Pulmonary Abscess and Aspiration Pneumonia Quiz
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Questions and Answers

What is the recommended treatment for a pulmonary abscess caused by anaerobes?

  • Amoxicillin
  • Ciprofloxacin
  • Vancomycin
  • Clindamycin (correct)

Which descriptor is commonly associated with aspiration pneumonia due to anaerobes?

  • Chalky white sputum
  • Clear sputum
  • Green sputum
  • Foul-smelling sputum (correct)

What is a possible risk factor for aspiration leading to pneumonia?

  • Adequate gag reflex
  • High physical activity
  • Regular dental check-ups
  • Hypodontia (correct)

What appearance might a pulmonary abscess have on a chest X-ray?

<p>Air-fluid level (B)</p> Signup and view all the answers

Which organism is indicative of oropharyngeal normal flora in cases of aspiration?

<p>Bacteroides (C)</p> Signup and view all the answers

Which condition is characterized by sensitivity to Aspergillus skin antigen and presents with asthma-like symptoms?

<p>Acute bronchopulmonary aspergillosis (A)</p> Signup and view all the answers

What happens if a patient treated for a pulmonary abscess continues to have a lesion visible on chest X-ray after a year?

<p>Failure of maintenance of basement membranes (C)</p> Signup and view all the answers

Which of the following is NOT a common risk factor for aspiration pneumonia?

<p>Regular exercise (D)</p> Signup and view all the answers

What condition is indicated by severe ear pain in a 2-year-old following a viral infection, with dried blood and seropurulent fluid observed?

<p>Tympanic membrane perforation (A)</p> Signup and view all the answers

What is the typical cause of bullous myringitis?

<p>Streptococcus pneumoniae (A)</p> Signup and view all the answers

Which imaging technique is required for diagnosing mastoiditis?

<p>CT scan (A)</p> Signup and view all the answers

What is a common presenting symptom of otitis externa in diabetic patients?

<p>Painful ear pinna displacement (D)</p> Signup and view all the answers

What is the primary mechanism behind dyspnea in patients with pulmonary edema due to left heart failure?

<p>Increased alveolar-arteriolar oxygen gradient (D)</p> Signup and view all the answers

What type of preventive treatment might be recommended for a college student with frequent water exposure?

<p>Acetic acid-alcohol drops (C)</p> Signup and view all the answers

In the context of pulmonary edema, what does 'cephalization of pulmonary vessels' indicate?

<p>Increased pulmonary venous pressure (A)</p> Signup and view all the answers

Which condition is most closely associated with the development of ARDS in patients following a near-drowning incident?

<p>Aspiration of freshwater (B)</p> Signup and view all the answers

What does a lingering fever after an upper respiratory tract infection indicate?

<p>Sinusitis (C)</p> Signup and view all the answers

What bacterial infection is most commonly associated with necrotizing otitis externa?

<p>Pseudomonas aeruginosa (C)</p> Signup and view all the answers

What condition can lead to bilateral exudative chest infiltrates and decreased oxygen saturation?

<p>Toxic shock syndrome (C)</p> Signup and view all the answers

In a patient presenting with ARDS, what is the PaO2/FiO2 ratio that indicates acute respiratory distress?

<p>Between 100 and 200 mm (B)</p> Signup and view all the answers

What does a diagnosis of myringitis refer to?

<p>Isolated inflammation of the tympanic membrane (C)</p> Signup and view all the answers

What is the main cause of pulmonary edema characterized as transudation of fluid into alveolar spaces?

<p>Elevated pulmonary capillary hydrostatic pressure (C)</p> Signup and view all the answers

Which of the following is NOT a common cause of ARDS?

<p>Pulmonary embolism (A)</p> Signup and view all the answers

Which statement accurately describes pulmonary capillary wedge pressure (PCWP) in left heart failure?

<p>PCWP is elevated in left heart failure. (A)</p> Signup and view all the answers

What is the recommended treatment for sinusitis?

<p>Amoxicillin/clavulanate (Augmentin) (B)</p> Signup and view all the answers

Which two viral proteins are featured in the structure of the influenza virus?

<p>Hemagglutinin and neuraminidase (B)</p> Signup and view all the answers

What effect does neuraminidase have on newly synthesized viral particles?

<p>It cleaves sialic acid residues so viral particles can exit the host cell (A)</p> Signup and view all the answers

In which condition is a CT scan typically performed?

<p>Chronic sinusitis lasting more than 12 weeks (B)</p> Signup and view all the answers

What feature characterizes antigenic drift in influenza viruses?

<p>Point mutations in hemagglutinin and/or neuraminidase (B)</p> Signup and view all the answers

What do oseltamivir and zanamivir do in the context of influenza treatment?

<p>Act as neuraminidase competitive inhibitors (D)</p> Signup and view all the answers

Which of the following is NOT a typical symptom of sinusitis?

<p>Sore throat (B)</p> Signup and view all the answers

What symptom is particularly noted as a key finding suggesting the flu?

<p>Myalgias (C)</p> Signup and view all the answers

What is responsible for antigenic shift in influenza viruses?

<p>Coinfection of two different influenza viruses (B)</p> Signup and view all the answers

Which organism is a likely cause of pneumonia in a patient recovering from influenza?

<p>Staphylococcus aureus (C)</p> Signup and view all the answers

What is the primary age recommendation for the intranasal live-attenuated influenza vaccine?

<p>2 years to 45 years (B)</p> Signup and view all the answers

The spike proteins of SARS-CoV-2 primarily bind to which receptor in human cells?

<p>ACE2 receptor (C)</p> Signup and view all the answers

Which of the following best describes the potential presentation of COVID-19?

<p>Symptom range from mild cold-like symptoms to severe disease (C)</p> Signup and view all the answers

What was the suggested origin of SARS-CoV-2 before laboratory theories emerged?

<p>Natural zoonotic origin from animals (D)</p> Signup and view all the answers

Which type of vaccine delivers mRNA coding for the spike protein of SARS-CoV-2?

<p>mRNA vaccine (D)</p> Signup and view all the answers

What is the general recommendation for the timing of the killed influenza vaccine?

<p>Yearly in the fall or winter (D)</p> Signup and view all the answers

What adverse effects have been linked to both live viral infection and vaccination?

<p>Bell's palsy and myocarditis (C)</p> Signup and view all the answers

What is the recommended vaccination schedule for children starting at 6 months of age?

<p>PCV15 at 2, 4, 6 months, then again at 12-15 months (A)</p> Signup and view all the answers

Which high-risk groups require an extra dose of PCV15 followed by PPSV23?

<p>Patients with chronic renal failure and immunosuppressed individuals (C)</p> Signup and view all the answers

What is a characteristic presentation of Tracheoesophageal fistula (TEF) in neonates?

<p>Coughing up milk during initial feeding (D)</p> Signup and view all the answers

At what age does the IM killed influenza vaccine start being administered?

<p>At 6 months (C)</p> Signup and view all the answers

Which of the following statements about the coronavirus vaccination schedule is correct?

<p>Starting at 6 months with 2-3 doses recommended (C)</p> Signup and view all the answers

What is the highest yield for diagnosing Tracheoesophageal fistula?

<p>Insertion of a nasogastric tube (D)</p> Signup and view all the answers

Which of the following is NOT true about vaccination mandates?

<p>They have resulted in unanimous support. (D)</p> Signup and view all the answers

Flashcards

Pulmonary Edema from Left Heart Failure

Fluid buildup in the alveoli due to increased pulmonary capillary hydrostatic pressure caused by left heart failure. This is a common cause of dyspnea on the USMLE.

Cephalization of Pulmonary Vessels

The phenomenon where the pulmonary vessels appear larger at the apex of the lungs due to fluid buildup. This is a sign of pulmonary edema.

Acute Respiratory Distress Syndrome (ARDS)

A life-threatening condition causing widespread inflammation and fluid leakage into the alveoli which impairs gas exchange. It typically arises due to sepsis, trauma, or aspiration.

Increased Alveolar-Arteriolar Oxygen Gradient in Pulmonary Edema

In a patient with pulmonary edema, the oxygen level in the alveoli remains normal, but the oxygen level in the blood is low due to impaired gas exchange. This leads to an increased oxygen gradient between the alveoli and the blood.

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Pulmonary Decompensation in Pancreatitis

A common complication of pancreatitis leading to respiratory distress due to fluid buildup in the alveoli.

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Non-Cardiac Pulmonary Edema

A type of pulmonary edema not caused by left heart failure. This can occur due to conditions like ARDS or TRALI. Important to consider, but less common on the USMLE compared to left heart failure.

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PaO2/FiO2 Ratio

The ratio of arterial oxygen partial pressure (PaO2) to the fraction of inspired oxygen (FiO2) used to assess the severity of ARDS.

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PPD Test

A skin test used to detect latent tuberculosis infection. A positive test requires further evaluation, and it is never repeated.

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Hot Tub Lung

A lung infection caused by inhaling Mycobacterium avium complex (MAC) bacteria, often associated with hot tub use.

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Pulmonary Abscess

A lung infection caused by aspiration of oropharyngeal anaerobes, often seen in patients with risk factors like alcoholism, dementia, stroke, or missing teeth.

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Aspiration Pneumonia

A lung infection caused by the aspiration of normal oropharyngeal flora, often seen in patients with risk factors like alcoholism, dementia, stroke, or missing teeth.

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Acute Bronchopulmonary Aspergillosis (ABPA)

An asthma-like presentation in a patient with sensitivity to Aspergillus skin antigen, often seen in farmers.

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Tympanic membrane perforation

A rupture in the eardrum, often caused by pressure changes or infection. It often presents with ear pain, blood drainage, and difficulty hearing.

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Mastoiditis

Inflammation of the mastoid bone, typically caused by untreated otitis media. It presents with ear pain, swelling behind the ear, and possible fever.

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Myringitis

Inflammation of the tympanic membrane, often characterized by small fluid-filled blisters. It can be caused by viruses or bacteria.

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Otitis externa

Infection of the external ear canal, often caused by bacteria like Pseudomonas. It presents with pain, itching, and discharge.

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Sinusitis

An inflammation of the sinuses, often caused by a viral infection or allergies. It can present with headache, facial pressure, and congestion.

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IgA deficiency

A type of immune deficiency characterized by recurrent sinopulmonary infections. Patients often experience frequent pneumonias and may present with a sore cheek, indicating sinus involvement.

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Influenza

A common viral infection characterized by respiratory distress, fever, and muscle pain (myalgias). It can be differentiated from other diagnoses based on the presence of myalgias, often a key finding on the USMLE.

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What does hemagglutinin do?

The viral protein that mediates influenza's attachment to host cells by binding to sialic acid receptors.

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What does neuraminidase do?

The viral protein that enables the release of newly synthesized viral particles from the host cell by cleaving sialic acid residues.

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Antigenic drift

Small, gradual changes in the hemagglutinin and/or neuraminidase proteins of influenza virus. This leads to seasonal epidemics due to the virus’s ability to evade the immune system.

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How do drugs like oseltamivir work?

Antiviral drugs like oseltamivir (Tamiflu) and zanamivir (Relenza) are sialic acid analogs that act as neuraminidase inhibitors. Therefore, they prevent new viral progeny from leaving the cell.

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Typical antibiotic treatment for sinusitis

A type of antibiotic often used to treat sinusitis. Unlike otitis media and strep pharyngitis, sinusitis usually requires an antibiotic that includes a beta-lactamase inhibitor (clavulanate).

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Bell's palsy

A rare complication of both live viral infections and vaccinations, characterized by facial paralysis, usually temporary.

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Myocarditis

A rare complication of both live viral infections and vaccinations, characterized by inflammation of the heart muscle, usually temporary.

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Tracheoesophageal fistula (TEF)

The condition where the upper esophagus ends as a closed pouch and the lower esophagus connects to the trachea, leading to milk regurgitation and coughing in newborns.

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How do you diagnose TEF?

A diagnosis of TEF is made via the inability to insert a nasogastric tube fully

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Staphylococcus aureus (S. aureus)

A bacterium commonly associated with bacterial pneumonia following recent influenza infection. It is a gram-positive coccus that appears in clusters.

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Inactivated Influenza Vaccine (IM)

A vaccine against influenza that uses inactivated (killed) virus particles. It is recommended for individuals 6 months of age and older, and should be given yearly in the fall or winter. It is safe to administer to pregnant women.

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Intranasal Live-Attenuated Influenza Vaccine

A vaccine against influenza that uses a weakened, live-attenuated virus. It is recommended for individuals 2-45 years old who are immunocompetent and not pregnant.

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Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)

The virus responsible for the 2019 global pandemic. It belongs to the coronavirus family.

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Coronavirus

A family of viruses that includes SARS-CoV-2. They are characterized by their characteristic spike proteins, which give them a crown-like appearance on electron microscopy.

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Angiotensin-Converting Enzyme 2 (ACE2)

A receptor found on human cells that SARS-CoV-2 binds to. This allows the virus to enter and infect respiratory epithelial cells.

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Respiratory Symptoms in COVID-19

A common symptom of COVID-19 that ranges from mild respiratory symptoms similar to the common cold to severe respiratory disease with multi-organ failure.

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Study Notes

Pulmonary Edema

  • Pulmonary edema is fluid buildup in the alveoli, often due to left heart failure.
  • Non-cardiac causes include ARDS, TRALI, and increased pulmonary capillary hydrostatic pressure.
  • Symptoms include shortness of breath, bilateral crackles, and low oxygen saturation.
  • Diagnosis is often aided by chest X-rays or CT scans
  • Acute respiratory distress syndrome (ARDS) is likely if the PaO2/FiO2 ratio is below 300.
  • This is a significant indicator for unilateral conditions.
  • Bilateral chest infiltrates can occur from several causes, including pancreatitis, aspiration, toxic shock syndrome, near-drowning, and trauma.
  • TRALI (Transfusion-Associated Lung Injury) presents within 6 hours of transfusion.
  • Mechanism is abnormal neutrophil priming in response to cytokines in the blood products.
  • TACO (Transfusion-Associated Circulatory Overload) occurs more than 6 hours post-transfusion.
  • This is a type of cardiogenic pulmonary edema, where the left heart struggles with the increased volume and transudation into the alveoli.

Pneumonia

  • Lobar pneumonia, commonly associated with Streptococcus pneumoniae, often presents with a right lower lobe consolidation, and dullness to percussion.
  • Bilateral interstitial pneumonia, particularly in immunocompetent patients, is often associated with Mycoplasma.
  • Pneumocystis jirovecii pneumonia (PJP) is a specific concern in HIV/AIDS patients with bilateral interstitial/ground glass pneumonia.
  • Identifying the specific organism requires careful consideration of patient history and clinical presentation.
  • Bacterial pneumonia following influenza is often caused by Staphylococcus aureus.
  • Patient presenting with pneumonia and hyponatremia/diarrhea can likely be infected by Legionella.
  • If a patient has pneumonia in conjunction with recent air-conditioning exposure, consider Legionella as a possible cause.
  • Pneumonia in infants, newborns, and young children has different etiologies and should be diagnosed with the appropriate pathogen in mind.

Bronchiolitis, Bronchitis, and Croup

  • Bronchiolitis, frequently found in infants under 18 months, is often caused by respiratory syncytial virus (RSV).
  • Laryngotracheal bronchitis (croup), presenting in older children, is typically characterized by a hoarse, barking cough, and a steeple-sign on X-rays.
  • Treatment is generally supportive and not pharmacological unless life-threatening.

Epiglottitis, Bacterial Tracheitis, and Pertussis

  • Epiglottitis, a relatively rare illness, is a serious infection that obstructs the airway.
  • Bacterial tracheitis is characterized by a viral URTI followed by stridor, unlike epiglottitis by the ability to open the mouth.
  • Pertussis, whooping cough, is characterized by a succession of coughs followed by an inspiratory stridor. Hygeglycemia or postoperative emesis is a prominent indicator.

Pleurodynia

  • Pleurodynia is a viral infection exhibiting sharp or lateral chest pain attributed to intercostal muscle spasms.

Pulmonary Abscess

  • Pulmonary abscess is frequently caused by a foreign material/aspiration of oropharyngeal bacteria.
  • The presence of "foul-smelling sputum" is typical in abscesses and points to aspiration of anaerobic bacteria (Bacteroides).

Acute Bronchopulmonary Aspergillosis (ABPA)

  • This condition is identified by an Asthma-like presentation coupled with fever and hypersensitivity to aspergillus.

Cryptogenic Organizing Pneumonia (COP)

  • A condition that presents like pneumonia.
  • A restrictive lung disorder that does not respond to antibiotics.

Otitis Media (OM)

  • OM is an inflammation of the middle ear and commonly caused by streptococcus pneumoniae).
  • Serous OM is characterized by fluid behind the tympanic membrane.
  • Tympanic membrane perforations are usually followed by otalgia.

Sinusitis

  • Sinusitis is indicated by lingering URTIs lasting beyond 10 days.
  • It is often caused by Streptococcus pneumoniae or other bacteria that cause upper respiratory infection complications.
  • A CT scan with or without nasal endoscopy is useful if the condition has prolonged symptoms (more than 12 weeks).

Tuberculosis

  • Tuberculosis (TB) is a bacterial infection that primarily affects the lungs.
  • Key symptoms include fever, night sweats, weight loss, and hemoptysis.
  • Diagnosis starts with a PPD skin test.
  • If PPD is positive, chest x-ray proceeds, followed by treatment based on the test results.

Hot Tub Lung

  • Hot tub lung is an infection associated with breathing in fumes, such as Mycobacterium avium complex (MAC).

Other Diseases

  • Specific information on other diseases (e.g., Coronavirus, Influenza) wasn't included in this portion, so more info is needed.
  • Discussions on pediatric topics (e.g., tracheoesophageal fistula, choanal atresia) are related to their respective categories.

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Description

Test your knowledge on pulmonary abscesses, aspiration pneumonia, and related conditions. This quiz covers treatment recommendations, risk factors, and diagnostic imaging associated with these medical conditions. Perfect for students and professionals in the medical field.

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