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infectioues Repiratory Flashcards

1
Q

What is screen test for TB?
When consider positive?
If test posative how to determine if active or latent?

A

Tuberculosis skin test

> 15% mm for low risk
10mm for high risk

X-ray

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2
Q

What is the most common cause of lung abscess?

X ray feature?

RX?

A

Aspirations pneumonia

Dense Consolidation + air fluids level

Amoxicillin-sulbactam , carbapenem

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3
Q

Mangment of influenza?

A

Supportive tretment
If Pt present during 48h oseltamivir decrease course of disease

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4
Q

how to dignosed mycobacterium avium ?

A

to dignosed a non tuberculous lung disease u need , clilnical , lab , imiging
= culter of two sputum collected over week + imiging

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5
Q

how bronchiolitis present and how to confirm the dignosis ?

A

wheezing , tachypnea ,cough
Dx : nasopharyngeal swap for fluorescent antibody staining

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6
Q

mangment of bronchiolitis ?
when to hosptilized ?
main mangment if he nedd hosptlization ?

A

supportive care
(nasal suction and hydration)

marked respiratory distress , apnea , hypoxemia , feeding difficulties

highe-flow oxygen nasal cannula & monitoring

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7
Q

what is the prophylaxisi of RSV ?
when to use it ?

A

nirsevimab

infant < 8 month entering their first RSV season
if mother dose not taking RSV vaccine during gestation

8-19 month who are at risk , entering thire second RSV

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8
Q

how to score croup ?
=> clilnical feature used to score

A

westley croup severity score

level of consciousness
cyanosis
( in general if present need specialization /icu )

strider
retraction
air entry
(mild/ moderate )

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9
Q

how to managing croup ?

A

all chilled should take corticosteroid

for moderate
steroid and racemic epinephrine

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10
Q

URI prodrome + croup symptom => highe fever and inspiratory and exoiratory stridore , toxic appearing, dignoses ?

A

bacterial tracheitis

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11
Q

x ray feture for :
croup
bacterial tracheitis
epiglottitis

A

for 1st tow
steeple sign

last one
thumbprint

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12
Q

what could lead to false positive/negative tuberculin skin test (TST) ?

A

(+) vaccination + non tuberculosis mycobacterial

(-) corticosteroid / HIV ( affect immune respone )

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13
Q

pattern of klebsiella pneumoniae ?

A

alcoholic PT , aspiration
currant-jelly sputam
upper lobe infltration

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14
Q

most common causative agent for croup ?

A

parainfluenza viruses

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15
Q

how to mange croup ?

A

for mild => single dose dexamethasone
moderate => dexa + epinephrine

sever = specialization and respiratory support

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16
Q

how measles present ?
pathognomonic sign ?

A

highe grade fever
3 C , cough coryza , conjunctivitis
rash start from head toward toe

koplil spots is pathognomic

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17
Q

how to confirmed diagnosis of measles ?

A

IgM serum antibodies

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18
Q

mangment of measles ?
what supplement Pt need ?

A

supportive mangment
Vitamin A supplement

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19
Q

most common complication of measles ?

A

diarrhea

ear infection

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20
Q

pattern of pertussis ?

A

3 stage :

  • catarrhal phase (1-2w)
    like common cold with conjunctivitis and excessive lacrimation
  • paroxysmal phase (2-6w)
    main character of whooping cough ( cough end with highe pitch inspiratory end

-convalescent phase :
symptome start to resolved

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21
Q

mangment of pertussis ?

A

azithromycin ( dose not improved disease cours but affect transmission

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22
Q

diagnosis of pertusis ?

A

nasopharngial swap

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23
Q

when to suspect bacterial tracheitis ?

A

croup pattern that improved => wosring symptome with toxic appearance

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24
Q

most common cusae of bacterial tracheitis ?

A

S.auris

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25
dignosis / mangment of bacterial tracheitis ?
bronchoscopy definitive dignosis - air way mangment (OR) -IV antibody -bronchoscopy is Dx and Rx
26
how to assessed pneumonia severity ?
CURB 65 0-1 = low risk =>3 highe risk
27
in sever case of croup not improved withe dexamethasone and racemic epinephrine ?
giving racemic epinephrine every tow hours supportive mangment
28
how to treat pnemonia ?
1 no co-morbedity and no past three month use of antibiotic = azithromusin 2 co-mor OR 3M flourqinlon or betalactam+azithromysin hospital admision = same above ICU admision = all above special consideration -psudomonaus = piperacillin
29
EPV triad ?
pharyngitis , fever, lymphadenopathy
30
dignosis of EPV ?
heterophile-posative (The test is specific for heterophile antibodies produced by the human immune system in response to EBV infection. like pregnancy test )
31
mangment of infectious mononucleosis? what antibiotic used ?
supportive avoied contact sport to protect spleen (splenomegaly) amoxcellin could lead to generalized maculopapular rash
32
Complication of congintial rubella ?
hearing lose heard diseas ( PDA, pulmonary artery stenosis ) cataract
33
how pertussis affect respiratory system ?
damege cilia
34
pattern of diphtheriae ? mangment ?
sore throat fever lymphadenobathy etc/. (pseudomembranes ) erythromycin 500 mg q4d for 14 days isolation (report) airway support
35
what cardiac complication could caused by diphtheria ?
myocarditis
36
mangment of latent TB ?
1st line : - rifampin & isoniazid = for 3M once weekly - rifampin = 4M daily - isonized = 9m daily - INH & rifapentine =3m (short course is prefferd ) alternative : INH = 6-9M
37
what supplement should be coadministered with isoniazid ?
pyridoxine (Vitamins B6)
38
when TST consider Positive ?
induration = 15mm - if no risk induration = 10 mm - immigration last 5 year -IV user -live or work at highe risk area -comorbitdy (DM, CKD,lymphoma , malnutrion ) -child<4 year 5mm = induration HIV TB contact organ transplant / chronic immuncompromised (steroids user )
39
indicators for bacterial pnemonia ?
symptome < 7 days with lobar or segmental consolidation
40
witch three bacterial are most common cause of pneumonia in hiv Pt ?
S.pnemonia S.auris Hemophilus influenzae
41
TB + Pregnant what is the regiment Pt take ?
RIPE with out P rifampin , isoniazid , ethambutol for 6 month pyrazinamide X
42
latent TB + pregnant ?
same firest line rifampin + isoniazid add B6
43
Ab for mycoplasma pneumoniae?
macrolide ( azithromysin and calrithromucin )
44
if macrolide resistant suspected , what Ab for atypical pneumoniae should used ?
doxycycline or fluoroquinolone
45
most coomon cause of lung abcess ? risk factor ? Ab used
aspiration pnumonia superimposed infection after influnza mainly by S. auris ampicillin-sulbactam carbapenems
46
most common complication of bronchiolitis ?
secondary bacterial pneumonia
47
how to diagnosed influenza ? mangment ?
clinically , confirm by PCR /culture Mx/ supportive oseltamivir for high risk idelly within 48 houer
48
how long to get immunization after taking influenza vaccine ?
2 week
49
most common cause of pnemonia in HIV Pt ?
S.pnumonia most common in immunocompetent or immune compromised
50
most common adversed effect of MMR vaccine ?
febrile seizure
51
at bronchiolitis when O2 saturation consider adequate and no need for supplemental Oxygen ?
=>90 is good at bronchiolitis and close monitoring for hydration and nutrition is enough .
52
prophylaxis of pertussis ( Pt contact with sick Pt ) ?
azithromycin alternative ( trimethoprim-sulfamethoxazole )
53
malignancy related to epastian-barr virus ?
nasopharyngeal cancer
54
most common auscultation finding in croup ?
inspiratory stridor
55
witch vaccination decreased incidence of epiglottitis ?
H. influenza
56
best imaging modality to dignosed bronchiectasis ? name the sign on imaging ?
highe resoltion CT ring sign + tram track appearance
57
pattern of bronchiectasis ?
1 Hx of recurrent RT infection with copious sputum 2 Hx of cystic fibrosis . immune deficiency , airway obstruction , primary ciliary dyskinesia
58
mangment of bronchiectasis ?
AB airway clearance (chest physiotherapy, bronchodilator ) mucolytic
59
shape of streptococcus pneumonia ?
gram-positive lancet-shape diplococcie
60
psittacosis pattern ?
bet-bird owner or worker present with dry cough and hepatosplenomegaly
61
organism cause psittacosis ?
chlamydia psittaci
62
Ab for psittacosis adult , chiled , pregnant ?
doxycycline for pregnant and child erythromycin
63
Xray psittacosis ?
64
X ray show in psittacosis ?
prehilar or lower lobe infiltration
65
first and second line Ab for acute bacterial sinusities ?
amoxicilline -clav if allergic -cefdinir -cefuroxim -cefpodoxime
66
Pt with strock , what consider risk to developed aspiration pneumonia ?
using NGTube
67
affected area in lung cused by aspiration pnemonia ?
superior segment of lower lobe or posterior segments of upper lobe
68
minimum age of influenza vaccine ? type*
6 minth note : from 6 m -23m inactivated vaccine recomndedd
69
chlamydia trachomatis pattern and mangment ?
3-19 week age present with conjunctivitis and pnemonia (staccato cough : machine gun-like) macrolid azithromycin
70
centore criteria interpretation ?
1 exudative tensile 2 tender anteriore cervical lymphadenopathy 3 Absence of cough 4 Fever 5 age <15 -1 if age >45 =>2 go to RADT (rapid antigen detecting test)
71
centore criteria interpretation ?
1 exudative tensile 2 tender anteriore cervical lymphadenopathy 3 Absence of cough 4 Fever 5 age <15 -1 if age >45 =>2 go to RADT (rapid antigen detecting test)
72
most common cause of bacterial pharyngitis ? main complication for this organism ?
group A B-hemolytic streptococcus complication : Rhuematic fever , post-streptocoocal glomerulnephrities peritonsillar abscess
73
most common cause of lung abscesses , and organism related ?
aspiration pneumonia polymicrobial infection with anerobic bacteria .
74
Rx of lung abscess?
ampicillin- sulbctam carbapenems
75
pattern of epiglottitis ?
rapid onset respiratory distress , drolling tripod position (leaning forward with neck extended )
76
pattern of roseola ?
fever --subside--> rash maculopapular rash start from trunk then to peripherally
77
mangment of rosola infantum ?
suuportive
78
pneumocystis pneumonia organism ?
fungel pneumocystis jirovecii
79
diagnostic indicators of pneumocystis pneumonia ?
- CD4 < 200 - x-ray show bilateral infiltration (batwing pattern) high level of 1-3-beta-D-glucan
80
in pneumonia when using of macrolide not preferred regarding resistance in local area ?
if reseitant =>25%
81
amoxicilline dose in mangment of pneumonia ?
highe dose 1g tid for 5 days
82
witch bacteria are most commonly associted with acute bronchitis ?
perussis , mcoplasm pnemoniae , chlamydia
83
how to confirm diagnoses of pertussis ?
culter (gold stander, more spesafic , tak days ) PCR nasopharngeal specimen : ( more sensetive , take houers ) PCR prefferd over culter
84
sign for improvement after taking antibiotic for Pt Ex: pneumoniea ?
fever reduction in 48-72 hour
85
sign for improvement after taking antibiotic for Pt Ex: pneumoniea ?
fever reduction in 48-72 hour
86
most common cause of empyema ?
pneumonia with parapneumonic effusion
87
witch are respiratory fluoroquinolones ?
moxifloxacin levofloxacin gemifloxacin
88
what is RIME ?
rwactive infectioues mucocutaneous eruption folloing infectioues trigger ( mainlly mycobacterium pneumonia) affecte mucosal surfes and skin ( mouthe nose conjctive genital area ) involved <10% of the skin
89
Ab for CAP aspiration susbected in pediatric ?
ampicilline-sulbactam or **clindamycine**
90
pneumonia + bird /Hx of travel ?
histoplasmosis
91
mangment of histoplasmosis ?
immuncompetant , <4 week , mild = supportive no = itraconazole 200mg PO TID for 1st 3day => then OD for 12 week for more sever disease ( resp faliuer etc..) = liposomal amphotericin
92
true/fals : start oseltamivir with out definitive dignosis for influenza ? true/fals : start oseltamivir even if Pt take Flu Vacc ?
true ( during seasonal outbreak of influenza clinical dignosis is sufficient ) true
93
diagnoses of influenza ?
reverse transcription polymerase chain reaction RT-PCR
94
high risk group in influenza ?
age > 65 age < 2 pregnant immunocompromised comorbidity
95
mangment of aspiration pneumonia in adult ?
evidence of abcessess : amcilline- sulbactam amoxciline-clavulante amoxcilline + metro no evidence : mang as CAP
96
what viral infection is known to greatly increase the susceptibility to bacterial tracheitis ?
influenza A
97
mangment of tracheitis ?
air way mangment (OR) IV antibiotic
98
antibiotic for infectious epiglottitis ? most common organism ?
heamophilues influenza third generation cephalosporins + antistaphylococcus (cefotaxime + vancomycin )
99
when should u repeat Xray for Pt with pneumonia ?
6 week
100
most common transplant-related infections ?
depend on the time of infection first month : nosocomial pathogens : s.auries , pseudomonas, MRSA 1-6 month : CMV , EBV, listeria , pneumocystis after 6 month : CMV , EBV ,HSV ,Hb ,Hc ,Tb
101
Ab used for sever CAP ?
3rd generation cephal + macrolides or resp fluoroquinolone
102
Ab used for sever CAP ?
beta lactam + macrolides or resp fluoroquinolone
103
Hx of bird exposure + cough Ab to use ?
histoplasmosis => itraconazole or amphotericin B
104
mechanism of action for oseltamivir ?
treatment of influenza work by inhibiting neuraminidase
105
oseltamivir contraindicated for pregnant Pt ?
false / it is first line treatment
106
preferred methode to diagnosed acute bacterial rhinosinusitis ?
clinical presentation is preferred and enough for start antibiotic
107
common site for aspiration pneumonia ?
Rt lung
108
mangment of pharyngitis ?
centore criteria => 2 RADT if + amoxicillin alternative cephalosporin
109
Q: What is the role of urine-based detection of mycobacterial cell wall glycolipid lipoarabinomannan assay in diagnosing tuberculosis?
A: It is most useful for diagnosing tuberculosis in patients positive for human immunodeficiency virus, particularly in those with CD4 counts of 100 cells/ mm³ or less.
110
pattern of epiglottitis ?
abrupt onset distress and drooling fever stridore
111
empiric tratment for M. pneumonia ?
beta lactam well NOT improved PT A: doxycycline or macrolide or fluroquinolone
112
mangment of latent TB in pediatric ?
isoniazid

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