21: PNA, Bronchitis, Tb, Respiratory Viruses

Question 1

three things that point towards bacterial bronchitis vs viral

Answer 1

1. higher fever
2. change in sputum color
3. procalcitonin biomarker

Question 2

cardinal symptom in viral and bacterial bronchitis

Answer 2

cough

Question 3

when to get a CXR with a URI

Answer 3

1. r/o PNA
2. rales
3. signs of pleural inflammation
4. previous pulmonary dz
5. hemoptysis
6. immunocompromised pt
7. severely ill - high fever, low O2, confusion, etc.

Question 4

only test pts for influenza if they are at high risk for complications - this includes which groups?

Answer 4

1. pregnant pts
2. kids <5
3. adults 65+
4. pts with neurologic disorders
5. pts with lung or heart disease
6. pts with blood disorders, DM, CKD
7. immunocompromised pts
8. BM >40

Question 5

3 neuraminidase inhibitors for the flu

Answer 5

oseltamivir, baloxavir, zanamivir

Question 6

HAP

Answer 6

PNA 48+ hrs after admission to hospital

Question 7

VAP

Answer 7

ventilator-acquired PNA - 48hrs+ after ET intubation

Question 8

empyema

Answer 8

collection of pus in pleural cavity

Question 9

cavitation

Answer 9

normal lung tissue replaced by a cavity

Question 10

5 RFs for multidrug resistant infection

Answer 10

1. Abx in last 90 days
2. septic shock
3. ARDS preceding VAP
4. 5+ days inpatient before HAP/VAP
5. Tx where 10%+ gram neg isolates are resistant or unknown rates

Question 11

5 RFs for MRSA

Answer 11

1. Abx in last 90 days
2. renal replacement therapy in last 30 days
3. GERD meds
4. Hx MRSA in last 90 days
5. hospitalization in unit with MRSA rates are 20%+ or unknown

Question 12

four RFs for pseudomonas

Answer 12

1. Abx in last 90 days
2. structural lung disease (COPD, CF)
3. recent hospitalization
4. gram stain of respiratory secretions shows predominantly gram negative bacilli

Question 13

CURB-65: whats it mean to have certain scores?

Answer 13

0-1: tx at home
1-2: favor admission
3: admission
4-5: favor ICU admission

Question 14

three vaccines that prevent PNA

Answer 14

1. influenza
2. pneumococcal conjugate or polysaccharide
3. haemophilus influenza B (Hib)

Question 15

how many doses does a pt need of the pneumococcal conjugate vs pneumococcal polysaccharide

Answer 15

1. conjugate: 1 dose

2. polysaccharide: 1-2 depending on indication

Question 16

Tb differential Dx

Answer 16

1. Other fungal infection
2. Sarcoid
3. Lung abscess
4. Septic emboli
5. Lung CA
6. Lymphoma

Question 17

Two important parts of treating Tb besides the actual treatment

Answer 17

1. Reporting to local health authorities

2. Directly observed therapy - decreases non-adherence

Question 18

Multi-drug resistant Tb drug regimen

Answer 18

4 months: IPE + bedaquilinie + moxi/levofloxacin + prothionamide/ethionamide + clofazimine

Question 19

Tb vaccine

Answer 19

BCG (Bacillus of Calmette and Guerin), given mostly at birth in countries besides the US =

Question 20

Three most important pulmonary fungal infections

Answer 20

1. Aspergillus
2. Pneumocystis jirovecii
3. Cryptococcus neoformans