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Pulmonology > Infections > Flashcards

Infections Flashcards

1
Q

Pneumonia

Path

A
  • into alveoli
  • Neutro from pulm capillary to alveoli
  • phagocytosis, release cytokine
  • inflammation –> neutrophilic exudate
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2
Q

Pneumonia

Causes

A
  • Bacteria
  • Mycobacteria
  • viral
  • fungal
  • Rickettsial (q fever)
  • parasitic
  • mixed
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3
Q

Rickettsia

organism

A

Q fever
Coxiella Burnetti
Rickettsia typhi

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4
Q

Pneumonia

Hx

A
  • Onset rapidity
  • Fever degree
  • Shaking chills?
  • cough - prod/non
  • Dyspnea
  • Pleuritic chest pain
  • other conditions? tobacco?
  • Exposures (triggers, occupational)
  • travel
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5
Q

Pneumonia

PE

A
  • Gen = Toxic?
  • Fever
  • Tachycardia
  • Tachypnea
  • O2sat
  • breath sounds
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6
Q

Pneumonia

Breath sounds

A
  • Rhonchi
  • Bronchial
  • reduced/distant
  • Egophany
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7
Q

Pneumonia

Dx

A
  • CXR
  • CBC (leukoctyosis, left shift, bandemia)
  • Sputum Gram/culture
  • Blood culture
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8
Q

Pneumonia

Sputum

A

Adequate :
>25 neutrophils/HPF
<10 epithelial cells/HPF

Gram (immediate)

Culture (48-72)

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9
Q

Pneumonia

Use bronchoscopy if….

A
  • immunosuppressed
  • no sputum (TB?)
  • w/ neoplasm/FB
  • no response to ABX
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10
Q

CAP typical

A
  • Classic PNA s/s
  • CXR appearance
  • respond to ABX
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11
Q

CAP atypical

A
  • less ill-appearing
  • CXR different
  • need different ABX
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12
Q

Pneumonia

Typical Organisms

A
  • Strep pneumoniae
  • H influ
  • Moraxella catarrhalis
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13
Q

Pneumonia

Atypical Organisms

A
  • Mycoplasma pneumo
  • Chlamydia Pneumo
  • Legionella pneumophilia
  • Clamydia psittaci
  • Francisella tularensis
  • Coxiella burnetii (q fever)
  • Fungal
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14
Q

alchohol associated w/

A

klebsiella
S. pneumo
TB

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15
Q

COPD associated w/

A

H flu
M. catarrhalis
Pseudomonas
Legionella

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16
Q

Dementia associated w/

A

anaerobes

enteric Gram -

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17
Q
  • Single shaking chill
  • Cough, rust color sputum
  • Fever
  • Pleuritic pain
  • Signs of consolidation

Bug? DX test results?

A

Strep Pneumoniae

MC CAP

  • Lancet shaped G+ diplococci on G-stain
  • also urinary S. Pneumo antigen test
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18
Q

Strep Pneumoniae

Suppuritive complications

A
  • sinusitis
  • endocarditis
  • meningitis
  • parapneumnonic effusion/empyema
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19
Q

Strep Pneumoniae

Tx
Inpatient? Outpatient?

A 
Inpatient= 
*Respiratory fluoroquinolone
(moxi, gemi, levo) 
OR 
*B-lactam+macrolide

Outpatient+
*Macrolide (azithro, clarithro, erythro) + B lactam (Amoxi, augmentin) if resistant

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20
Q

Pneumococcal vaccine

When/How to give?

A

> 65 y/o, current smoker, or dz/old/immunocompromised

2 separate vaccines

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21
Q
  • cause of pneumonia in adults (3-38% of cases)
  • Associated with COPD and alcoholism, older or immunosuppressed
  • High fever, chills, cough with purulent sputum, abdominal pain & diarrhea
  • Pleural effusion common
  • Hyponatremia and ↑LDH
  • Encapsulated strains more virulent
  • B-lactamase production common

Bug? DX test?

A

Haemophilus Influenzae Pneumonia
2nd MC

*Urine Legionella Ag = L pneumophilia (90% cases)
*Sputum culture = G(-) rods
((G(-) cocci = M.catarrhalis))
*PCR
*Serology

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22
Q

Haemophilus influenzae

Tx

A

Azithromyacin OR respiratory fluoroquinolone

Prevent = Hib vaccine

Hospitalization

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23
Q
  • Gradual onset
  • Low grade fever & other systemic symptoms more prominent
  • Non-productive cough
  • Diffuse or patchy infiltrate on CXR with little or no pleural effusion
A

Atypical Pneumonia

includes “walking pneumonia”

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24
Q

Atypical pneumonia

MC
LC

A

MC YOUNG= Mycoplasma (young adult), Chlamydophila (school age children)

MC OLD/IMMUNO = Legionella

LC= Psittacosis, tularemia, Q fever

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25
Q

*MC cause = LRI young adults
*Sore throat, nonproductive cough, headache, bullous myringitis
*X-rays often appear worse than clinical findings
*DX = clinical + serology confrimation
(cold agglutinins) or culture

A

Mycoplasma pneumoniae

MC Atypical Pneumonia

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26
Q

Mycoplasma

Tx

A

macrolide

NO B-LACTAM (no cell wall)

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27
Q

Viral pneumonia

Organisms?

A

IMMUNOCOMPROMISED/ PREMATURE/ LUNG DZ

  • RSV (MC kids)
  • Flu
  • Adenovirus (kids, military)
  • Coronavirus
  • CMV
  • HSV, VZV
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28
Q

Viral Pneumonia

Tx

A
  • supportive

* antivirals (Neuraminidase inhibitor, Ribavirin inhaled)

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29
Q

*RLL, RML = MC
*Possible Abcess, air fluid levels
*lead to chemical pneumonitis, bronchial obstrucion, or bacterial pneumo
*MC Anaerobic
(some mixed aerobe/anaerobe)

A

Aspiration Pneumonia

30
Q

Aspiration Peumonia

Tx

A

for oral flora + anaerobes

B-lactam + clindamycin

31
Q

CAP

DX

A
  • Hx
  • CXR
  • +/-Gram
  • +/-sputum/blood
  • +/-Legionella/pnuemo UAT
32
Q

CAP

Tx
Healthy?
Comorbidity?

A

CONSIDER LOCAL
Outpatient/healthy
*Macrolides
*Doxy

Inpatient/Co-morbidity

  • Fluoroquinolones
  • Oral B-lactam + macrolide
  • Amoxi (high dose) + clav

ICU
*B-lactam + fluoroquinolone

33
Q

CURB65

A 
0-1 = low risk
2 = your call
3+= admit
34
Q

Empyema

cause

A

MC anaerobes

EMERGENCY

35
Q
  • Nasal/pharyngeal complaints then cough
  • Sputum common
  • tracheal involvment? substernal chest pain
A

Acute Bronchitis

DX: Hz + PE

36
Q

Acute Bronchitis

Tx

A

Symptomatic (fluids, cough suppressant)
*cough persists? CXR

NO ABX

37
Q

Influenza

Incubation/shedding

A

Incubation = 1-4 days

Shedding = day before s/s start to 5-10 days after onset

38
Q

Abrupt onset of:

  • Fever
  • Myalgias
  • Pounding headache
  • Fatigue
  • Non-productive cough
  • Non-exudative pharyngitis (sometimes)
  • tachycardia
  • NO rhinorrhea
A

Influenza

39
Q

Influenza

Dx

A

rapid flu

Rule out:
Pneumonia = CXR
Strep = Rapid strep/throat culture

40
Q

Influenza

Tx

A
  • Rest
  • Hydration
  • NSAIDS (fever/myalgias)
  • Stay home
  • Avoid immunocompromised
  • Neurmindase inhibitor (oseltamivir, zanamivir, Peramivir) W/IN 48 HOURS
41
Q

TB

Incubation period

A

2-12 weeks

42
Q

TB locations

A
  • Lungs
  • Lymph nodes
  • Vertebral bodies
  • Adrenal glands
  • Meninges
  • GI tract
43
Q

Latent TB

s/s

A

NONE

get PPD

44
Q

TB Skin test

> 5mm

A

HIV+
close contacts
Fibrotic CXR lesion
transplant patient

45
Q

TB skin test

> 10mm

A
  • High prevalence country
  • HIV-
  • long-term care faciility
  • medically underserved
46
Q

TB skin test

> 15 mm

A

everyone else

47
Q

Latent TB

Tx

A

Isoniazid /
Isoniazid + Rifapentine /
Rifampin

48
Q
  • Cough
  • Weight loss/ anorexia/ cachexia
  • Fever
  • Night sweats
  • HEMOPTYSIS
  • Chest pain
  • Fatigue
A

Active TB

49
Q

TB

DX

A

CXR =

  • Reactivation: Coin lesions/ cavitations
  • Primary: middle/lower consolidation
  • Miliary TB

Sputum stain = Acid-fast bacilli

50
Q

Active TB

Tx

A

4 drug x 6 mos

  • Pyrazinamid
  • Isoniazid
  • Rifampin
  • Ethambutol/Streptomycin

OBSERVE for S.E.
Not infectious after 2 weeks tx

51
Q
  • pneumo s/s
  • dry cough
  • hz of environmental exposure
A

Fungal Pneumo

52
Q

Primary Fungal Pneumonia

Organisms

A
  • Blastomyces dermatidis
  • Coccidioides immitis
  • Histoplasma capsulatum
53
Q

Opportunistic Fungal Pneumonia

Organisms

A
  • Aspergillus species
  • Candida species
  • Pneumocystis jirovecii
54
Q
  • Dense infiltrate typically upper lobe w/ hilar adenopathy
  • MC asymptomatic
  • fever
  • dry cough
  • chest pain/myalgias / arthralgias
  • sometimes erythema nodosum
  • travel to Southwest
A

Coccidioidomycosis

Tx Itraconazole / fluconazole

55
Q

Coccidioidomycosis

Tx

A

Itraconazole / fluconazole

56
Q
  • planting new grass/ turning soil
  • Yardwork w/ chickens
  • Tearing down old buildings
  • Bat cave
  • usually near Mississippi-Ohio River valley
A

Histoplasmosis

Tx. Amphotericin THEN itraconazole

57
Q

NO HILAR/ MEDASTINIAL ADENOPATHY

  • Men w/ outdoor occupations
  • Acute: asymtomatic, pulm infiltrate, fever, cough
  • Chronic: productive cough, fever, night sweats, weight loss, hemoptysis, dyspnea, cavitary lesion
  • Southeast/East
A

Blastomycosis

Tx. itraconazole

58
Q

Blastomycosis

A

itraconazole

59
Q

Primary TB

A

Initial infection

CONTAGIOUS

60
Q

Latent (Chronic) TB

A

Caseating gruanulomas (control initial infxn)

PPD (+) 2-4 weeks after infxn

NOT CONTAGIOUS

61
Q

Secondary TB

A

low immunity reactivates latent TB

apex/upper lobes w/ caseating granuloma

CONTAGIOUS

62
Q
  • Contaminated water supplies, air con/coolers
  • GI s/s
  • UP LFTs, hyponatremia
  • no person-to-person
A

Legionella Pneumonia

63
Q
  • after viral illness
  • Immunocompromised + elderly
  • ABSCESS
  • Bilateral w/ multilobar infiltrates
A

Staphylococcus aureas

Gram (+)

64
Q
  • ETOHolics
  • Cavitary lesions, upper lobes (especially R)
  • chronic illness, aspiration
A

Klebsiella pneumonaie

Gram (-) bacilli

65
Q

aspiration of acidic gastric contents

A

pneumonitis

66
Q

Interstitial pneumonia

bug?

A

virus

mycoplasma

67
Q

Alveolar pneumonia

bug?

A

bacteria

68
Q

Primary Pneumonia

A

CAP

69
Q

Secondary Pneumonia

A
  • Hospital (nosocomial)

* Pseudomonas (vascular lesion)

70
Q

Childhood pneumococcal vaccination

A

PCV13

71
Q

Elderly/chronic dz Pneumococcal vaccine

A

PPSV23

72
Q

Legionella

Tx

A
  • Levofloxacin

* Azithromycin

Pulmonology (12 decks)

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