infectioues Repiratory Flashcards
What is screen test for TB?
When consider positive?
If test posative how to determine if active or latent?
Tuberculosis skin test
> 15% mm for low risk
10mm for high risk
X-ray
What is the most common cause of lung abscess?
X ray feature?
RX?
Aspirations pneumonia
Dense Consolidation + air fluids level
Amoxicillin-sulbactam , carbapenem
Mangment of influenza?
Supportive tretment
If Pt present during 48h oseltamivir decrease course of disease
how to dignosed mycobacterium avium ?
to dignosed a non tuberculous lung disease u need , clilnical , lab , imiging
= culter of two sputum collected over week + imiging
how bronchiolitis present and how to confirm the dignosis ?
wheezing , tachypnea ,cough
Dx : nasopharyngeal swap for fluorescent antibody staining
mangment of bronchiolitis ?
when to hosptilized ?
main mangment if he nedd hosptlization ?
supportive care
(nasal suction and hydration)
marked respiratory distress , apnea , hypoxemia , feeding difficulties
highe-flow oxygen nasal cannula & monitoring
what is the prophylaxisi of RSV ?
when to use it ?
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
how to score croup ?
=> clilnical feature used to score
westley croup severity score
level of consciousness
cyanosis
( in general if present need specialization /icu )
strider
retraction
air entry
(mild/ moderate )
how to managing croup ?
all chilled should take corticosteroid
for moderate
steroid and racemic epinephrine
URI prodrome + croup symptom => highe fever and inspiratory and exoiratory stridore , toxic appearing, dignoses ?
bacterial tracheitis
x ray feture for :
croup
bacterial tracheitis
epiglottitis
for 1st tow
steeple sign
last one
thumbprint
what could lead to false positive/negative tuberculin skin test (TST) ?
(+) vaccination + non tuberculosis mycobacterial
(-) corticosteroid / HIV ( affect immune respone )
pattern of klebsiella pneumoniae ?
alcoholic PT , aspiration
currant-jelly sputam
upper lobe infltration
most common causative agent for croup ?
parainfluenza viruses
how to mange croup ?
for mild => single dose dexamethasone
moderate => dexa + epinephrine
sever = specialization and respiratory support
how measles present ?
pathognomonic sign ?
highe grade fever
3 C , cough coryza , conjunctivitis
rash start from head toward toe
koplil spots is pathognomic
how to confirmed diagnosis of measles ?
IgM serum antibodies
mangment of measles ?
what supplement Pt need ?
supportive mangment
Vitamin A supplement
most common complication of measles ?
diarrhea
ear infection
pattern of pertussis ?
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
mangment of pertussis ?
azithromycin ( dose not improved disease cours but affect transmission
diagnosis of pertusis ?
nasopharngial swap
when to suspect bacterial tracheitis ?
croup pattern that improved => wosring symptome with toxic appearance
most common cusae of bacterial tracheitis ?
S.auris
dignosis / mangment of bacterial tracheitis ?
bronchoscopy definitive dignosis
- air way mangment (OR)
-IV antibody
-bronchoscopy is Dx and Rx
how to assessed pneumonia severity ?
CURB 65
0-1 = low risk
=>3 highe risk
in sever case of croup not improved withe dexamethasone and racemic epinephrine ?
giving racemic epinephrine every tow hours
supportive mangment
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
EPV triad ?
pharyngitis , fever, lymphadenopathy
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 )
mangment of infectious mononucleosis?
what antibiotic used ?
supportive
avoied contact sport to protect spleen (splenomegaly)
amoxcellin could lead to generalized maculopapular rash
Complication of congintial rubella ?
hearing lose
heard diseas ( PDA, pulmonary artery stenosis )
cataract
how pertussis affect respiratory system ?
damege cilia
pattern of diphtheriae ?
mangment ?
sore throat fever lymphadenobathy etc/.
(pseudomembranes )
erythromycin 500 mg q4d for 14 days
isolation (report)
airway support
what cardiac complication could caused by diphtheria ?
myocarditis
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
what supplement should be coadministered with isoniazid ?
pyridoxine (Vitamins B6)
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 )
indicators for bacterial pnemonia ?
symptome < 7 days with lobar or segmental consolidation
witch three bacterial are most common cause of pneumonia in hiv Pt ?
S.pnemonia
S.auris
Hemophilus influenzae
TB + Pregnant what is the regiment Pt take ?
RIPE with out P
rifampin , isoniazid , ethambutol for 6 month
pyrazinamide X
latent TB + pregnant ?
same firest line
rifampin + isoniazid
add B6
Ab for mycoplasma pneumoniae?
macrolide ( azithromysin and calrithromucin )
if macrolide resistant suspected , what Ab for atypical pneumoniae should used ?
doxycycline or fluoroquinolone
most coomon cause of lung abcess ?
risk factor ?
Ab used
aspiration pnumonia
superimposed infection after influnza mainly by S. auris
ampicillin-sulbactam
carbapenems
most common complication of bronchiolitis ?
secondary bacterial pneumonia
how to diagnosed influenza ?
mangment ?
clinically , confirm by PCR /culture
Mx/ supportive
oseltamivir for high risk idelly within 48 houer
how long to get immunization after taking influenza vaccine ?
2 week
most common cause of pnemonia in HIV Pt ?
S.pnumonia most common in immunocompetent or immune compromised
most common adversed effect of MMR vaccine ?
febrile seizure
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 .
prophylaxis of pertussis ( Pt contact with sick Pt ) ?
azithromycin
alternative ( trimethoprim-sulfamethoxazole )
malignancy related to epastian-barr virus ?
nasopharyngeal cancer
most common auscultation finding in croup ?
inspiratory stridor
witch vaccination decreased incidence of epiglottitis ?
H. influenza
best imaging modality to dignosed bronchiectasis ?
name the sign on imaging ?
highe resoltion CT
ring sign + tram track appearance
pattern of bronchiectasis ?
1 Hx of recurrent RT infection with copious sputum
2 Hx of cystic fibrosis . immune deficiency , airway obstruction , primary ciliary dyskinesia
mangment of bronchiectasis ?
AB
airway clearance (chest physiotherapy, bronchodilator )
mucolytic
shape of streptococcus pneumonia ?
gram-positive
lancet-shape diplococcie
psittacosis pattern ?
bet-bird owner or worker
present with dry cough and hepatosplenomegaly
organism cause psittacosis ?
chlamydia psittaci
Ab for psittacosis adult , chiled , pregnant ?
doxycycline
for pregnant and child erythromycin
Xray psittacosis ?
X ray show in psittacosis ?
prehilar or lower lobe infiltration
first and second line Ab for acute bacterial sinusities ?
amoxicilline -clav
if allergic
-cefdinir
-cefuroxim
-cefpodoxime
Pt with strock , what consider risk to developed aspiration pneumonia ?
using NGTube
affected area in lung cused by aspiration pnemonia ?
superior segment of lower lobe
or posterior segments of upper lobe
minimum age of influenza vaccine ? type*
6 minth
note : from 6 m -23m inactivated vaccine recomndedd
chlamydia trachomatis pattern and mangment ?
3-19 week age present with conjunctivitis and pnemonia
(staccato cough : machine gun-like)
macrolid azithromycin
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)
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)
most common cause of bacterial pharyngitis ?
main complication for this organism ?
group A B-hemolytic streptococcus
complication :
Rhuematic fever ,
post-streptocoocal glomerulnephrities
peritonsillar abscess
most common cause of lung abscesses , and organism related ?
aspiration pneumonia
polymicrobial infection with anerobic bacteria .
Rx of lung abscess?
ampicillin- sulbctam
carbapenems
pattern of epiglottitis ?
rapid onset respiratory distress , drolling
tripod position (leaning forward with neck extended )
pattern of roseola ?
fever –subside–> rash
maculopapular rash
start from trunk then to peripherally
mangment of rosola infantum ?
suuportive
pneumocystis pneumonia organism ?
fungel pneumocystis jirovecii
diagnostic indicators of pneumocystis pneumonia ?
- CD4 < 200
- x-ray show bilateral infiltration (batwing pattern)
high level of 1-3-beta-D-glucan
in pneumonia when using of macrolide not preferred regarding resistance in local area ?
if reseitant =>25%
amoxicilline dose in mangment of pneumonia ?
highe dose
1g tid for 5 days
witch bacteria are most commonly associted with acute bronchitis ?
perussis , mcoplasm pnemoniae , chlamydia
how to confirm diagnoses of pertussis ?
culter
(gold stander, more spesafic , tak days )
PCR nasopharngeal specimen :
( more sensetive , take houers )
PCR prefferd over culter
sign for improvement after taking antibiotic for Pt Ex: pneumoniea ?
fever reduction in 48-72 hour
sign for improvement after taking antibiotic for Pt Ex: pneumoniea ?
fever reduction in 48-72 hour
most common cause of empyema ?
pneumonia with parapneumonic effusion
witch are respiratory fluoroquinolones ?
moxifloxacin
levofloxacin
gemifloxacin
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
Ab for CAP aspiration susbected in pediatric ?
ampicilline-sulbactam or
clindamycine
pneumonia + bird /Hx of travel ?
histoplasmosis
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
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
diagnoses of influenza ?
reverse transcription polymerase chain reaction
RT-PCR
high risk group in influenza ?
age > 65
age < 2
pregnant
immunocompromised
comorbidity
mangment of aspiration pneumonia in adult ?
evidence of abcessess :
amcilline- sulbactam
amoxciline-clavulante
amoxcilline + metro
no evidence :
mang as CAP
what viral infection is known to greatly increase the susceptibility to bacterial tracheitis ?
influenza A
mangment of tracheitis ?
air way mangment (OR)
IV antibiotic
antibiotic for infectious epiglottitis ?
most common organism ?
heamophilues influenza
third generation cephalosporins + antistaphylococcus
(cefotaxime + vancomycin )
when should u repeat Xray for Pt with pneumonia ?
6 week
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
Ab used for sever CAP ?
3rd generation cephal + macrolides
or
resp fluoroquinolone
Ab used for sever CAP ?
beta lactam + macrolides
or
resp fluoroquinolone
Hx of bird exposure + cough
Ab to use ?
histoplasmosis
=> itraconazole or amphotericin B
mechanism of action for oseltamivir ?
treatment of influenza
work by inhibiting
neuraminidase
oseltamivir contraindicated for pregnant Pt ?
false /
it is first line treatment
preferred methode to diagnosed acute bacterial rhinosinusitis ?
clinical presentation is preferred and enough for start antibiotic
common site for aspiration pneumonia ?
Rt lung
mangment of pharyngitis ?
centore criteria => 2
RADT if +
amoxicillin
alternative cephalosporin
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.
pattern of epiglottitis ?
abrupt onset
distress and drooling
fever stridore
empiric tratment for M. pneumonia ?
beta lactam well NOT improved PT
A: doxycycline or macrolide
or fluroquinolone
mangment of latent TB in pediatric ?
isoniazid
