CM 5 Flashcards
describe viral characterization. what type of precautions?
enveloped negRNA, H/NA, M1 = matrix protein, M2 = channel protein. droplet precautions
describe viral pathogenesis
incubation = 2-3d, viral shed 5-7d, shed before sxs by 12-24h, causes 2ndry bacterial PNA by s pneu, aureus/MRsA, s pyogenes)
describe viral vax
inactivated or live attenuated, don’t give live to immunocompromised; anyone >6mo should get annual vax. grow on chicken eggs, mammalian cx, recombinant protein synthesis
dx vs radiograph findings vs tx flu
nasopharyngeal swab for sample, PCR for dx vs ground glass vs M2 inhibitor amantadine for A but resist, NA inhibitor oseltam/zanam/peramivir for A>B but day 1/2 and adjust for renal, capa endonuclease inhibitor baloxavir = newer but similar to oseltamivir; corticosteroids not rec b/c resistance, prolong shed, 2ndary infxn
pt has ARDs from flu A; how to tx? you can get ARDs from COVID, what other severe manifestation?
PEEP, prone, neuromusc blockade, pulm vasodil, ECMO. viral PNA
transmission vs labs vs img of COVID
resp droplets, fomites, superspread vs inc transaminase, CRP, Ddimer, IL6, procalcitonin, ferritin; nml to low CBC w/ leukp/lymphopenia vs ground glass, consolidation, crazy paving, reverse halo or atoll sign
describe inflam syndrome vs clinical course for COVID
inc inflam markers, cytok storm; organ transplant & ca pts at high risk vs incubation 5d, severe sxs 2nd wk
dx vs tx COVID. hosp precautions?
NAAT/PCR URT > LRT, igM detection in 12d, may be used as surveillance tool vs supportive, remdesivir if early, dexamethasone dec mortality by 28d, paxlovid but many DI. airborne & contact
CD4 200-500 vs <200 vs <100 = more susceptible to? stains to identify PJP? tx for PJP?
bacterial pneumonia and MTB vs PJP vs toxoplasma, mycobacterium avium, and Cryptococcus. Methenamine, silver, giemsa of BAL vs IV high dose TMP/MX, Pentamidine (lots of side effects) or atovaquone (if sulfa allergy)
dx vs tx aspergillus
galactomannan or BD glucan assays; Skin test, ab’s to aspergillus fumigatus, eos w/ bronchiectasis vs itraconazole plus corticosteroids 3-6mo if mild; voriconazole or liposomal amphotericin B or echinocandins (caspofungin) if invasive
key findings in histo? tx for coccoides? sxs vs dx vs tx for blasto?
lymphadenopathy, cavitary TB, granulomatous dz, fibrosing mediastinitis. itraconazole for 3-6mo if persist/severe, ampho B if disseminated. systemic pyogranuloma, resembles flu or PNA vs sputum or urine ag vs voriconazole inducted then itraconazole x12mo; ampho B for disseminated
sxs vs dx vs tx for cryptococcus? sx vs dx vs tx for nonmyco TB?
granulomatous, pneumonitis, meningitis, AMS vs crypto ag if disseminated vs itraconazole w/ ampho B + flucytosine induction. intracellulare, avium, kansii in water/soil; more common in tall slender pts w/ scoliosis or pectus excavatum; upper lobe cavitary dz, hemoptysis vs sputum cx pos x2 vs azithromycin, rifampin, and EMB; Chelonae, abscessus require IV therapy
BCG live attenuated vax protect against which types of TB? 1o transmission?
childhood meningeal and spinal TB, not pulm TB. smear pos pulm dz, droplets, indoors > outdoors b/c can die by UV light (homeless shelters, prisoners, exposed to infected)
dx vs tx TB (even M/XDR)
sputum cx & NAA, Ziehl or kinyoun technique, fluorescent microscopy w/ immune O stains, Lowenstein takes 4-6d, liquid media pos in 1-2wks, TB expert gene can detect M/XDR TB early vs RIPE, monthly sputum cx, DOT; moxifloxacin, amikacin, cycloser, ethionamide, aminosalicylic acid, clofazimine, linezolid, amox/clav
feature of primary vs reactivated vs extrapulm/primary progressive TB
lymphadenopathy, Ghon complex; rare cavities & pos cx -> gastric aspiration for dx vs common pres; primary exposure then latent now active; likes apical & post segs of lung, thick apcial & pleural cavities; sputum pos; immunocompromised show infiltrates, lymphadenopathy, pleural effusion, military pattern vs POTTS dz = spinal TB; disseminated TB (brain, kidney, spinal)
