels).
When is it appropriate to discharge a patient with an acute asthma exacerbation without systemic corticosteroids?
When the patient has an immediate full resolution with acute bronchodilators.
What is the primary goal of implementing modifications to position and diet in patients prone to respiratory issues?
To prevent additional episodes.
When is bronchoscopy with biopsy typically reserved for in lung infections?
When they fail to improve or resolve with initial antibiotic therapy.
In patients with hypertrophic cardiomyopathy, what is the effect of negative chronotropy and negative inotropy on LV blood volume?
Negative chronotropy increases diastolic filling time to increase LV end-diastolic volume, and negative inotropy decreases contractility to cause blood ejection to complete at a higher LV end-systolic volume.
What is the typical presentation of tuberculous pleural effusion in HIV patients?
Fever, cough, pleurisy, and weight loss.
Why is pleural fluid smear usually aseptic in tuberculous pleural effusions?
Because tuberculous pleural effusions are caused by a hypersensitivity reaction to M tuberculosis or its antigens.
Why is antiretroviral therapy (ART) often delayed in HIV patients with tuberculosis?
To reduce the risk of immune reconstitution inflammatory syndrome.
What is the primary indication for trastuzumab use in cancer treatment?
The treatment of patients with HER2-positive tumors.
What is the typical radiographic finding in patients with Pneumocystis pneumonia?
Bilateral, interstitial infiltrates.
What is the initial evaluation method for Pneumocystis pneumonia?
Induced sputum samples; bronchoalveolar lavage is the next step.
What is the mechanism by which trastuzumab-associated cardiotoxicity develops?
Unknown, but it is a known complication of trastuzumab use.
What is the target oxygen saturation level for managing asthma exacerbation during pregnancy?
SaO2 ≥95%
What type of corticosteroids is preferred in managing asthma exacerbation during pregnancy?
Oral corticosteroids (e.g., prednisone)
What is the indication for IVC filter placement in a patient with DVT and contraindication to anticoagulation?
Absolute contraindication to anticoagulation (e.g., intracranial hemorrhage or active major bleeding source)
What is the trade-off of using IVC filters in patients with DVT?
Lowering the incidence of PEs by half, but increasing the risk of recurrent DVT by roughly 2-fold
What is the definition of an acute asthma exacerbation?
Increase in asthma symptoms (e.g., cough, dyspnea, wheezing) combined with a >20% reduction in peak expiratory flow rate
What is the most common trigger for asthma exacerbation?
Viral upper respiratory infection
What is the role of systemic corticosteroids in managing mild asthma exacerbations in the outpatient setting?
To reduce symptoms and prevent future exacerbations requiring hospitalization
What is the recommended dosage and duration of corticosteroid therapy for asthma exacerbation?
Prednisone 40-60 mg daily for 5-10 days
What is the indication for emergency medical care in patients with asthma exacerbation?
Severe symptoms (e.g., hypoxemia, difficulty speaking, use of accessory muscles, reduction in peak expiratory flow >50% from baseline)
What is the benefit of prompt treatment with systemic corticosteroids in patients with asthma exacerbation?
Fewer future exacerbations requiring hospitalization and improved long-term asthma control
What is the target of trastuzumab, and how is it used in cancer treatment?
Trastuzumab targets human epidermal growth factor receptor 2 (HER2) and is used in addition to adjuvant chemotherapy for the treatment of patients with HER2-positive tumors.
How does the incidence of cardiotoxicity differ between trastuzumab monotherapy and trastuzumab combined with anthracycline and cyclophosphamide?
The incidence of cardiotoxicity is approximately 5% with trastuzumab monotherapy, but it is 25% with trastuzumab combined with anthracycline and cyclophosphamide.
Why is trastuzumab-associated cardiotoxicity generally reversible, whereas chronic anthracycline-associated cardiotoxicity may not be reversible?
Trastuzumab-associated cardiotoxicity is reversible because it does not involve myocyte necrosis, destruction, and replacement by fibrous tissue, whereas chronic anthracycline-associated cardiotoxicity may not be reversible due to these changes.
Is trastuzumab-associated cardiotoxicity dose-related, and how does it compare to anthracycline-associated cardiotoxicity in this regard?
Trastuzumab-associated cardiotoxicity is not dose-related, in contrast to anthracycline-associated cardiotoxicity, which is strongly related to cumulative doses.
What is the typical outcome of left ventricular ejection fraction (LVEF) decline caused by trastuzumab, and how does it differ from the outcome of anthracycline-associated cardiotoxicity?
Trastuzumab-associated decline in LVEF is usually asymptomatic and may occasionally lead to overt clinical heart failure, but in most patients, there is complete recovery of cardiac function after treatment discontinuation. In contrast, chronic anthracycline-associated cardiotoxicity may not be reversible after treatment discontinuation.
A patient presents with worsening cough and fever, and radiographic findings suggest lung abscess. What is the likely cause of this condition? Identify the anaerobic bacteria involved and the host defense mechanism triggered. Test your knowledge of respiratory infections and diagnosis.
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