Dubin - High Yield Associations Flashcards by Erin Kretovics

phospholipid-laden MPs
intersitial pnumonitis
organizing pneumonia
ARDS
HSN

amiodarone induces plum dz

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long rods, ferruginous bodies

asbestosis

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endocarditis hard to tx
result of aspiration
ass’d with IVDAs
blotchy pneumo w/ supperative cavities or nodules b/l
murmur over tricuspid
septic emboli
fever of unk origin
normally in the oropharynx

HACEK

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prophylax for PCP with

TMP-SMX (aka bactrim)

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common pneumo post flu
MC community aquired pnumo
diplococci
rigors
chills

strep pneumo

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non-immunized pts
enlarged epiglottis > drooling (can’t swallow)
common cause of pneumonia in COPD’ers and post-flu

H. flu

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diabetics (DKA)
leukemic pts
chronic sinusitis
no response after 8 wks of Abs
dies from erosion into brain!
black on nose

mucor

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thermophillic actinomyces
around moldy hay
IgG and IgM on BAL
non-caseating granulomas
foam cells
episodic

Farmer’s Lung - HS pneumonia

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fungal growth in lung field

- occupying old lesion (possibly pneumonia)

aspergilloma

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difficult to tx asthmatic
+++ eosinophils
mucous is brown and stringy
“gloved finger” on CXR

ABPA

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can infect almost every type of tissue
possibly immunocomp pts with low CD4
nuchal rigidity
photosensitivity
evolution into full blown meningitis

cryptococcal meningitis

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india ink stain

cryptococcus

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cold agglutinins
common in adolescnt/college age
low PaO and high PaCO2
bullous myrigits

mycoplasma

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tx for mycoplasma penumonia

macrolides (eg: erythromycin)

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immuno def child
recurrent ear & sinus infs
possible giardia

IgA Immunodef

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pt in MVA w/ blood transfusion

- marked transfusion rxn d/t Abs

IgA Immunodef

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acid fast (Ziehl-Neelson stain)

- can cause miliary TB

mycobacterium

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intense coughing attack during expiration
high pictched respiraratory sound
forceful inspiration
bulging neck vv
cyanosis

pertussis

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barking cough

- relieved by humidity

croup

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grows on charcoal yeast
ass’d exposure to water source (like AC unit)
relative bradycardia

legionaires

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tx of histo, coccidiomycosis, blasto

amphotercin B

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tx of aspiraion pneumonia (kills microaerophilic organisma)

clindamycin

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MC pneumos ass’d with COPD

H. flu, moraxella, staph

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gm - facultative intracellular bacteria
transmitted via flea bite
birefringent
safety pin shaped
prairie dogs

yersina pestis

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tx for + PPD skin test

6-12 mo INH

drug that causes hepatotoxicity w/ elevated liver enzymes, peripheral neuropathy

isoniazid (INH)

drug that causes deafness

streptomycin

drug that causes red-orange secretions (tears, urine, ect)

rifampin (RIF)

drug that causes optic neuritis and red-green colorblindness, possible dizziness and vertical nystagmus

ethambutol (EMB)

how do you diff btwn BCG vaccine and previous TB inf

quantiferron gold

- infant w/ runny nose, cough, wheezing - intercostal retractions w/ grunting - worse in winter months

RSV

- ppl on cruise ship with resp s/s | - treats flu A & B

oseltamivir (tamiflu)

amatadine and rimatatine tx what?

only flu A

tx for pseudomonas

gentomycin

- hunter around great lakes region/ north east - skin lesions - nodular appearance - broad based budding

-bastomycosis

- SW US, CA, and Mexico - small calcificaitons on CXR - chronic inf gets into bone and joints - red, painful skin lesions - subQ pre-tibial nodules - "coin lesions" - hx of fever and non-productive cough - recent visit to SW US (AZ)

coccidiomycosis

- ass'd with endocarditis - pneumonia-like syndromes - cattle birthing season (in amniotic fluid) - hepatomegaly w/ elevated liver enzymes - very high T

Q fever

- causes Q fever | - intracellular pathogenic bacterial smiliar to rickettsia but w/ genetic and physiologic differences

coxiella burnetti

- rabbits - puneumo-like etiology but doesn't lead to restrictive lung dz - hunters who hunt rabbits

franciella tularensis

- dropping DLCO - bronchiolitis obliterans with organizing pneumo - prodromal s/s of flu - SOB for a few mo's thats been getting worse

intersitial pulmonary fibrosis

- rust colored sputum - high fever 102-103 - chills & rigors - MC pnumo in HIV + - lobar pneumonia

strep pneumo

tx of strep pneumo

macrolide (ex: erythromycin)

- gm - rod causing NCI - green sputum - CF kids - hosp respirators - burn pts

pseudomonas aeruginosa

- incarcerated - immigrant from "-stan" or india - homeless

People who's PPD is + at 10mm

HIV pt's PPD is + at?

5mm

San Joaquin Valley Fever is cause by

coccidodies immitis

- immunocomp pt (esp HIV) - oropharyngeal or esophageal colonization - person on multiple ABs for a long period of time - ICS overuse

candida albicans inf

- widened mediastinum - gm + rod - spore former - add's with farm animals - skin version has black eschar

bacillus anthracis

- ass'd with aspiration pneumonia - often causes valvular damage - gm - bact often found in oropharynx

HACEK organism

HACEK organisms

``` Haemophilus Aggregabacter Carciobacterium Eikenlla Kingella ```

- red currant jelly sputum - etoh abuse - bulging fissure on x-ray - lives in the gut, skin, mouth - lobar

klebsiella pneumonia

how do you test for legionella

urinary Ag test

- cave diving - ohio river valley - low grade temp - b/l hilar LAD - characteristically restrictive lung dz w/ dec DLCO - cavitary lung disease

histoplasmosis

- apex of lung - cavitated lesion thats now filled with something (old TB lesion) - ball of fungus

aspergilloma

tx of aspergilloma that fails antifungal tx

surgical removal

tx of ABPA

corticosteroids (ex: prednisone)

- sulfer granules - lumpy jaw - slow growing - penetrates bone and siunus tracts

actinomycoses israelii

- obligate intracellular organism that is a common cause of penumonia - ass'd with bird poop (esp parrots) - causes high T + myalgias

chlamydia psittaci

what drug wouldn't you use to tx mycoplasma inf? why?

penicillin; b/c it doesn't have a cell wall

- pneumonia in COPD and elderly - kidney bean shaped - gm - diplococci

moraxella chatarrhalis

- beta2 agonist - stimulates increased in cAMP via adenylcyclase in bronchial smooth mm - causes bronchodilation

albuterol

- b/l hilar LAD - non-caseating granulomas - can cause eye and/or skin lesions - hypercalciuria/emia - anergy - elevated ACE - decreased DLCO

sarcoidosis

- hyperventilating and hypoxemic - can be d/c from ED based on response to bronchodilator tx - needs systemic corticosteroids

stage 2 asthmatic

- not hypoxemic - hyperventilating w/ normal PO2 - facilitate hospital d/c with ipratropium via nebulizer w/ beta agonist

stage 1 asthmatic

- generally ill normal PCO2 d/t resp mm fatigue - elective intubation and mechanical ventilation usually indicated - admit to ICU - parenteral corticosteroids w/ con't bronchodilator - may benefit from theophylline

stage 3 asthmatic

- PO2 is low w/ high PCO2 - pts have less than 20% lung function - require intubation and mech ventilation - admit to ICU - theophylline may be added to tx

stage 4 asthmatic

causes of increased DLCO

- polcythemia - early CHF - pulmonary hemorrhage - L>R cardiac shunt

causes of decreased DLCO

- interstitial lung dz - empysema - CHF: pulm edema & HTN - pulmonary embolism

AEs of corticosteroids

- moon facies - buffalo hump - cataracts - thin skin - aseptic necrosis of the femoral head - elevated BS - abd striae

pts who do not respond to bronchodilators, O2, corticostroids, and IV fluids w/ in 24h should receive

aminophylline (theophilline)

what is levalbuterol and what are the benefits of using it?

- R isomer or albuterol | - less AEs: doesn't affect heart rhythm and less frequent occurrence of tremors

AEs of theophylline

- tachy - nausea - seizure (decreased threshold, esp in kids) - anxiety

fungus that grows as both a yeast and fillamentous cell

candida

mast cell stabilizer

cromolyn

Status asthmaticus pts on mechanical vent are at very high risk of developing what?

penumothorax

Reid index in chronic bronchitis

>0.4

MC cultured oragnisms during a COPD exacerbation

- Strep pneumo | - H. flu

COPD CXR findings

- hyperinflation of lungs - flattening of the diaphragm - hyperlucency of the lungs

xopenex

- aka levaluterol - R isomer of albuterol - less AEs: dec tachy & tremors - more expensive than albuterol

albuterol

- beta-2-agonist - increase cAMP - decreases bronchoconstriction

montelukast

LT modifier

MOA: theophylline

prevent cAMP breakdown via PDE

first line drug fro life-threaning asthma

adrenaline (epi)

omalixumab

- monoclonal Ab against IgE | - need monthly injection

pulsus paradoxis >20 mm Hg

severe airway obstruction

pulsus paradoxis in pts with severe asthma

= 15 mmHg

disappearance of wheezing on chest auscultation

status asthmaticus

every person > 50 yo and chronic lungers get this vaccine

pneumococcal vaccine

- intermittant s/s when around allergen - IgE mediated - Type III HSN rxn - FEV1/FVC > 95%

HSN pneumonia

- hemoptysis - hematuria - recent URI - c-ANCA

Wegner's granulomatosis (granulomatosis with polyangiitis)

- anti-GBM | - hemoptysis

goodpasture's

mnemonic for dd of cavitary lung lesions

- C: carcinoma - A: autoimmune - V: vascular - I: infection - T: trauma - Y: young/congenital

- hx of RA - pleuritis w/ or w/out effusion - autoimmune disorder

rheumatoid lung

velro-like crackles ass'd with

interstitial lung process

3 drugs that cause lung injury

- bleomycin (chemo) - amiodarone (antiarrhythmic) - methotrexate

tx of drug induced lung dz

corticoteroids

- pnemonitis or fibrosis - previous hx of radiation - possible progression to respiratory failure

radiation therapy

- SOB over past year - linear opacities on CXR - restrictive PFTs - decreased diffusion capacity - clubbing/cyanosis possible - dry cough - NKDA and no meds - no hx of smoking

idiopathic pulmonary fibrosis

- hx of asbestos exposure - wt loss - possible pleural effusion - encasing lung masson CT - on biopsy cells can look like mesenchymal stroma or epi cells

mesothelioma

- hilar adenopathy - erythema nordosum - arthritis

Lofgren Syndrome (acute presentation of sarcoid)

- uveitis - parotid gland involvement - fever - possible facial nerve palsy

Heerfordt's Syndrome

most common ECG finding of pulmonary embolism

sinus tachycardia

normal pop's PPD is + at

15 mm

>/= 10 mm PPD is + for what groups

- incarcerated - immigrants from "-stan" - hospital workers

+ PPD for HIV pts

5 mm

dx CF with

sweat test

CF inheritance pattern

"egg shell" calcifications on CXR

silicosis

- ARDS - diffuse alveolar infiltrates - ground glass appearance on CXR - honeycombing - DAD on biopsy - acute widespread ALI

acute interstitial pneumonia

- diaphragmatic pleural plaques - decreased DLCO - pleural thickening

asbestosis

- p-ANCA - +++ eosinophils - asthma - palpable purpura - GI s/s - elevated IgE - elevated BUN:Cr - numbness in extremities

churg-strauss

calcified pleural plaques

asbestosis

intermittent asthma

-s/s less than 1x per wk -nocturnal s/s no more than 2x per mo FEV1 or PEF >/= 80%

mild persistent asthma

- s/s > 1x/wk but less than 1x per day - nocturnal s/s more than 2x per mo - FEV1 or PEF >/= 80%

moderate persistant asthma

- daily s/s - nocturnal s/s occur > 1x/wk - daily SABA use - FEV1 or PEF 60-80%

severe persistent

- daily s/s - frequent exacerbations - FEV1 or PEF = 60%

silicosis pts are at an increased risk of what infection

- RA - coal worker's pneumoconiosis - intrapulmonary nodules

Caplan syndrome

golden-brown fusiform rods

asbestosis

low voltage ECG

- pericardial effusion | - COPD

- +++eosinophils - recent travel to tropical area - high ESR - splenomegaly - charcot-leyeden cyrstals in sputum - can cause elephatiasis

wuchereia bancrofti

- +++ eosinophils in lung - response to parasitic infiltrate - can cause GI obst d/t parasite - high T - n/v

Loeffler's syrome

- rat urine - deer mouse reservoir - aerosolized rodent excretion - non cardiogenic shock - ARDS - pulmonary edema - hemorrhagic fever - pneumonia

hantavirus

- ASA - asthma - nasal polyps

Samter's Triad (ASA induced asthma)

Quelling Reaction + oranisms

- Strep pneumoniae - Klebsiella pneumoniae - Neisseria meningitidis - Haemophilus influenzae - Escherichia coli - Salmonella

- sickle cell patient | - asplenic pt

more susceptible to quelling + organisms

candida esophagitis

CD4

- hilar LAD - peripheral granulomatous lesion - middle or lower lung lobes - possible calcification - langerhans cells with lymphocytes

ghon complex

bacillus anthracis tx

ciprofloxacin

cat breeder

toxoplasmosis

- hat shaped organism - foamy cells - methenamine silver stain

PCP

- lancet shaped diplococcus - gm + - alpha-hemolytic

strep pnumo

legionella tx

- erythromycin or azithromycin | - rifampin

MC type of tularemia

ulceroglandular (lesions on face and eyes)

tx of MRSA

vancomycin

tx of staph

methcillin or nafcillin

tx of VRE

linezolid

tx of flu A and B

oseltamivir

2 fungi you see skin lesions with

- blasto | - coccidio

2 common bugs that cause post flu pneumonia

- h flu | - staph areus

cause of croup

parainfluenza virus

TWAR

bad case of chalmydiophilia pneumo

organism w/out cell walls

mycoplasma

AFB organism

mycobacterium

sandblaster

silicosis

- animal urine - flu-like stage - renal stage > RBC casts

leptospirosis

how the flu changes from year to year to create new outbreaks/epidemics

antigenic drift

shift that causes new flu strain and pandemics

antigenic shift

- adrenal hemorrhage - hypotension - DIC - N. meningititis inf

Waterhouse- Friederichsen Syndrome

- fever - chill - HA - rash sparing face, palms, soles - gm - - intracellular organism

rickettsia prowazekii

- MERS | - SARS

coronavirus

- high occurance of nasal polyps - bronchiectasis - aspergillosis - sweat Cl- test - pancreatic insufficiency - hemoptysis - chronic mucoid pseudomonal infection.

mutation at ch7q3.112

recurrent penumothorax w/out family hx of A1AT

lymhangioleiomyomatosis (LAM)

- superior sulcus tumor - non-small cell - compression of brachiocephalic v, subclavian a, phrenic n or recurrent laryngeal - horner's syndrome

pancoast tumor

most common inherited hypercoagulable sate

Factor V Leiden

- ass'd w/ small cell lung ca - mm weakness - Ab against presynaptic Ca channels - mm weakness improves with sustained mm contraction

Lambert-Eaton Syndrome

PE seen with long bone fx

fat emboli

- PE seen with giving birth | - ass'd with DIC and ARDS

amniotic fluid emboli

text-book PE ECG finding

S1 Q3 T3

tx of PE

thorombolytic therapy

tx of PE in pregnancy

enoaxaprin (HMW heparin) subQ 2x/d

where is histamine stored?

- mast cells - blood vessels - basophils

using erythromyci and terfenadine together increased risk of what?

torsade de pointes

DLCO in interstitial diseases

decreased

TLC in COPD

increased

TLC in asthma

increased

asthma is a _________ disease

obstructive

DLCO in emphysema

decreased

FEV1/FVC ratio in obstructive lung disease

FEV1/FVC ratio in restrictive lung diseases

> 95% or normal

amount of gas inspired or expired with each breath

tidal volume

amount of air remaning in the lung after maximal expiraiton

residual volume

sarcoidosis is a ________ disease

restrictive

TLC in lung fibrosis

decreased

breathing through pursed lips

emphysema

spirometry measures

vital capacity

whole body plethymography allows you to measure

residual volume

neuromuscular restrictive lung diseases

- myasthenia gravi | - guillian barre

>15% increased in FEV1 in response to a B2 agonist think

asthma

residual lung volume is increase in _________ lung diseases d/t air trapping

obstructive

- exertional dyspnea - dry cough - velcro raled - clubbing - cyanosis

intersitial pulmonary fibrosis

emphysema in

A1AT

- high temp - high PaCO2 - low CO - low pH

right shift

- low temp - low PaCO2 - high CO - high pH

left shift

respiratory acidosis

metabolic acidosis

pH>7.4 | PCO2 less than 40 mm Hg

respiratory alkalosis

pH>7.4 | PCO3 > 40 mm Hg

metabolic alkalosis

common paramyxovirus infecting kids

RSV

- larvae in soil - GI s/s: N/V/D - epigastric pain

Strongyloides

CD4 lt 50

MCA

CD4 lt 100

toxoplasmosis

CD4 lt 200

PCP

urease positive

klebsiella

optochin positive

strep pneumo

c-polysaccharide antigen

strep pneumo

Serum precipitans

IgG

Serum precipitans

IgG