ID Flashcards
1
Q
VAP/HAP
A
Avoid tigecycline
2
Q
Aspergillus
A
- Initial therapy for invasive: Vori +/- caspofungin
- If intolerant of vori, use isavuconazole or lipid ampho
- no pleural effusions
- halo signs
- posaconozole for prophylaxis
- chronic necrotizing - vori, or itraconazole
3
Q
Influenza Vaccine
A
Decreased COPD exacerbations
4
Q
Pertussis
A
Bordetella pertussis
Posttussive emesis
Cough lasts for weeks
Macrolides early in course effective
5
Q
ESBL
A
Can be treated with tigecyline, colistin or possibly aminoglycoside but all cause renal tox
6
Q
Hanta virus
A
Rapidly progressive PNA Thrombocytopenia Immunoblasts on smear Deer mice droppings Capillary leak
7
Q
TB Meningitis
A
Steroids recommended for 6-8 weeks
ART should NOT be started within first 8 weeks in HIV
8
Q
Pulmonary TB
A
- ART should be started within 2 weeks for patients with CD4<50 and within 8-12 weeks for CD4>50
- Daily isoniazid, rifampin, pyranzinamide and ethambutol in first 8 weeks
- PZA, streptomycin, fluoroquinolones not recommended in pregnancy
9
Q
Pleural TB
A
- Effusions in up to 1/3 of Pulm TB
- increased risk as CD4 goes down
- pleural biopsy shows caseating granulomas
- ADA > 40 - very sensitive. Very sensitive when exudate is lymphocytic
10
Q
MAC
A
- Can cause granulomas in the airway
- For HIV treatment is clarithromycin, ethambutol and usually rifabutin
- associated with hormonal and immune abnormalities
- presents in 2 distinct ways
- existing lung disease
- fibrocavitary disease
- non existing lung disease
- fatigue, weight loss common
- fever not common
- older women, white, non smokers
- pectus excavatum, scoliosis, mitral valve prolapse
- may have CF mutation
- existing lung disease
- INH not active against MAC
- macrolide + ethambutol + a rifamycin
- relapse is common
11
Q
Actinomycosis
A
- treatment with high dose Pen G
- pen allergic - tetracyclines, erythromycin, clinda
- often originates in cervicofacial region
- invades mediastinum
12
Q
CVID
A
- get pneumonia that are covered by childhood vaccines
- mixed obstructive and restrictive
- impaired B-cell differentiation
- average age of diagnosis 20-40 years
- bronchiectasis +/- granulomatous lymphocytic disease
- encapsulated organisms
13
Q
Pneumonia Vaccine
A
- PPSV23 - 23 purified capsular polysaccharides
- covers 60-70% of invasive pneumococcus
- decreases infection risk
- does not decrease mortality
- everyone over 65
- every 5 years
- PCV13 - protein-conjugate polysaccharide vaccine
- stimulates better immunity because of protein bound
- no reduction in mortality
- repeat not needed
- vaccine naive - PCV13 given first
- PPSV23 at least 1 year later
14
Q
Cocci
A
- treatment for lung with risk of dissemination with fluconazole or itraconazole
- dimorphous fungus
- septated hyphae in the soil
- forms spherules in the lung
- arthralgias
- eosinophilia
- hilarious LAD
- EN
- diagnosed with antibodies
- or by identifying spherules
- grows easily on culture
- most don’t need treatment
15
Q
Legionella
A
- culture on buffered charcoal yeast agar (BCYE)
