Hersh CIS Pneumo Flashcards

1
Q

no cell wall

causes microcytic anemia

A

mycoplasma pneumonia

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2
Q

Hyponatremia

A
  • Legionella
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3
Q

Positive urinary antigens

A

– S. pneumo and Legionella

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4
Q
A

mycoplasma pneumonia

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5
Q

similar in presentation to Mycoplasma but with a hoarse voice!!!

A

Chlamydia pneumoniae – similar in presentation to Mycoplasma, hoarse voice!!!

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6
Q

Fevers, chills, cough (may be dry), dyspnea (typically with exertion)

A

CAP atypical pneumonia (legionelle, chlymedia, mycoplasma pneumonia)

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7
Q

Follows URI like sx

A

CAP atypical penumonia

Follows URI like sx: rhinitis, laryngitis, pharyngitis, sinusitis

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8
Q

EMPIRIC ABX FOR CAP: ambulatory

A

macrolide (azithromycin, clarithromycin, erythromycin)

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9
Q
  1. EMPIRIC ABX FOR CAP in pt w/ncreased risk for drug resistance due to
    1. having Abx in the past 90 days
    2. immunosuppression
    3. exposure to kids
A

FLUOROQUINOLONE OR MACROLIDE + beta-lactam

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10
Q

EMPIRIC ABX FOR CAP: hospitalized patients

A

Hospitalized Patients – FLUROQUINOLONE

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11
Q

EMPIRIC ABX FOR CAP: ICU pts

A
  1. ICU
    1. Combo of
      1. FLUROLOQUINOLONE
      2. antipneumococcal beta lactam
        1. 3rd gen cephalosporin or ampicillin sulbactam
    2. Add piperacillin-tazobactam, cefipime, or a “penem” for Pseudomonal coverabe
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12
Q

EMPIRIC ABX FOR CAP: ICU pts needing pseudomonal coverage

A
  1. ICU:
    1. FLUROLOQUINOLONE + antipneumococcal beta lactam (3rd gen cephalosporin or ampicillin sulbactam)
    2. Add piperacillin-tazobactam, cefipime, or a “penem” for Pseudomonal coverabe
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13
Q
A
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14
Q

How do you know what to do with a pt presenting with symptoms of pneumonia?

A

CURB65

  1. Confusion = 1 pt
  2. Blood Urea nitrogen > 20 mg/l = 1 pt
  3. Respiration >/= 30 breaths/min
  4. Blood pressure = 1 pt
    1. systolic < 90 mmHg
    2. diastolic = 60 mmHg
  5. Age >/= 65 = 1 pt

Score

0-1 = low risk, outpatient

2 = moderate severity: short impatient hospitalization or closely supervised outpatient tx

3-5 = severe pneumonia: hospitalization required, consider ICU admission

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15
Q

gram negative bacillus (pleomorphic), aerobic, flagellate: what will i grow on?

A

legionelle

Legionella pneumophilia – gram negative bacillus (pleomorphic), aerobic, flagellate, water lover, urinary antigen

buffered charcoal yeast extract agar

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16
Q

gram negative bacillus, encapsulated, pyocyanin and pyoverdine, smells like grapes, water lover, colonizer in CF and bronchiectasis.

A

Pseudomonas aeruginosa

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17
Q

gram negative diplococci, encapsulated (typeable) or no capsule (non-typeable), Chocolate agar (factors V and X), smokers, immunocompromised.

A

Haemophilus influenzae

gram negative diplococci, encapsulated (typeable) or no capsule (non-typeable), Chocolate agar (factors V and X), smokers, immunocompromised.

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18
Q

gram negative DIPLOCOCCUS

fastidious, aerobic. Big time for smokers, COPD, asthmatics, malignancies. Generally exacerbates predisposing conditions and then forms a PNA

A

Moraxella catarrhalis

– gram negative coccobacillus, fastidious, aerobic. Big time for smokers, COPD, asthmatics, malignancies. Generally exacerbates predisposing conditions and then forms a PNA

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19
Q

positive Thompson test, difficulty walking, pain behind ankle

A

levofloxacin

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20
Q

MacConkey agar

A

What the dickens is MacConkey agar??

  • Selects for G(-) bacteria, especially enteric bacteria!

Has bile salts and crystal violet in the media: these select for Gram negative bacteria only.

Also, has LACTOSE which selects for fermenters

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21
Q

ENCAPSULATED, gram negative, ferments lactose, grows in mucoid colonies. Bulging fissure, currant jelly sputum, immunocompromised and EtOH.

A

Klebsiella pneumoniae

– ENCAPSULATED, gram negative, ferments lactose, grows in mucoid colonies. Bulging fissure, currant jelly sputum, immunocompromised and EtOH.

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22
Q

IS gram negative, but not a lactose fermenter. Additionally, SEVERE pt presentation: fever, headache, weakness, chest pain, dyspnea, pulmonary hemorrhages (bloody sputum)

A

Yersinia pestis – IS gram negative, but not a lactose fermenter. Additionally, SEVERE pt presentation: fever, headache, weakness, chest pain, dyspnea, pulmonary hemorrhages (bloody sputum)

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23
Q

Fast Fermenters

A

Fast Fermenters: “Lactose? OH-KEE!!!!”

KEE: Klebsiella, E. coli, Enterobacter

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24
Q

Slow Fermenters:

A

CS

Citrobacter, Serratia

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25
Q

atypical, no cell wall, extracellular, bullous myringitis, cold agglutinins, scattered pulmonary infiltrates (if anything), younger pts, generally self-limiting, dry cough

A

Mycoplasma pneumoniae – atypical, no cell wall, obligate intracellular, bullous myringitis, cold agglutinins, scattered pulmonary infiltrates (if anything), younger pts, generally self-limiting, dry cough

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26
Q

gram positive diplococci, encapsulated, alpha hemolytic, optochin sensitive, urinary antigen, lobar PNA, MOST COMMON CAUSE OF CAP (and meningitis). Sick patients: fevers, chills, cough, rust colored sputum, dyspnea, and weakness.

A

Streptococcus pneumoniae – gram positive diplococci, encapsulated, alpha hemolytic, optochin sensitive, urinary antigen, lobar PNA, MOST COMMON CAUSE OF CAP (and meningitis). Sick patients: fevers, chills, cough, rust colored sputum, dyspnea, and weakness.

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27
Q

gram negative, non-lactose fermenter, buffered yeast charcoal medial, lover of water systems, hyponatremia, relative bradycardia, can affect multiple people at same time

A

Legionella pneumoniae – gram negative, non-lactose fermenter, buffered yeast charcoal medial, lover of water systems, hyponatremia, relative bradycardia, can affect multiple people at same time

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28
Q

gram positive, catalase and coagulase positive, known to follow viral pneumonia, necrotizing, pulmonary hemorrhages, salmon colored sputum.

A

Staphylococcus aureus

– gram positive, catalase and coagulase positive, known to follow viral pneumonia, necrotizing, pulmonary hemorrhages, salmon colored sputum.

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29
Q

encapsulated gram negative, lactose fermenter, mucoid colonies, currant jelly sputum….

A

Klebsiella pneumoniae – encapsulated gram negative, lactose fermenter, mucoid colonies, currant jelly sputum….you can fill in the rest!

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30
Q

vaccination against capsular polysaccharide antigens of 23 strains

A

Pneumovax – against capsular polysaccharide antigens of 23 strains

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31
Q

vaccination protective against 13 strains

A

Prevnar 13

Prevnar 13 – protective against 13 strains

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32
Q

who gets the pneumococcal vaccine? what are C/I? when is it administered?

A

Age ≥65, immunocompromised, asplenic patients, pts 2-64 for risk factors

Contraindications: serious allergic reaction to previous vaccination (anaphylaxis)

**Hold off on vaccination until your patient’s are better!!!

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33
Q

Gram (-) encapsulated organism that produces pyocyanin

A

Pseudomonas aeruginosa

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34
Q

G+ diplococci (lancet shaped), rust colored sputum, lobar PNA

A

Streptococcus pneumoniae – G+ diplococci (lancet shaped), rust colored, lobar PNA

35
Q

no cell wall, extracellular, bullous myringitis, anemia, cold agglutinins, younger adults

A

Mycoplasma pneumoniae - no cell wall, extracellular, bullous myringitis, anemia, cold agglutinins, younger adults

36
Q

gram negative rod, CF, bronchiectasis, green (pyocyanin and pyoverdine), grape smelling, encapsulated, biofilms (alginate)

A

Pseudomonas aeruginosa – gram negative rod, CF, bronchiectasis, green (pyocyanin and pyoverdine), grape smelling, encapsulated, biofilms (alginate)

37
Q

a gram negative coccobacillus that grows on chocolate agar

A

Haemophilus influenza

38
Q

non-enveloped, dsDNA, icosahedral virus.

Common cold

viral keratoconjunctivits

conjunctivitis

pharyngitis

Can cause overlapping symptoms.

Viral Cx standard, can use direct assay or enzyme immunoassay.

A

Adenovirus – non-enveloped, dsDNA, icosahedral virus. Common cold, viral keratoconjunctivits, conjunctivitis, pharyngitis. Can cause overlapping symptoms. Viral Cx standard, can use direct assay or enzyme immunoassay.

39
Q

Sx: fevers, chills, myalgias, HA, nasal stuffies, coryza, nonproductive cough. Fever >38C, LAD. diffuse pneumonitis and hypoxemia. Leukopenia.

A

A. Orthomyxovirus – 8 segmented (-)ssRNA, Hemagluttinin and Neuriminadase spikes. Sx: fevers, chills, myalgias, HA, nasal stuffies, coryza, nonproductive cough. Fever >38C, LAD. Can cause diffuse pneumonitis and hypoxemia. Leukopenia is common. Rapid Flu is suboptimal. PCR is preferred. ***REYE SYNDROME – don’t give ASA to kids!

40
Q

ssRNA. Fever, cough, dyspnea, GI sx (diarrhea, ab pain). Fecal-oral transmission. Travel to ME, esp Saudia Arabia. Thrombocytopenia, lymphopenia/cytosis, transaminitis. SEVERE – ARDS presentation.

A

C. MERS – Coronavirus, ssRNA. Middle Eastern Respiratory Syndrome. Fever, cough, dyspnea, GI sx (diarrhea, ab pain). Fecal-oral transmission. Travel to ME, esp Saudia Arabia. Thrombocytopenia, lymphopenia/cytosis, transaminitis. SEVERE – ARDS presentation.

41
Q

Travel to China, Hong Kong, Taiwan. Initial flu-like sx and can progress rapidly to ARDS. Cough, difficulty breathing, severe hypoxia.

A

SARS – Severe Acute Respiratory Syndrome. Coronavirus. Travel to China, Hong Kong, Taiwan. Initial flu-like sx and can progress rapidly to ARDS. Cough, difficulty breathing, severe hypoxia.

42
Q

similar to orthomyxo, history of exposure to dead or sick poultry. Fever (prolonged), cough, dyspnea. RT-PCR. Start with OSELTAMIVIR (same for prophylaxis after exposure)

A

H5N1

– similar to orthomyxo, history of exposure to dead or sick poultry. Fever (prolonged), cough, dyspnea. RT-PCR. Start with OSELTAMIVIR (same for prophylaxis after exposure)

43
Q

gram positive, catalase and coagulase positive, necrotizing PNA, golden colony growth, follows flu.

A

S. aureus – gram positive, catalase and coagulase positive, necrotizing PNA, golden colony growth, follows flu.

44
Q
A
  1. Histoplasmosis
    1. microconidia found in caves with bat/bird droppings.
    2. Dimorphic yeast in body, fungi in natural environment.
    3. Narrow-based budding.
    4. Mild PNA unless immunocompromised, chronic course.
    5. Most resolve on their own.
    6. Prevalent in: Ohio, Missouri, and Mississippi River Valleys. Lesions calcify on CXR (coin lesion)
45
Q
A
  1. Histoplasmosis –
    1. microconidia found in caves with bat/bird droppings.
    2. Dimorphic yeast in body, fungi in natural environment.
    3. Narrow-based budding.
    4. Mild PNA unless immunocompromised, chronic course.
    5. Most resolve on their own.
    6. ***Prevalent in: Ohio, Missouri, and Mississippi River Valleys. Lesions calcify on CXR (coin lesion)
46
Q
A

Coccidioidomycosis (C. immitis – Valley Fever) – chronic PNA, fungi spherule with endospores, dimorphic, prevalent in Southwest (CA, NM, AZ, San Juaquin River Valley).

Some will develop painful erythematous nodular lesions – ERYTHEMA NODOSUM. Self-limiting

47
Q

a fungus caused this on a patient in the southwest

A

Coccidioidomycosis (C. immitis – Valley Fever)

– chronic PNA, fungi spherule with endospores, dimorphic, prevalent in Southwest (CA, NM, AZ, San Juaquin River Valley). Some will develop painful erythematous nodular lesions

ERYTHEMA NODOSUM. Self-limiting

48
Q

chronic PNA, soil with decomposing matter (leaves, wood), BROAD BASED BUDDING YEAST.

Can cause SKIN, BONE, and NEURO changes.

A

Blastomycosis (Blastomyces dermatitidis) – chronic PNA, soil with decomposing matter (leaves, wood), BROAD BASED BUDDING YEAST. Can cause SKIN, BONE, and NEURO changes.

49
Q
A

Blastomycosis (Blastomyces dermatitidis) – chronic PNA, soil with decomposing matter (leaves, wood), BROAD BASED BUDDING YEAST. Can cause SKIN, BONE, and NEURO changes.

50
Q

FLU PREVENTION: who, vaccine, C/I

A

recommended that all persons over the age of 6 months of age be vaccinated!

Inactivated influenza virus

Contraindications: previous allergic reaction, egg allergy (there are alternatives), Guillan-Barre within 6 weeks of previous flu vax.

51
Q

microconidia found in caves with bat/bird droppings. Dimorphic – yeast in body, fungi in natural environment. Narrow-based budding. Mild PNA unless immunocompromised, chronic course. Most resolve on their own. ***Prevalent in: Ohio, Missouri, and Mississippi River Valleys. Lesions calcify on CXR (coin lesion)

A

Histoplasmosis – microconidia found in caves with bat/bird droppings. Dimorphic – yeast in body, fungi in natural environment. Narrow-based budding. Mild PNA unless immunocompromised, chronic course. Most resolve on their own. ***Prevalent in: Ohio, Missouri, and Mississippi River Valleys. Lesions calcify on CXR (coin lesion)

52
Q

chronic PNA, fungi spherule with endospores, dimorphic, prevalent in Southwest (CA, NM, AZ, San Juaquin River Valley). Some will develop painful erythematous nodular lesions – ERYTHEMA NODOSUM. Self-limiting

A

Coccidioidomycosis (C. immitis – Valley Fever) – chronic PNA, fungi spherule with endospores, dimorphic, prevalent in Southwest (CA, NM, AZ, San Juaquin River Valley). Some will develop painful erythematous nodular lesions – ERYTHEMA NODOSUM. Self-limiting

53
Q

chronic PNA, soil with decomposing matter (leaves, wood), BROAD BASED BUDDING YEAST. Can cause SKIN, BONE, and NEURO changes.

A

Blastomycosis (Blastomyces dermatitidis) – chronic PNA, soil with decomposing matter (leaves, wood), BROAD BASED BUDDING YEAST. Can cause SKIN, BONE, and NEURO changes.

54
Q

Culture results from sputum, blood, and urine demonstrate a Gram-negative, aerobic, catalase positive, bacillus that flourishes on BC agar. The organism does not ferment lactose…

A

Burkholderia cepacia –

G(-) bacillus

catalase positive, non-lactose fermenter.

Grows on BC agar (has crystal violet and bile salts – colonies are pearly gray).

Also colonizes CF pts (or with bronchiectasis) and is found on hospital equipment and irrigation systems.

VERY HARD TO TREAT, MULTI-ABX resistant

55
Q

G(-) bacillus, oxidase positive, catalase positive, aerobic, pyocyanin/pyoverdine, non-lactose fermenter.

A

Pseudomonas aeruginosa – G(-) bacillus, oxidase positive, catalase positive, aerobic, pyocyanin/pyoverdine, non-lactose fermenter.

56
Q

Gram (-) bacillus, encapsulated, anaerobic, EtoH, currant jelly sputum, mucoid colonies, bulging fissure, lobar or necrotizing.

A

Klebsiella pneumoniae – Gram (-) bacillus, encapsulated, anaerobic, EtoH, currant jelly sputum, mucoid colonies, bulging fissure, lobar or necrotizing.

57
Q

Gram (-) coccobacillus, chocolate agar, encapsulated

A

Haemophilus influenza – Gram (-) coccobacillus, chocolate agar, encapsulated

58
Q

gram (-) bacillus, lactose fermenter, oxidase negative, anaerobic. Opportunistic, mechanical ventilaltion. Coliform bacteria. MOTILE!!!

A

Enterobacter- gram (-) bacillus, lactose fermenter, oxidase negative, anaerobic. Opportunistic, mechanical ventilaltion. Coliform bacteria. MOTILE!!!

59
Q

… exposure to infected rodents via urine, feces, saliva. Prodromal phase mimics many flu-like syndromes. Rapidly progresses to Hanta CP (cardiopulm) syndrome with RESPIRATORY Distress. Look for clues in History!!!

Labs: Thrombocytopenia, leukocytosis, elevated LDH, pulmonary infiltrates B/L

A

Bunyavirus – HANTAVIRUS.

Zoonotic, exposure to infected rodents via urine, feces, saliva. Prodromal phase mimics many flu-like syndromes. Rapidly progresses to Hanta CP (cardiopulm) syndrome with RESPIRATORY Distress. Look for clues in History!!! Labs: Thrombocytopenia, leukocytosis, elevated LDH, pulmonary infiltrates B/L

60
Q

ABRUPT high fever, HA, myalgias. Fevers and sx last through duration of illness. May have mild PNA or rapidly progress to respiratory distress. Hepatitis with no jaundice, acute endocarditis, maculopapular rash. Leukocytosis and thrombocytopenia.

A

Coxiella burnetti –

obligate intracellular. Small, gram-negative. Has ENDOSPORE ABRUPT high fever, HA, myalgias. Fevers and sx last through duration of illness. May have mild PNA or rapidly progress to respiratory distress. Hepatitis with no jaundice, can cause acute endocarditis, maculopapular rash. Leukocytosis and thrombocytopenia. Think shepherds, farmers, cattle birthers.

61
Q

flu symptoms, rapid antigen detection, 8 segmented RNA.

A

Orthomyxovirus – flu symptoms, rapid antigen detection, 8 segmented RNA.

62
Q

fevers, HA, Aseptic meningitis (possible meningeal signs), severe myalgias.

Hepatitis with jaundice,

enal failure with nephritis, subconjunctival hemorrhage.

Rodents, cattle, horses, sheep goats – watch out for aborted animals

A

Leptospirosis – spirochete. HIGH fevers, HA, Aseptic meningitis (possible meningeal signs), severe myalgias. Hepatitis with jaundice, renal failure with nephritis, subconjunctival hemorrhage. Rodents, cattle, horses, sheep goats – watch out for aborted animals!

63
Q

gram negative, intracellular, endospore. HIGH fevers (don’t relent), HA, myalgias. Mild PNA or respiratory distress. Hepatitis with NO jaundice!

Leukocytosis and thrombocytopenia.

A

Coxiella burnetti – gram negative, intracellular, endospore. HIGH fevers (don’t relent), HA, myalgias. Mild PNA or respiratory distress. Hepatitis with NO jaundice! Leukocytosis and thrombocytopenia. Shepherds, cattle birthers, etc

64
Q

gram negative aerobic

abrupt onset of nonspecific sx: fevers, chills, HA, abdominal pain, diarrhea.

Ulceroglandular ds – most common.

Single lesion at a tick bite site with a central eschar with assc.

Adenopathy.-pleural effusions with different opacification patterns.

A

Francisella tularensis

gram negative aerobic. abrupt onset of nonspecific sx: fevers, chills, HA, abdominal pain, diarrhea. Ulceroglandular ds – most common. Single lesion at a tick bite site with a central eschar with assc. Adenopathy. Pulmonary tularemia - pleural effusions with different opacification patterns. See next slide.

65
Q

no cell wall

abrupt HA, dry cough, myalgias, dyspnea.

CXR – indistinguishable from many bacterial and viral PNA.

Can have epistaxis and splenomegaly.

A

Chlamydia psittacosis

obligate intracellular, gram negative, no cell wall. Reservoir – birds. Can see with pet shop owners and vets, ducks, turkeys. Obtain – inhaled bird feather dust, infected feces. Sx: abrupt HA, dry cough, myalgias, dyspnea. CXR – indistinguishable from many bacterial and viral PNA. Can have epistaxis and splenomegaly. History is paramount!

66
Q

obligate intracellular, no cell wall, EB (infectious aspect!!) and RB, follows URI, HOARSNESS.

A

Chlamydia pneumoniae – obligate intracellular, no cell wall, EB (infectious aspect!!) and RB, follows URI, HOARSNESS.

67
Q

no cell wall, bullous myringitis, cold agglutinins, generally follows URI.

A

Mycoplasma pneumoniae – no cell wall, bullous myringitis, cold agglutinins, generally follows URI.

68
Q

generally ELEVATED in bacterial infections

A

Procalcitonin = generally ELEVATED in bacterial infections

69
Q

Neutropenic and Cystic Fibrosis

A

Neutropenic and Cystic Fibrosis – Pseudomonas

70
Q

Asplenic

A

Asplenic (susceptible to encapsulated organisms) – Klebsiella, S. pneumoniae, H. influenzae, Nisseria sp,

71
Q

Smokers, COPD

A

Smokers, COPD – Moraxella, H. influenzae

72
Q

Alcoholics

A

Alcoholics – Klebsiella

73
Q

S/P influenza –

A

S/P influenza – S. aureus

74
Q

Bird handlers

A

Bird handlers – C. psittaci

75
Q

Animal breeders (incl. vets)

A

Animal breeders (incl. vets) – Coxiella burnetti (Q fever)

76
Q

Hunters, Rabbit Exposure, Lawn Care

A

Hunters, Rabbit Exposure, Lawn Care – Francisella tularensis

77
Q

Sputum characteristics: Rust colored

A

Rust colored: S. pnuemoniae

78
Q

Sputum characteristics: Salmon colored

A

Salmon colored: S. aureus

79
Q

Currant jelly colored sputum

A

Currant jelly colored: K. pneumoniae

80
Q

Possibly green tinged sputum

A

Possibly green tinged: P. aeruginosa

81
Q

Foul-smelling sputum

A

Foul-smelling: anaerobes

82
Q
A

abscess: CAVITATION WITH AIR FLUID LEVEL

83
Q
A

interstitial pneumonia

84
Q
A

lobar pneumonia