Infections

Question 1

Alveolar hypoventilation is the cause of hypoxia in pneumonia. True/false?

Answer 1

False. The cause is intrapulmonary shunt.

Question 2

Health care associated or hospital acquired pneumonia definition; empiric therapy

Answer 2

Pneumonia developing in more than 48hr after admission or within 90 days after hospitalization.
Rx- high incidence of gram negative bacilli like e.coli n pseudomonas makes macrolides unacceptable as empiric therapy. Antipseudomonal cephalosporins or antipseudomonal ampicillin or carbapenems

Question 3

Criteria for admission in pneumonia

Answer 3

CURB65= confusion, uremia,

RR>30, BP<90/60, age>65

Question 4

Empiric therapy for CAP

Answer 4

Out pt- previously healthy, no abx in the past 3 months—> macrolides or doxy
-comorbidities or abx in 3months—> respiratory quinolones(Levo, moxy)
Inpatient- resp quinolones or ceftriaxone with azithro

Question 5

Lights criteria
Exudate Vs transudate
Empyema

Answer 5

Pleural fluid protein to serum protein>0.5
Pleural LDH to serum LDH>0.6
LDH > 2/3upper limit of normal(=60)
If empyema, glucose will b very low(consumed by the large amount of WBC and bacteria); PH is usually<7.2

Question 6

Ventilator associated pneumonia Rx

Answer 6

Combine 3d/t drugs1. Antipseudomonal betalactam(ceftazidim, cefepime; piperacillin/tazobactam; carbapenems) 2. 2nd antipseudomonal agent (aminoglycosides, quinolones) 3. Anti MRSA ( vancomycin, linezolid)

Question 7

Pneumococcal vaccine 13 polyvalent vaccine followed in 6-12months by 23polyvalent vac is given to those with?

Answer 7

• age above 65
• chronic heart,kidney,liver,lung dis
• asplenia
• hematologic malignancy
• immunocompromised

Question 8

PTB, the single most accurate test is?

Answer 8

Pleural biopsy

Question 9

Chronic pulmonary Aspergillosis

 - risk factors 
 - criteria for dx(3)

Answer 9

Usu in immunocompetent( invasive aspergillosis in immunocompromised) with a hx of pulmonary disease such as cavitary TB
Dx is made by the presence of
1. >3months of sxs- fever, weight loss, cough, hemoptysis, dyspnea, fatigue 2. Cavitary lesion containing debris, fluid or aspergilloma(fungus ball) 3. Positive aspergillus IgG serology

Question 10

Chronic pulmonary Aspergillosis

 - risk factors 
 - criteria for dx(3)

Answer 10

Usu in immunocompetent( invasive aspergillosis in immunocompromised) with a hx of pulmonary disease such as cavitary TV
Dx is made by the presence of
1. >3months of sxs- fever, weight loss, cough, hemoptysis, dyspnea, fatigue 2. Cavitary lesion containing debris, fluid or aspergilloma(fungus ball) 3. Positive aspergillus IgG serology

Question 11

Normal plural fluid PH
Transudative pleural effusion ph
Exudative

Answer 11

Normal 7.6
7.4-7.55
7.3-7.45
<7.3 is usu empyema or decreased hydrogen ion efflux from the pleural space eg pleiritis, tumor, pleural fibrosis

Question 12

Infants with bronchiolitis( RSV) are at high risk of developing ———

Answer 12

Apnea and respiratory failure