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Paige: Pulm Module! > Infectious d/o > Flashcards

Infectious d/o Flashcards

1
Q

What is the MC cause of CAP?

A

Streptococcus pneumoniae

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2
Q

What is the most common bacteria in pts with CAP and other lung disease?

A

Haemophilus influenzae

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3
Q

What is the MC cause of atypical (walking) pneumonia?

A

Mycoplasma pneumonia

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4
Q

Which pneumonia bacteria is related to outbreaks assocated with water supply?

A

Legionella pneumophila

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5
Q

Which pneumonia is seen post viral illness?

A

Staphylococcus aureus

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6
Q

What 4 other bacterias can cause pneumonia?

A

Chlamydia pneumoniae

Klebsiella pneumoniae

Anaerobes

Pseudomonas aeruginosa

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7
Q

Which viral pneumonia is MC in infants/small children?

A

RSV and parainfluenza

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8
Q

Which viral pneumonia is MC in adults?

A

influenza

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9
Q

In all, which microbes cause CAP?

A

S pneumonia

mycoplasma, chlamydia, viral (in healthy)

H influenzae, M catarrhalis (in COPD)

Legionella

Klebsiella and GNR (in ETOH)

S aureus

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10
Q

In all, which microbes cause hospital acquired pneumonia?

A

Gm neg rods

Pseudomonas

Klebsiella

Enterobacter

Serratia

Acinetobacter

S aureus

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11
Q

so what is community acquired pneumonia (CAP)?

A

patient acquires pneumonia outside of hospital/nursing home OR within 48 hours of admission

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12
Q

What is nosocomial (hosp acquired) pneumonia?

A

pneumonia occurs more than 48 hours after admission

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13
Q

Which organisms are “typical” pneumonia?

A

S pneumo

H influenzae

Klebsiella

S aureus

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14
Q

Which organisms are “atypical” pneumonia?

A

Mycoplasma

Chlamydia

Legionella

Viruses

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15
Q

What are the clinical manifestations of typical pneumonia?

A

sudden fever

prod cough

pleuritic chest pain

tachycardia/pnea

Rigors

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16
Q

What are the clinical manifestations of atypical pneumonia?

A

low grade fever

dry, nonprod cough

myalgias, malaise, sore throat, HA, N/V/D

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17
Q

What will you see on PE with typical pneumonia?

A

signs of consolidation like bronchial breath sounds, dullness to percussion, inc fremitus, crackles

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18
Q

What will you see on PE with atypical pneumonia?

A

Normal!

maybe crackles or rhonchi

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19
Q

How ya gonna diagnose pneumonia?

A

CXR/CT: Exudative pleural effusion may be present. Abcess formation

Sputum culture

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20
Q

What will you see specifically on Klebsiella CXR/CT?

A

RUL with bulging fissure and cavitations

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21
Q

What if you sputum comes back rusty and blood tinged? What organism?

A

Strep pneumonia

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22
Q

Sputum is like currant jelly?

A

Klebsiella

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23
Q

sputum is green?

A

H influenzae

Pseudomonas

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24
Q

sputum is foul?

A

anaerobes

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25
Q

What abx will you give for CAP outpatient?

A

macrolide or doxycycline

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26
Q

What will you give for CAP inpatient?

A

B lactam + macrolide (or doxy)

OR broad spectrum FQ

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27
Q

What will you give for CAP in ICU?

A

B lactam + macrolide OR

b lactam + broad FQ

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28
Q

What will you give for hosp acquired?

A

Anti-pseudomonal B lactam + anti-pseudomonal AG or FQ

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29
Q

What will you add to hosp acquired pneumo if you suspect legionella? MRSA?

A

legionella: macrolide

MRSA: vancomycin

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30
Q

How else can you manage a pt with pneumonia?

A

02, IV fluids

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31
Q

What are the pneumococcal vaccines?

A

PCV13: in childhood vaccination

PPV23: used in adults

(2-64y with chronic disease, 65+ otherwise)

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32
Q

How common is TB?

A

Not that common in US, but one of the leading causes of death worldwide

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33
Q

How is TB transmitted?

A

Respiratory droplets of Mycobacterium

Must inhale the droplets

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34
Q

Who is at a greater risk for getting TB?

A

those exposed

those from high prev areas

those immunodeficient (HIV)

under 4y

IVDU

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35
Q

What is the pathophysiology of TB?

A

Inhalation of airborne droplets –> mycobacterium reaches alveoli, gets ingested by macrophages –> if bacteria remains viable, active infection occurs

36
Q

There are three outcomes to getting infected. What are they?

A

Primary TB

Chronic (Latent) Tb

Secondary (Reactivation) TB

37
Q

What is primary TB?

A

the outcome of the initial infection - usually self-limited

patients are contagious in this stage

common in <4y

38
Q

What is chronic (latent) TB?

A

A pt gets the infection, but is able to control it

patients not contagious

(this happens about 90% of the time)

39
Q

What is secondary (reactivation) tb?

A

a pt who had the latent infection now gets reinfected

patients are contagious

common in HIV, elderly, malignancy, steroid use

40
Q

When TB is active, what are the clinical manifestations?

A
  1. Pulmonary sx: chronic prod cough, chest pain, hemoptysis
  2. Constitutional sx: night sweats, fever/chills, fatigue, anorexia, wt loss
41
Q

What will you see on PE with TB?

A

Signs of consolidation: rales/ronchi, dullness

42
Q

What is extra-pulmonary TB?

A

When it affects any organ system

e.g. Pott’s dz affects vertebrae

43
Q

What do you use to screen for TB?

A

PPD: Purified Protein Derivative

Give and examine in 48-72h

44
Q

What is a + PPD test

A

>5mm with a strong suggestion of TB (e.g. HIV, family members w/ it, abn CXR)

>10mm for other high-risk populations

>15mm for everyone else

45
Q

When will you see a false + PPD?

A

Chronic (latent) inf 2-4 weeks post exposure

46
Q

What is the gold standard for dx of TB?

A

Acid-fast bacilli culture

done on 3 different occasions + all must be negative

47
Q

What diagnostic measure do you use to EXCLUDE TB?

What would TB look like on this test?

A

CXR

Reactivation: upper lobe fibrocavitary

Primary: middle/lower lobe consolidation

48
Q

How do you treat TB?

A

Tx duration is 3-6 mos

RIPE: Rifampin, INH, Pyrazinamde, Ethambutol

49
Q

When is treated TB no longer infectious?

A

2 weeks after therapy begins

50
Q

What’s broncholitis?

A

inflammation of the bronchioles (lower resp tract)

51
Q

What is the pathophys of bronchiolitis?

A

your airways get obstructed because there is necrosis, which causes epithelium to slough off

there is also edema, causing narrowing

52
Q

What causes acute broncholitis?

A

RSV MC

also adenovirus, influenza, parainfluenza

53
Q

What are the risks for developing bronchiolitis?

A

infants 2mos-2y

exposure to cigs

no breastfeeding

premature

54
Q

How is bronchiolitis transmitted?

A

HIGHLY contagious

trans by direct contact w/ secretions

usually fall to spring

55
Q

What are clinical manifestations of bronchiolitis?

A

Fever

URI sx days before

respiratory distress inc. wheezing, tachypnea, nasal flaring, cyanosis

56
Q

How do you dx bronchiolitis?

A

Nasal washings: using monoclonal Ab testing

CXR shows nonspecific findings

57
Q

What’s the best predictor of bronchiolitis?

A

Pulse oximetry

02 < 96% admit to hosp

58
Q

How do you tx bronchiolitis?

A

Supportive w/ 02, fluid, antipyretics

Meds (ehhhh): b agonists

Severe: ribavirin

59
Q

How do you prevent bronchiolitis?

A

palivizumab prophylaxis

60
Q

What are sequellae of bronchiolitis?

A

otitis media w/ strep

pneumonia (MC)

asthma later in life (MC)

61
Q

What is acute bronchitis?

A

inflammation of trachea/bronchi

62
Q

What causes acute bronchitis?

A

MC Viruses

Adenovirus, parainfluenza, coxsackie, rhinovirus, RSV

Can also be caused by bacteria (S pneumo, H inf, M cat, Mycoplasma)

63
Q

When does acute bronchitis occur?

A

After URI

64
Q

Clinical manifestations of acute bronchitis?

A

similar to pneumonia

Cough - hallmark

65
Q

What is the gold standard diagnosis for acute bronchitis?

A

Clinical!!!!

CXR will be nonspecific or normal

66
Q

How do you manage acute bronchitis?

A

fluids, rest, antitussive drugs +/- bronchodilators

NO abx if healthy adult

67
Q

What is croup?

A

inflammation of the upper airway (larynx, subglottis, trachea)

68
Q

When does croup occur?

A

After an acute viral infection

MC parainfluenza, also adenovirus

69
Q

In what age group does croup occur?

A

6mos - 6y

70
Q

What is the pathophys of croup?

A

Infection leads to subglottic larynx and trachea swelling (which causes the sx)

71
Q

What are the sx of croup?

A

stridor, “barking” cough, hoarseness, dyspnea (worse at night)

maybe URI sx

72
Q

How do you dx croup?

A

Usually clinical

BUT you’ll prob get a cervical XR and see a steeple sign (subglottic narrowing of trachea)

73
Q

How do you treat croup?

A

cool, humidified air mist

oral steroids

02

74
Q

What is acute epiglottitis (supraglottitis)?

A

inflammation of the epiglottis, causes swelling

emergency

75
Q

What causes epiglottitis?

A

MC H influenzae type B

76
Q

Who gets epiglottitis?

A

MC in children 3mos-6y

males 2x MC

in adults: DM is a risk

77
Q

What are sx of epiglottitis?

A

Dysphagia, Drooling, Distress

Fevers, odynophagia, stridor, dyspnea, hoarseness, tripoding

78
Q

How do you diagnose epiglottitis?

A

Laryngoscopy is definitive. Cherry red epiglottis with swelling

Lat Cerv XR: Thumb Sign

79
Q

How do you treat epiglottitis?

A

Maintain airway

Dexamethasone can decrease airway edema

Tracheal intubation if severe

Abx: 2nd and 3rd gen cephalosporins

80
Q

What is pertussis?

A

whooping cough!

highly contagious infection

81
Q

What causes pertussis?

Who gets it?

A

Gm neg coccobaccilus

Children <2y

82
Q

What are the sx of pertussis?

A
  1. catarrhal phase: URI sx 1-2 wks
  2. paroxysmal phase: severe paroxysmal coughing fits with inspiratory whoop; emesis after cough
  3. convalescent phase: cough and emesis resolve
83
Q

How do you dx pertussis?

A

Nasopharyngeal swap w/in first 3wks

Severe lymphocytosis on CBC

84
Q

How do you treat pertussis?

A

Supportive is the mainstay

Abx (although they don’t help sx, only contagiousness): macrolides 1st line, Bactrim as 2nd line

85
Q

What are complications of pertussis?

A

pneumonia, encephalopathy, otitis media, sinusitis, seizures

Paige: Pulm Module! (7 decks)

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