Infectious Pulmonary Disorders Flashcards
Most common ventilator associated bacterial infection?
pseudomonas
Caused by RSV, diagnosed by nasal washing
Bronchiolitis
Caused by Hib, unvaccinated child, Thumbprint sign on X-Ray
acute epiglottitis
Caused by Parainfluenza virus, barking cough and stridor, Steeple’s sign, racemic epinephrine
croup
Inspiratory whoop, treat with macrolide, diagnose by nasopharyngeal swab, booster vaccine at 11-12 y/o
Pertussis (Whooping Cough)
Rust-colored sputum - common in patients with splenectomy
S. pneumoniae
Salmon colored sputum - MRSA treat with vancomycin
S. aureus
Ventilators, patients become sick fast - treat with 2 antibiotics
Pseudomonas
low NA+ (hyponatremia), GI symptoms (diarrhea) and high fever
legionella
Young people living in dorms, (+) cold agglutinins, bullous myringitis
mycoplasma
Currant jelly sputum, drinkers, aspiration
klebsiella
Patient with non-remitting cough/bronchitis non-responsive to conventional treatments. Caused by fungal inhalation in western states
Coccidioides (valley fever)
bird or bat droppings (caves, zoo, bird)
Histoplasma capsulatum
found in soil can disseminate and can cause meningitis.
Cryptococcus
Apical infiltration
Tuberculosis
What should be considered with a diffuse ground glass appearance and no pulmonary nodules on chest X-ray?
infiltrative lung disease
What should be considered with a localized ground glass appearance and a pulmonary nodule on chest X-ray?
lung cancer
What should be considered in a patient with pneumonia who was exposed to bird or bat droppings in the Mississippi to the Ohio river area?
Histoplasma capsulatum
List three classes of antibiotics which may be used for Klebsiella pneumoniae.
Cephalosporins
Aminoglycosides
Fluoroquinolones
What two antibiotic classes may be considered to treat legionella pneumonia?
Macrolides and fluoroquinolones
What other bacterial pneumonia are patients who have pseudomonas pneumonia prone to get?
S. aureus pneumonia shares similar risk factors specifically nosocomial
What are the combinations of antibiotics which may be used for pseudomonas pneumonia?
- Anti pseudomonal beta-lactam PLUS an antipseudomonal quinolone or aminoglycoside
- Antipseudomonal quinolone PLUS an aminoglycoside
At least how many antibiotics should be used at the same time for pseudomonas pneumonia?
Always treat w/ at least 2 antibiotics
What are the antibiotics which may be used for MRSA pneumonia?
Vancomycin or linezolid + Levofloxacin or ciprofloxacin
List the antibiotics classes for inpatient ICU treatment in a patient with a pneumonia caused by Strep pneumoniae or non MRSA staph.
Beta-lactam + macrolide or fluoroquinolone
List the antibiotics classes for inpatient non ICU treatment in a patient with a pneumonia caused by Strep pneumoniae or non MRSA staph.
Beta-lactam PLUS a macrolide
List the antibiotics classes for outpatient treatment in a patient with comorbidities and a pneumonia caused by Strep pneumoniae or non MRSA staph
Fluoroquinolone doxycycline or macrolide PLUS a beta lactam
List the antibiotics classes for outpatient treatment in a healthy patient with pneumonia caused by S. pneumoniae or non MRSA staph.
Fluoroquinolone, doxycycline or macrolide
How many millimeters of induration is considered positive when reading a PPD result in an HIV positive patient?
> 5 mm
A “cinnamon breath smell” is associated with what pulmonary infection?”
Tuberculosis
Red orange urine occurs with which tuberculosis medication?
Rifampin
Ethambutol side effect?
optic neuritis
What is given to prevent neuropathy in a patient receiving isoniazid (INH) therapy?
B6 (pyridoxine)
Where will older pulmonary lesions from tuberculosis be found?
lower lobes
Where will newer pulmonary lesions from tuberculosis be found?
Upper lobe cavitary lesions
What lab is elevated in PJP pneumonia?
LDH
What pneumonia is associated with air conditioning vents and spas?
legionella
What is the most likely Dx? Young IV drug user with fever severe hypoxia and diffuse infiltrates on X-ray?
PJC pneumonia
Bacterial pneumonia which occurs in a young patient after flu is most likely caused by what organism?
staph aureus
Rusty sputum?
Strep pneumoniae pneumonia
What pneumonia associated with diarrhea and low sodium levels?
Legionella
Flu can be treated with oseltamivir within how many hours of onset of symptoms?
48 hrs
Most common cause of acute bronchitis?
viral
Name the commonly used meds to treat active tuberculosis infection.
RIPE: Rifampin Isoniazid (INH) Pyrazinamide Ethambutol
Which vitamin should be given along with isoniazid (INH) therapy?
Vit B6 (pyridoxine)
Which vitamin should be given along with isoniazid (INH) therapy?
Vitamin B6 (pyridoxine)
What is the recommended treatment for a healthcare worker with a first time positive PPD?
Isoniazid (INH) for 6 months
What is the sputum test for tuberculosis?
AFB smear and cultures
What is the Dx? Recent international travel now with fever night sweats cough hemoptysis SOB and weight loss.
tuberculosis
Treatment for PJC pneumonia?
Trimethoprim-sulfamethoxazole or pentamidine
Pneumonia seen in HIV patients with low CD4 counts?
PJC= Pneumocystis jiroveci (formerly called PCP)
Treatment for Histoplasma pneumonia?
amphotericin B
Pneumonia associated with inhalation of bat or bird droppings?
histoplasma
Treatment for immunocompromised patient with fungal pneumonia?
Itraconazole or fluconazole
Chest X-ray shows RUL abscess. Most likely organism?
Klebsiella (often associated with aspiration)
Pt with suspected pneumonia has “currant jelly colored” sputum. Most likely organism?
klebsiella
What organism is associated with positive cold agglutinins?
mycoplasma
Name 2 antibiotics you can use to treat Legionella.
Macrolide or Fluoroquinolone
Chest X-ray shows lobar pneumonia. Most likely organism?
strep pneumoniae
What medications are recommended for MRSA pneumonia?
Vancomycin or linezolid + levofloxacin or ciprofloxacin
Organism causing pneumonia spread by contaminated water?
legionella pneumonia
Pneumonia often related to post intubation, ventilator or hospital?
pseudomonas pneumonia
Pt with suspected pneumonia/URI has salmon/pink colored sputum. Most likely organism?
staph aureus
Pt with suspected pneumonia/URI has rusty colored sputum. Most likely organism?
strep pneumoniae
Which virus can lead to pneumonia after URI and also often causes diarrheal illness/GI symptoms?
adenovirus
Virus causing pneumonia after exposure to rodent feces (Western states)?
hantavirus
Most common cause of viral pneumonia in adults?
influenza
Name the organisms that cause typical pneumonia.
Strep pneumoniae
Staph aureus
Group A Strep
Organisms responsible for atypical pneumonia?
Mycoplasma pneumoniae
Chlamydia pneumoniae
Legionella
Organism usually causing pneumonia after aspiration?
klebsiella
Should normal percussion over the lung fields sound dull or resonant?
resonant
What does positive egophony on auscultation in a patient with pneumonia mean?
When listening over the area of consolidation, patient will say “eee” and it sounds like “aaa”
What is the Dx? Previously healthy patient with abrupt onset of fever headache malaise occurring in the winter months.
Influenza
What childhood vaccine protects children from pertussis?
DTaP
Preferred treatment for pertussis?
Clarithromycin or azithromycin
Organism that causes whooping cough?
Bordetella pertusis
Steeple sign on a frontal chest X-ray showing tracheal narrowing?
croup
Virus that causes croup?
Parainfluenza virus type 1
Child has barking cough and stridor?
croup
What is the Dx? Child presents with dysphagia, drooling and respiratory distress. Lateral neck X-ray shows “thumbprint sign”.
acute epiglottitis
How is RSV diagnosed?
Analysis/culture of Respiratory secretions
Most common cause of acute bronchiolitis in an infant?
Respiratory syncytial virus (RSV)
