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PULMONARY BOARDS > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

Tx of echinococcus

A

albendazole

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2
Q

Tx of strongyloides

A

ivermectin

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3
Q

___ is associated with increased risk of invasive pneumococcal PNA

A

opioid use

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4
Q

___ (behavior) is associated with increased CAP

A

high alcohol consumption

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5
Q

risk factors for pseudomonas pna

A
  1. prior pseudomonas infection
  2. bronchiectasis
  3. tracheostomy
  4. COPD
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6
Q

WHich imaging has highest sensitivity of PNA

A

POCUS
CT Chest

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7
Q

Most common pathogens in lower respiratory infection

A

VIRUSES - more common than bacterial
#1 rhinovirus
Influenza A & B
HMP
RSV
Parainfluenza
Coronavirus
Adenovirus

and #1 strep pneumoniae

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8
Q

MRSA nares has what components of the following (high or low)

Sensitivity
Specificity
PPV
NPV

A

85% sensitivity
92% specificity
POOR PPV (57%)
great NPV (98%)

If the test is negative, very unlikely that MRSA is present in the lungs

Parente, Clin ID 2018

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9
Q

Does having MRSA in the past 12 mo show colonization?

A

no

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10
Q

In non-severe outpatient CAP, what testing is indicated

A

Influenza
Covid

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11
Q

In severe and non-severe admitted patients with CAP, what testing is indicated

What about immunocompromised patients

(Based on ATS/IDSA 2019 guidelines)

A

Influenza
Blood & resp culture (only if risk of MRSA or pseudomonas in non-severe)
Legionella U Ag only if local outbreak
MRSA PCR

In severe CAP and immunocompromised, additionally should include legionella UAg no matter what, Strep urinary Ag
PNA PCR (NAAT)
RVP

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12
Q

What is the effect of using procalcitonin in treatment of CAP

A

reduce the # of days the patient will be on Abx

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13
Q

CURB 65

A

Confusion
Urea
Resp
Blood pressure <90/60

> 65 yo

3 or more requires hospitalization

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14
Q

Severe CAP criteria (whether or not to admit to ICU)

A

Either 1 major or 3+ minor

Major criteria:
1. Septic Shock with need of vasopressors
2. Respiratory failure requiring mechanical ventilation

Minor:
- RR >30bpm
- P:F ratio <250
- Multilobar infiltrates
- Confusion
- Uremia BUN >20
- Leukopenia <4000
- Thombocytopenia <100
- Hypothermia core <36C
- Hypotension requiring aggressive fluid resus

Minor: RPM CULTHH

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15
Q

CAP outpatient tx

A

No comorbidities:
the usuals (amox, doxy, or macrolides)

+ comorbidities:
Augmentin
Cefuroxime
PLUS macrolide or doxy
or resp fluoroquinolone

ATS/IDSA 2019

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16
Q

CAP inpatient tx

A

Non-severe:
beta-lactam + macrolide
OR
resp fluoroquinolone
+ antipseudomonal if prior pseudomonas in 12 mo

Severe:
betalactam + macrolide
OR
betalactam + resp fluoroquinolone

for either above:
+ Anti-MRSA to be added if prior MRSA infection in 12 mo

+ anti-pseudomonal if prior pseudomonas in 12 mo

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17
Q

Covid tx outpatient

A

paxlovid
can get remdesivir

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18
Q

Indication for starting remdesivir for covid 19

A

hospitalization
O2 requirement (but not if its so severe you need HFNC, can consider in those who are at high risk of dz progression)

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19
Q

Indication for starting dexamethasone in covid 19

A

requiring O2 supplement

If with HFNC, should be given with remdesivir

If still very hypoxic, add baricitinib or IV tocilizumab

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20
Q

Indication for giving IV tocilizumab in covid-19 infection

(or IV sarilumab)

A

Hospitalized, requiring mechanical ventilation or ECMO

within 24h of MICU admission

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21
Q

When is remdesivir NOT indicated for covid-19 infection

A

hospitalized without O2 requirement OR mechanically ventilated OR ECMO

(so the mild-moderate people can get it, not the severe)

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22
Q

Duration of abx for CAP coverage in the hospital

A

3-5-7days if clinically stable

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23
Q

When should you cover for anaerobes in PNA

A

severe CAP (even this is controversial)
Parapneumonic effusion

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24
Q

WHen is corticosteroids indicated in CAP

A

severe CAP with high CRP
Covid-19 with O2 requirement

Contraindicated in influenza

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25
Q

Vaccinations indicated for respiratory protection (6)

A

Influenza
Covid-19
RSV
PCV20
Herpes Zoster
TdaPertussis

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26
Q

Definition of HAP

A

> 48h in the hospital

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27
Q

Ventilator associated pneumonia definition

A

ventilated for >48h

AND

2 or more of:
fever
abnormal WBC
sputum purulence
New infiltrate

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28
Q

VAP after vomiting in a patient who had abd surgery, patient likely has which pathogen

A

pseudomonas aeruginosa!

Gram negative bacteria

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29
Q

Rate of anaerobes in VAP and aspiration pneumonia

A

pretty much none

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30
Q

Superinfections in the ICU associated with covid-19 include which pathogens?
(4 bacteria, 2 fungi)

A

acinetobacter
e. coli
kleb
pseudomonas

candida
aspergillus

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31
Q

MDR risk factors (3)

A
  1. IV abx in the past 90 days
  2. Unit rate >20% of MRSA
  3. positive screening or prior infection or colonization with MDR
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32
Q

Most relevant risk factor for suspecting MDR pathogens in patients with HAP

A

prior IV Abx use within 90 days

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33
Q

HAP tx (no MDR risk factors with low risk of death)

A

zosyn
cefepime
levoflox
imipenem or meropenem

consider coverage for MSSA

If CF or NonCF bronchiectasis, consider pseudomonal coverage

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34
Q

VAP tx

A

MRSA coverage
Pseudomonal coverage (consider double)

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35
Q

Risk factor for MRSA

A

Prior 90d abx therapy
Unit rate 10-20% prevalence or unknown
Need for vent support or septic shock

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36
Q

When to add double pseudomonal coverage in HAP

A

High mortality risk
VAP
prior risk of pseudomonas

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37
Q

What abx should you not use alone for HAP

A

aminoglycoside

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38
Q

Duration of tx for HAP or VAP

A

7d

unless non-lactose fermenting GNR (pseudomonas, acinetobacter, steno) and not getting better, consider longer duration

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39
Q

Tx for acinetobacter HAP/VAP sensitive only to polymyxins

A

IV polymyxin (colistin or polymyxin B)

AND

adjunctive inhaled colistin

No effect on mortality or nephrotoxicity but with clinical improvement

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40
Q

For GNR/acinetobacter VAP/HAP with sensitivity to aminoglycosides or polymyxins OR carbapenem resistant, must use ____

A

both inhaled and systemic abx

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41
Q

Should you treat ventilator associated tracheitis?

A

NO

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42
Q

Tx of acinetobacter and pseudomonas (at the same time)

A

cefiderecol

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43
Q

Treatment of acinetobacter

A

unasyn (beta lactams)
or carbapenems and fluoroquinolones

aminoglycoside or bactrim for UTI

Resistant disease: polymyxin B, colistin

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44
Q

Carbapenemase producing genes (Enterobacterales)

A

KPC
OXA-48
MBL

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45
Q

Most common resistance mechanism in pseudomonas (intrinsic)

A

DNA gyrase and topoisomerase IV (fluoroquinolone resistance)

AmpC (b-lactams)

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46
Q

Most common resistance mechanism in pseudomonas (imported)

A

class A, B, D ….

b-lactam (ESBL) and carbapenem resistance and abx inactivation

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47
Q

Important VAP prevention

A

Oral care- toothbrushing WITHOUT chlorhexedine

Minimize sedation

Maintain and improve physical conditioning

Avoid intubation/prevent reintubation

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48
Q

What ICU interventions have no impact on VAP rates

A

stress ulcer ppx
monitoring residual gastric volumes
closed endotracheal suctioning systems

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49
Q

percent of household contact that will become infected with TB

A

~35%

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50
Q

Percent of LTBI that progresses to TB disease

how about if you’re on HIV or TNF alpha-blockers?

A

~10% per lifetime

HIV and TNF alpha blocker = 10% PER YEAR

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51
Q

MDR TB definition

A

Resistant to INH AND Rifampin

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52
Q

XDR TB definition

A

MDR TB (INH, Rif) +

Fluoroquinolone
AND
at least one of the injectables or bedaquiline/linezolid

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53
Q

infecting dose of MTB = __#___ organisms

A

10

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54
Q

smear negative TB but culture positive, how infectious is the patient?

A

15-17%

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55
Q

Most common location of pulmonary TB in immunocompetent patient

A

RUL posterior segment

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56
Q

Sensitivity of 3x AFB and 2x MTB PCR for TB disease

A

85%

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57
Q

Pregnant patients and TB tx

A

IRE (no PZA - in US lack of safety data, though WHO recommends it)

for 2 mo, then 7 mo of IR (total 9 mo)

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58
Q

MDR TB tx

A

BPaL
Bedaquiline, Pretomanid
Linezolid

59
Q

Timing of highest risk of TB reactivation after exposure

A

within 1-2 years

60
Q

You can have + TST or IGRA with what other diseases other than MTB

A

M. bovis, NTM

61
Q

IGRA and TST PPV and NPV (in non-immunocompromised patients)

A

both >90% NPV

Better specificity of IGRA

62
Q

Dose of prednisone that increases TB reactivation risk

A

> 15 mg prednisone

63
Q

“Dimorphic” definition

A

can live in either shape as a yeast or mold depending on temp

64
Q

septated acute branching hyphae at 45 degree angle

A

aspergillus

65
Q

Biggest risk factor for invasive pulmonary aspergillosis

A

prolonged neutropenia

CGD

66
Q

Pauci-septated 90degree angle branching hyphae, ribbon like

A

mucor

67
Q

What can give you false positive galactomannan

A

histoplasma
high rice/pasta diet (What?)
plasma-lyte
some beta-lactams (older ones)

68
Q

Does TBBx increase sensitivity for diagnosing invasive pulmonary aspergillosis?

A

not much

69
Q

WHich are more likely to have pleural effusion, mucor or invasive aspergillosis?

A

mucor

70
Q

Other than vori, what other meds can you use for invasive aspergillosis

A

isavuconazonium

posaconazole (for ppx)

can be paired with echinocandin

71
Q

which type of aspergillus would aspergillus IgG ab be present?

A

chronic necrotizing pulmonary aspergillosis

AND

ABPA

72
Q

Tx of ABPA

A

steroids +/- itraconazole

+/- omalizumab

73
Q

BDG and Galactomannan for mucor

A

would be negative

74
Q

Mucor tx

A
  1. surgical resection
  2. antifungals (ampho, posaconazole, isovuconazole)
  3. immune reconstitution

stop iron chelating agent if they are on it

75
Q

candida in urinary or respiratory tract, do you treat?

A

more likely colonization

76
Q

spaghetti and meatballs, yeast and pseudohyphae on path

A

candida

77
Q

Treatment of toxoplasmosis

A

pyrimethamine and sulfadiazine

78
Q

Treatment of paragonimiasis

A

praziquantel (two long Ps!)

79
Q

fungal infection most likely to have peripheral eosinophilia

A

coccidiodomycosis

80
Q

treatment of mpox

A

tecovirimat

2nd line cidofovir

81
Q

Someone works with animal skinning, pleural effusion with lymphocytic predominance

A

Tuleremia

82
Q

Treatment for tuleremia

A

mild: doxy or cipro
mod to severe: aminoglycoside (classically genta)

83
Q

Pt with nocardiosis, aspergillosis and noncaseating granulomas on path, what does this patient likely have

A

chronic granulomatous disease CGD

84
Q

How do you test for CGD

A

test for dihydrorhodamine with indirect flow cytometry

85
Q

path showing “pseudohyphae, budding yeasts”

A

candida

86
Q

branching, beaded, anaerobe on path

A

actino

87
Q

branching beaded, will grow on agar (aerobe). weakly acid fast. Gram positive

A

nocardia

88
Q

which can you use with carbapenem-resistant enterobacterales?

ceftaz/avibactam or ceftolozane/tasobactam

A

ceftaz/avibactam

89
Q

Treatment of candidemia (antifungal and duration)

A

echinocandins –> later can transition to azoles if susceptible

Candidemia only: Continue two weeks after neg blood cultures

Endophthalmitis 4-6 weeks

Consider prophylaxis for 1 week with fluconazole if colonization of 2 or more sites (inconsistent literature)

90
Q

broad based dimorphic fungus like a bowling pin

+ skin lesion

A

blasto

91
Q

Mississippi/Arkansas/Michigan, dog is also sick, bony erosion, ulcerative, verrucous derm findings, pneumonia (or even ARDS) think ___

A

blasto

92
Q

Dx of blasto

A

serum and urine Ag, BAL

Ab to anti-BAD-1 Ag

93
Q

fruiting heads on path

A

aspergillosis

94
Q

Infection that is an absolute contraindication for lung transplant

A

Bukholderia cenocepacia, M. abscessus

95
Q

Owl’s eyes on path

A

CMV

96
Q

Blasto tx

A

no tx if sx are mild (like mild cough)

Mild-moderate: itraconazole 6-12 mo

Severe ampho B 1-2wk then itraconazole

CNS: ampho
Pregnancy: ampho (avoid azoles)

97
Q

Skin manifestation of coccidioidomycosis

A

erythema nodosum

98
Q

Dx of coccidio

A

Ab testing
Urine and serum Ag

99
Q

Spherules on culture or path

A

coccidiomycosis

100
Q

Treatment of coccidio

A

immunocompetent: observation

If sx persist >6 weeks:
fluconazole or itra
or amphotericin in severe cases

101
Q

Narrow based fungus

A

histo

102
Q

spelunking and bats, chicken coops pneumonia with pulm nodules

A

histo

103
Q

infection related to broncholithiasis and fibrosing mediastinitis

A

histo

104
Q

Dx of histo

A

serum Ag (sens 81%, spec 98%)
Urine Ag, BAL, CSF

culture may take 6 weeks to grow

105
Q

Tx of histo

A

mild or chronic - observation

moderate disease: itraconazole

severe: ampho

106
Q

Round, oval, helmet, crushed ping-pong ball or crescent shaped, dot-like foci with enhanced staining

A

PJP

107
Q

Tx for influenza that is contraindicated in asthma

A

zanamivir

108
Q

halo, narrow based budding, mucicarnine stain +

A

crypto

109
Q

Alternative to TMP-SMX for PJP

A

Add steroids if a-a gradient >35mmHg

Severe disease
clinda + primaquine
IV pentamidine

Mild disease:
TMP + dapsone
Atovaquone

110
Q

Difference between malaria and lepto (serum lab findings) (2)

A
  1. lepto has isolated elevated bilirubin
  2. hypoglycemia is more typical in malaria
111
Q

Tx for c. neoformans

A

Fluconazole (lung)

Ampho + flucytosine (CNS) - induction (minimal 2 weeks, or more if severe and cryp Ag still high), consolidation with fluconazole for 2 mo, then 1 year of maintenance therapy with fluc or other azoles (except itra) if not tolerating fluc

112
Q

Where is Cryptococcus gattii endemic

A

tropical and subtropical regions plus pacific coast of N america

113
Q

Azoles that need monitoring (levels)

A

itraconazole
posaconazole
voriconazole

(IPV)

114
Q

MOA of azoles

A

inhibit cell wall function/growth

115
Q

What is echinocandins fungicidal to

A

CANDIDA

echinoCANDins

116
Q

Which test should we use for influenza that is recommended by the CDC

A

RT-PCR (4-6h turn around time)

Rapid influenza Ag detection (neuroaminidase assay) has low/mod sensitivity but high specificity

117
Q

What viruses (aside from Sars-cov-2) can cause really bad ARDS

A

adenovirus
Human metapneumo

118
Q

who should be treated for influenza

A

pregnant ppl
immunocompromised

within 48h of sx
If hospitalized, lab confirmed, can prob treat >48h of sx

Start early, don’t wait for viral test to come back if influenza is suspected

119
Q

CMV timing post LT

A

1-6 mo (not in the acute post-transplant time)

120
Q

Which is more typical for actinomyces rather than nocardia

A

can extend fascial planes

121
Q

Tx of nocardia

A

bactrim

CNS involvement: bactrim, meropenem, amikacin (6 weeks IV), then ORAL bactrim, minocycline, augmentin

6-12 mo therapy

122
Q

Definition of “refractory MAC”

A

ongoing positive sputum after 6 mo

add amikacin (for pan-sensitive)

123
Q

Tx for patients exposed to MDR-TB

A

levofloxacin for 6-12 mo

124
Q

difference between crypto neoformans and c. gattii

A

c. neoformans: immunocompromised

c. gatti: immunocompetent ppl (eucalyptus tree)

125
Q

risk for actinomycosis

A

ETOH
Poor dentition

126
Q

actino on path

A

sulphur granules

127
Q

actino treatment

A

PENICILLINS
or
ceftriaxone

avoid aminoglycoside

128
Q

How is nocardia spread throughout the body

A

hematogenously

129
Q

How is actinomycosis spread throughout the body

A

direct invasion

130
Q

SE Asia, raw crab & crayfish ingestion, consolidation, eosinophilic pleural effusion, chocolate-colored sputum. Dx/Tx?

A

Paragonimus westermani

eggs in BAL + Elisa

Tx: praziquantel, triclabendazole

131
Q

SE asia, nocturnal cough, migratory GGOs, refractory asthma, peripheral eos, mosquito bite, elevated IgE. Dx?

A

Wuchereria bancrofti

Tx diethylcarbamzine

132
Q

Tx histoplasmosis

A

Mild: itraconazole
Severe: ampho

133
Q

Blasto tx

A

Mild: itraconazole
Severe ampho

134
Q

Cocci tx

A

Mild fluconazole or itraconazole
Severe ampho

135
Q

Sporothricosis tx

A

Mild itra
Severe ampho

136
Q

Paracoccidiomycosis tx

A

Mild itra +/- bactrim
Severe ampho

137
Q

Bipolar gram negative stain, safety pin looking; pathogen and tx

A

Yersinia

Tx aminoglycoside

138
Q

What disease look like malaria but can be transmitted through blood transfucion

A

Babesia

139
Q

What disease can cause mulch pneumonitis and cause eosinophilia

A

CGD

140
Q

Maltese cross

A

babesia

though can be in in the trophozite circular form too

141
Q

Difference between baloxavir and oseltamivir in influenza tx

A

Baloxavir has greater reduction in viral load by day 1 of treatment

142
Q

Procal lvl to discontinue abx

A

<0.5
OR
decrease by 80% from peak

143
Q

How do you get M. Bovis and what is it usually resistant to

A

unpasteurized cheese

PZA resistant

PULMONARY BOARDS (9 decks)

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