Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pulmonary Boards > Infections > Flashcards

Infections Flashcards

1
Q

What is the treatment for disseminated cryptococcus?

A

Phase 1- induction with ampho B and flucytosine for 2 weeks after clear CSF
Phase 2-consolidation with high dose fluconazole for 8 weeks
Phase 3- maintenance with low dose fluconazole for 1 year to life if continued immunosuppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which patients with CAP may benefit from systemic steroids?

A

Shock, CRP above 150. Can reduce mortality, risk of ARDS or vent support, can reduce time to stabilization and LOS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the features of Nocardia infection?

A

Histo- Gram+ branching filaments, weakly acid fast
Risk-Impaired cell-mediated immunity such as HIV/transplant/malignancy/steroid or with chronic lung dz
Features- PNA, lung abscess/cavity pleural effusion, mediastinitis, consider CNS involvement
Dx-stains/Cx, weakly acid-fast, not visualized on PAS like fungi, not colonizers
Tx-TMP-SMX, may add amikacin for CNS involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the features of Actinomyces infection?

A

Histo- Gram+ anaerobes filamentous
Risk- translocation or aspiration from oral/gential flora from caries, gingivitis, DM, malnutrition, bisphosphonate, tumor/radiation
Features- cervicofacial dz, PNA, lung abscess/cavity pleural effusion, fistulae, bluish discoloration with yellow exudate?
Dx-stains/Cx, growth take 15-20d, PAS/AFB negative, sulfur granules
Tx-PCNs, 2-3mo for mild 6-12 for severe, may need surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the features of PJP infection?

A

Histo- round/oval/hemet shaped yeasts
Risk- CD4 below 200, immunosuppression, heme malignancy, transplant
Features- diffuse bilateral reticular fine interstitial pattern

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the features of Cryptococcus infection?

A

Histo- encapsulated yeasts
Risk- HIV with low CD4, immunocompromised, cirrhosis
Features- meningitis, lung nodules, LAD, small effusions, endobronchial lesions
Dx- culture, antigen
Tx- mild fluconazole for 6m, severe (lung infiltrates) amphoB with flucytosine then fluconazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What infections are typically seen post-op transplant?

A

First 30days- from donor/recipient, surgery or hospitalization
1-6 months- opportunistic infections
6-12 months- community based infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the features of Blastomyces infection?

A

Histo- dimorphic, broad bud
Risk- Ohio/MS river valley
Features- subQ nodules (or irregular verrucous lesion) and bone involvement, persistent PNA
Dx- grows on Sabouraud agar in 2-4w, seen on tissue
Tx- itraconazole for mild, amphoB for 30d for severe then itraconazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the features of Coccidiomycosis infection?

A

Histo- large spherules, dimorphic, non-necrotizing granulomas
Risk- DM, immunosuppression, Filipino/African descent?, southwest US
Features- PNA, cavitation, effusions, nodules (miliary in hematogenous), LAD, arthritis, erythema multiforme, meningitis
Dx- serology, Cx, spherules on biopsy, +GMS/PAS stains
Tx- supportive for mild, fluconazole or itraconazole for mod, amhoB for disseminated or meningitis. Posa/vori for resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the features of histoplasmosis infection?

A

Histo- small and round, smaller than surrounding cells, +GMS
Risk- Ohio/MS river valley, bird/bat exposure
Features: pneumonia, LAD, lung nodules, broncholithiasis, fibrosing mediastinitis
Dx- histo antigen, histo galactomannon
Tx- supportive, or itraconazole for mild-mod, ampho for severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the features of Sporothrix infection?

A

Histo- small and cigar shaped
Features: nodular lympahngitis, outdoor exposures, pulmonary disease in COPD/ETOH middle aged men
Dx: culture or biopsy
Tx: itraconazole, ampho B for severe disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What can be added to MAC therapy if there is no culture conversion after 6 months?

A

Amikacin liposome INH suspension if susceptible
SE include hoarseness, throat irritation, bitter taste, thrush. Rarely ototoxicity, nephrotoxicity, and vertigo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What must be considered with rifamycins?

A

Renders OCP inactive
Can consider INH monotherapy for latent TB for 6-9mo for HIV -

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the features of Mucor infection?

A

Histo- broad based irregular or right angle branching hyphae, pauci septations (ribbon)
Risk- DM, heme malignancies, heme/solid transplant, iron overload, penetrating trauma
Features- sinus, skin, CNS, hemoptysis, angioinvasion, tissue necrosis, exophytic lesions, pleural effusion
Dx- Cx, no beta D glucan
Tx- source control with debridement, Ampho (alt isavuconazole/posa, vori has no action against), stop deferoximine (siderophore for mucor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the features of Echinococcosis infection?

A

Histo- host tissue surrounding cyst wall with brood capsule
Risk- dog tapeworm
Features- lung cysts, can rupture, recurrent hemoptysis, can disseminate to pleura and fistualize, crescent sign on CT if eroded into bronchus and lily sign of floating membranes
Dx- serology, tissue visualization
Tx- albendazole, resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is CDiff treated?

A

Oral vanc, alt fidaxomicin. Same for recurrent Dz. Fulminent also gets rectal if intolerant to oral. Fecal transplant may be considered.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How is severe and fulminant CDiff infection defined?

A

Severe- WBC 15, Cr 1.5, end organ injury
Fulminent- severe with shock, ileus, or megacolon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the features of Hantavirus infection?

A

Risk- East Oregon, exposure to rodents
Features- rapidly progressive PNA, thrombocytopenia, immunoblasts in blood smear, hemorrhagic fever, hemoconcentration, DIC
Dx: serologies, PCR
Tx: supportive care, ribavirin? in cardiopulmonary syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the features of Yersenia infection?

A

Risk- Oregon, prairie dog fleas
Features- painful LAD, fever, pneumonia, hemoptysis
Imaging: consolidation, cavity, or effusion
Dx: culture, PCR
Tx: aminoglycoside or fluoroquinolone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the features of Tularemia infection?

A

Histo- gram - coccibacillus, grows on chocolate agar
Risk- rabbit/rodent exposure, airborne exposure
Features- ulceroglandular, suppurative LAD, can have ocular involvement, lymphocytic effusion
Dx- serologies, Cx of drainage
Tx- gentamicin, doxy/cipro for mild dz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the features of Invasive Pulmonary Aspergillosis?

A

Histo- thin septate hyphae at acute angles
Risk-prolonged neutropenia, high steroids
Features- fever, pleuritic chest pain, hemptysis
Dx- serology, fungitell and galactomannon
Tx- ampho B, transition to vori (isavuconazole if intolerant)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are key things about diffuse panbronchiolitis?

A

Inflammatory disease of small airwys, seen in East Asia, mean age 40y, productive cough with sinusitis. Airway obstruction of PFTs and CT shows diffuse centrilobular nodular opacities with TiB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How can carbapenemase organisms be treated?

A

Ceftazidime-avibactam, cefiderocol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the features of Psittacosis infection?

A

Risk- bird exposure
Features- mono-like illness or atypical PNA, pharyngeal erythema, hepatosplenomegaly, hemoptysis, epistaxis, relative bradycardia. GGO, nonspecfic changes
Dx- serology, PCR
Tx- tetracylcine/doxy for 10-14 days, may suggest 21 days to prevent relapse

25
Q

What immune mechanism is measured by Quantiferon-TB Gold?

A

Delayed hypersensitivity- cell-mediated reaction initiated by T-lymph and mediated by effector T-cells and macrophages for release of interferon gamma
Antigens are specific to TB not found on MBovis-BCG, NTMs so fewer false positives

26
Q

What is the timeline and recommended treatment for pertussis?

A

Incubation- 7-10d
Catarrhal- 1-2 weeks, may start macrolide early to reduce transmission and potentially shorten duration of symptoms
Convalescence- 3-6 months

27
Q

What is the mechanism and benefit of baloxavir compared to oseltamivir?

A

Inihibits cap-dependent endonucleasse enzyme (versus oseltamivir inhibits neuroaminidase), similarily reduces symtpoms for 1 day but also reduces viral load

28
Q

What are the features and timelines for immune reconstitution inflammatory syndrome?

A

Decrease in viral load and increase in CD4 within the first week and can see the robust immune response to silent infection at this time, long term rise in CD4 in thymus 4-6w

29
Q

What are the features of disseminated Candida infection?

A

Histo- pseudohyphae and budding yeasts
Risk- cancer, immunosuppressed, malnutrition, prolonged antibiotics. Primary lung is rare
Tx: echinocandins for severe, fluconazole for mild
2 weeks after negative blood cultures, 4-6w for endopthalmitis

30
Q

What is the risk of latent TB becoming active TB?

A

4-6% lifetime risk. Quant can’t distinguish between active or latent

31
Q

What adjunct should be added for TB meningitis?

A

Steroids that is tapers over 6-8w with mortality benefit. Start ART after 8 weeks to avoid IRIS even if CD4 is below 50

32
Q

What are the recommendations regarding influenza management in pregnant patients?

A

Oseltamivir/zanamivir within 48hr (more data with oseltamivir, consider empiric treatment even if rapid flu negative in setting of a breakout and regardless of vaccination

Avoid zanamivir in asthmatics due to concerns of bronchospasm

33
Q

When to consider anaerobic coverage for aspiration PNA?

A

Lung abscess or empyema

34
Q

When to consider echinocandin susceptability testing?

A

Persistent positive cx from sterile site with previous echinocandin treatment. More frequent C glabrata resistence in particular due to FKS1/2 gene

35
Q

What drugs are available for carbapenemase producing bacteria?

A

Group A (KPC) can be treated with inhibitor combinations such as ceftazidime-avibactam (no activity to acinetobacter baumannii), mero-vaborbactam, and imipenem-relebactam, also cefiderocol
Group B (NDM-1) can be treated with cefiderocol
Colistin may provide some coverage, limited by toxicity

36
Q

What are the features of chronic pulmonary aspergillosis?

A

Features- weight loss, fatigue, cavities with mycetomas and pleural thickening, elevated CRP
Dx- cultures, serum IgG (avoid Bx due to risk of hemorrage as these are highly vascular)
Tx: Vori

37
Q

What are the features of human metapneumovirus?

A

Features- often with coinfection, cough/nasal congestion/sore throat, asthma exacerbations, severe dz with underlying lung conditions or immunocompromised. bronchiolitis
Dx- viral panel PCR of nasal/sputum/BAL
Tx- supportive

38
Q

How many cultures do you need positive to start treatment for NTMs?

A

2, a single culture is indeterminate. Sensitivity data is also needed if therapy is to be pursued

39
Q

What are the features of RMSF?

A

Histo- weakly gram- coccobacilli, GMS+
Risk- southern US, tick exposures
Features- viral prodrome, thrombocytpoenia, LFTs, leukopenia, fever/rash/headache, rash in first 3d on wrist/ankles progresses to trunk, meningitis, DIC
Dx- serologies best from 14-21d, lymphocytic and mild protein elevation in CSF, immunofluorescence in skin
Tx- doxy 5-7d, chloramphenicol for allergic pts

40
Q

What is recommended treatment for latent TB?

A

4m daily rifamycin
3m daily rifampin/INH
3m weekly rifapentine/INH
Better clearance with rifamycin over INH
INH 6-9m

41
Q

What should empiric therapy for exposure to MDR TB include?

A

Late gen fluoroquinolone +/- second agent for 6-12m, repeat testing after 8-10w

42
Q

What are the features of Babesiosis?

A

Histo-merozoites in tetrads (maltese cross), ring forms (similar to malaria)
Risk- tick exposure, 50+yo, asplenic, malignancy, HIV, immunosuppression, autumn
Features- headache, fever, myalgia, hemolytic anemia, thrombocytoppenia, AST elevation, blood transfusion in 6 mo, ARDS, DIC, CHF, AKI, AMS
Dx- PCR of babesia DNA, smear with Giemsa or Wright stains
Tx-atovaquone/azith 7-10d, plasmaphoresis for severe disease and high grade parasitemia

43
Q

What are the features of Dirofilaria infection?

A

Histo- dog heartworm seen on cross section with granulomatous formation and necrosis in vasculature, can cause thrombosis
Risk- dogs via mosquito
Features- solitary pulm nodule, necrotic, eosinophilia, intermittent hemoptysis, pleural based with effusions
Dx- histology
Tx- resection

44
Q

What are the features of Loeffler Syndrome?

A

Histo- eosinophilic infiltrates
Risk- parasites, drugs, idiopathic
Features- fever, cough, wheezing, dyspnea, rarely hemoptysis
Imaging- migratory opacities
Dx- rarely parasite in sputum
Tx- self limited, rarely needs steroids (ex strongyloides)

45
Q

What are the features of Strongyloides infection?

A

Histo- eggs, larvae
Risk- immunocompromised
Features- fever, cough, wheezing, dyspnea, hemoptysis
Imaging- Opacities that can quickly progress to ARDS
Dx- TBBx, ELISA IgG
Tx- thiabendazole or ivermectin

46
Q

What are the features of malaria?

A

Histo: ring form inside RBC (like Babesiosis)
Features: fever in traveler, diarrhea, progresses to sepsis, multiorgan failure
Dx: blood smear (thick and thin)
Tx: oral artermether-lumefantrine, IV artesunate for severe parasitemia

47
Q

What are the features of dengue fever?

A

Features: fever, malaise, arthralgias, petechiae if developing hemorrhage
Dx: serologies, viral antigen
Tx: supportive, focus on intravascular volume

48
Q

What are the features of leptospirosis?

A

Histo: spiral shaped motile aerobic spirochetes
Features: freshwater exposure, leukopenia/thrombocytopenia, renal failure, jaundice, ARDS, rhabdo
Imaging: patchy infiltrates
Dx: PCR, serologies
Tx: doxy/azith for mild, doxy/ceftriaxone/cefotaxime for severe

49
Q

What are the features of typhoid fever?

A

Histo: encapsulated gram negative rod, facultative anaerobe
Features: rose spot rash, fever, multiorgan failure (don’t usually see leukopenia), bradycardia, abdominal pain, peritonitis or bowel perf
Dx: blood/tissue culture, particularly bone marrow culture
Tx: ceftriaxone, fluoroquinolones if susceptible, dexamethasone for severe

50
Q

What is Lemierre syndrome?

A

Complication of pharyngitis seen in healthy young adults 1-3 weeks after infection. Septic thrombophlebitis of the IJ. Need anaerobic coverage. May need surgery if infection extends into soft tissues. Can then also have pulmonary nodules/cavities and other infectious processes. Can then move on to joint infection. Often fusobacterium necrophorum

51
Q

Which medications are contraindicated with ritonanir-nirmatrelvir?

A

CYP3A4 inhibitors (azoles, amiodarone, macrolides, SSRIs, CCBers, grapefruit)

52
Q

What are the features of monkeypox?

A

Histo: orthopox DNA virus
Features: rash (most commonly anogential) spread to mucosal areas and LAD
Dx: PCR
Tx: tecovirimat, supportive treatment

53
Q

What are the features of toxoplasmosis?

A

Histo:
Features: fever, pharyngitis, diffuse maculopapular rash, nontender cervical LAD, pneumonitis, ARDS, multiple ring enhancing lesions on brain MRI
Dx: serologies, no granulomas on Bx
Tx: pyrimethamine and sulfadiazine

54
Q

What is alpha-gal syndrome?

A

Tick bite meat allergy. Tick bites sensitize humans to alpha-gal then symptoms begin when alpha-gal is ingested, causing allergic reactions.
Food containing alpha-gal: mammalian meet, dairy, gelatin, glycerin

55
Q

What are the PNA vaccine guidelines?

A

PCV20 or PVC15 followed by PPSV23 a year later

56
Q

Which infections are commonly seen with chronic granulomatous disease?

A

Aspergillus, Burkholderia, Nocardia, S aureus, Serratia

57
Q

Which is the worst strep pneumococcus serotype?

A

3- thickest capsule, colonizes, forms necrotizing pneumonia and predictor of septic shock but otherwise less invasive

58
Q

When is dual coverage indicated for pseudomonas pneumonia HAP/VAP?

A

HAP: IV abx within 90 days, high risk of death, structural lung disease
VAP: risk of resistance, unit have 10+% resistant Gm-ves for the chosen abx or resistance, structural lung disease, avoid aminoglycoside monotherapy

7 day course

59
Q

What is the suggested treatment for acinetobacter?

A

First line: carbepenem vs unasyn
For polymixin only sensitive: IV polymixin B or colistin with adjunctive inhaled colistin

No role for adjunctive rifampicin or tigecycline

Pulmonary Boards (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions