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Finals > Lung Pathology Bugs & Drugs > Flashcards

Lung Pathology Bugs & Drugs Flashcards

1
Q

Sinusitis (Most common & main 2 BACTERIAL)

A

Viral is Most Common

Bacterial:
Strep pneumoniae
H. flu

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2
Q

Community acquired pneumonia (CAP)

Gram, Bug (and finding w/Bug)

A

Bacterial: Strep PNA gram (+) cocci
“rusty colored sputum”
Viral: Influenza, Adenovirus, RSV, Parainfluenza

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3
Q

Acute Exacerbation Bronchitis Bug & Drug

A

H. flu

Gram (-) rod

Tx: Augmentin

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4
Q

Atypical PNA Bugs (3)

A

Legionella pneumonia- high mortality
Mycoplasma pneumoniae
Chlamydophila pneumonia

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5
Q

Moraxella c. PNA Bug & Drug (4 choices)

A

Gram (-)

Tx:
Augmentin, Macrolides, Sulfa, Flouroquinolones

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6
Q

Influenza Sx,

Test?

A

ACUTE ONSET HIGH FEVER
body aches, runny nose

flu swab

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7
Q

Hospital Acquired PNA Definition?
Highly resistant Bugs
Common in which pts?

A

developing >48hrs after admission
Common in vented pts (VAP)

MRSA & Pseudomonas

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8
Q

Aspiration PNA risk factors

which side of lung?

A

Impaired swallowing (neurological disorders, esophageal disorders, ETOH, Drugs)

Right sided!

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9
Q

MRSA PNA vulnerable population?

Drug

A

Children at risk

Tx:
Vancomycin historically
Linezolid more effective

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10
Q

Chronic Bronchitis Definition?
3 cardinal Sx?
__/3 Sx is bacterial suggestive?
Bug(3) & Drug?

A

Daily cough x3 months x 2 years (continuous)

  1. inc SOB
  2. Inc Sputum volume
  3. Inc sputum purulence
    2/3 = bacterial

H. flu
Strep pna
M. cat

Tx:
Augmentin

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11
Q

Acute Bronchitis Bug

A

Usually Viral

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12
Q

Fungal Lung infect
Most common Bug?
At risk pts?
drug?

A

Aspergillus

Neutropenic fever, bone marrow transplants

Tx:
Voriconazole

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13
Q

Pertussis Bug?

Pop most at risk of M&M?

A

Bordetella Pertussis

Unvaccinated Children & infants <12mo

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14
Q

Pneumocystis PNA Bug

A

Pneumocystis jerovecii

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15
Q

Tuberculosis Bug?
Reservoir?
Transmission?

A

Mycobacterium tuberculosis

Humans only reservoir

Transmitted by airborne droplet

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16
Q

Mycobacterium Family stain?

A

Acid Fast (+) (AFB)

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17
Q

Management of (+) TB test (3)

A
  1. Obtain CXR
    2, Obtain Quantiferon or T spot
  2. Obtain 3 sputums on 3 diff days for AFB smear & Cx
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18
Q

TB bug

A

Typical or Atypical Mycobacterium Family

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19
Q

Active Vs Latent TB (contagious?)

Definition of Latent TB (skin test/sx/CXR)?

A

Active- Contagious
Latent-Not contagious
(+) skin test but no Sx/CXR findings

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20
Q

Tests for Mycobacterium Tuberculin? (3)

  • do they differentiate b/w latent & active?
  • which is preferred first line?
  • which is used in pt’s experiencing symptoms?
A

Mantoux Tuberculin-Skin test (TST)
-preferred first line test

QuantiFERON (TB test or GOLD)-blood test
-used in symptomatic pts

Colorado- T-spot testing (doesn’t rely on CD4 levels)

they DO NOT DIFFERENTIATE b/w latent & active

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21
Q

What kind of Hypersensitivity Rxn does TST cause

A

Delayed Type IV

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22
Q

Reading TST
time?
What to look for?
how to record?

A

after 48-72hrs
Measure induration NOT erythema!
induration-hard feel.
RECORD IN mm!!

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23
Q

(+) TST readings (3)

A

(+) at 5mm for:
-immunocompromised, live with TB pt, (+)CXR, HIV, organ transplant

(+) at 10mm for:
-children <4y, recent immigrants, drug users

(+) at 15mm for:
-healthcare workers, no known risk factors

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24
Q

Sx suggestive of Bacterial Sinusitis (4)

A

Sx >10d
Unilateral Maxillary facial sinus/tooth pn
Unilateral Purulent nasal D/C
Double or 2nd sickening
Cough & Discolored nasal D/C are not good predictors

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25
Q

CURB 65 use?

A

to determine whether or not to hospitalize a pt w/CAP

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26
Q

CURB 65 Acronym

A 
C- Confusion
U- uremia (BUN >20mg/dL)
R- Resp Rate > 30/min
B- BP (SBP<90; DBP <60)
65 - age >65y
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27
Q

when to admit CURB 65?

when to ICU

A

2-3 pts

4-5 pts

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28
Q

indication/Prevention of CAP

A

> 65y
Immunocompromised
asplenic

Prevnar 13 (polyvalent pneumococcal vaccine)

Hand Hygene

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29
Q

Gram (-) bugs

(F**K) but polite…

A

Pseudomonas
Haemophilus
E coli
Klebsiella

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30
Q

Gram (-) Tx

A

Flouroquinolones
Augmentin
Macrolides
Cephalosporins

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31
Q

Gram (+) Tx

A

Pencicillins, Macrolides, Flouroquinolones

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32
Q

Acute Bacterial Sinusitis Tx- Adults

Beta Lactam Allergy Tx Adults

A

Augmentin

Beta Lactam Allergy-Doxycycline

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33
Q

Children
Acute Bacterial Sinusitis Tx
Beta Lactam Allergy Tx

A

Tx- Augmentin

Beta Lactam Allergy-Levofloxacin

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34
Q

What antibiotic s not recommended for sinusitis?

A

Macrolides (-), (+)

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35
Q

Most deadly infectious disease in US?

A

CAP

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36
Q

Mycoplasma p. Tests

A

“walking PNA”
IgM test
cold aggulins- old tech

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37
Q

Legionella p. cause?

Dx (3 tests)

A

Outbreak from human-made water systems

Dx: Sputum Cx, Ag testing, CXR

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38
Q

Influenza Strains?
H?
N?

A

A most common (can infect mammals)
B, C only humams

H- Hemaglutin (bind virus to cell being infected)
N- Neuraminadase (virulence)

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39
Q

Influenza Immunization
Trivalent?
Quadrivalent? who always gets Quadrivalent?

A

Trivalent- 2A, 1B

Quadrivalent- 2A, 2B (>65yo)

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40
Q

Who should be vaccinated for flu?

A

Everyone >6mo

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41
Q

Who should not be vaccinated?

A

Severe rxn to chicken/eggs, GB, <6mo, Illness w/a current fever

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42
Q

Empyema Risk factor (70%)
Can progress to ___? (25-75% mortality in elderly)
Tx?

A

Untreated or complicated PNA

SEPSIS

Surgery & tailored ABX

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43
Q

Pertussis Drug? Prophylax?

A

1st- Macrolides
2nd- Sulfa
Prophylax close contacts (w/in 3 wks)

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44
Q

3 Stages of Pertussis-
timelines & Sx for each?
Which is the communicable period?
Incubation Period?

A

Cataharral- 7-10d
Coryza, fever, cough (mild)
COMMUNICABLE PERIOD

Paroxysmal- 1-6 WEEKS
Paroxysms of numerous rapid coughs- thick mucous
Long aspiratory effort w/ high pitched WHOOP at end
cyanosis (61%)
Vom/Exhaustion

Convalescent- 7-10d
Gradual recovery
Cough disappear 2-3wks

INCUBATION PERIOD- 5-10d

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45
Q

Pneumocystic Pneumonia classification?

A

Fungus

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46
Q

PJP gold standard Dx?

A

Silver strain

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47
Q

what lab will be elevated in 90% of pt’s w/PJP?

A

LDH

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48
Q

What is the classical finding for PJP on CXR?

A

BILATERAL diffuse hilar opacification

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49
Q

PJP prevention?

prophylaxis & Drug?

A

Stop Smoking!

Tx & prophylax with:
Bactrim (-), MRSA

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50
Q

1 infectious disease killer worldwide?

A

TB (3mil deaths/yr)

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51
Q

When does TB go from Latency to active?

A

if TB bacteria escape macropage cage (mast cell granuloma)

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52
Q

CXR findings for TB?
Which lobes?
Advanced Infection finding?
Active infection finding?

A

Patchy/nodular infiltrates

Upper lobes

Advanced infection- Cavity formation (caseating granuloma)

Active infection- Calcified nodules

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53
Q

Aspiration PNA bug

A

Anaerobic organisms:

Peptostrep, Prevotella, Fusobacterium, Bacteroides

54
Q

Influenza Tx

A

Tx:
Oseltamivir (Tamiflu)
Zanamivir (Relenza)
Baloxavir (Xofluza)

55
Q

Legionella Tx?

NL? Comorbids?

A

Tx: (Same as CAP)
NL pt (no comorbids/ MRSA/ pseudomonas): Amoxicillin 1g TID
or
Doxycycline 100mg BID

Comorbids: (Augmentin or Cephalosporin) + Macrolide
or only Flouroquinolone

56
Q

Influenza Antigen Shift?

Antigen Drift?

A

Antigen Shift- 2 strains combine to form a new strain-PANDEMIC
Antigen Drift- Point mutations over time

57
Q

Factors causing False (+) TB test (7)

A
  1. nontuberculosis mycobacteria
  2. BCG vaccine
  3. Anergy
  4. Recent TB infection (2-10d post exposure)
  5. newborns
  6. live virus vaccination
  7. poor technique
58
Q

Anergy

A

inability to surmount an immune response
(i.e. No reaction to a TST skin test 2/2 weakened immune system)
HIV

59
Q

Before initiating TB Tx (4)

A
  1. R/O TB Dz
  2. Determine prior Hx of Tx for TB
  3. Assess risk/benefits
  4. Determine current/prev drug therapy
60
Q

If CXR/ Quantiferon or Tspot (+)

and 3x Sputum (-) for TB…

A

Proceed with Tx for LATENT TB

61
Q

If CXR/ Quantiferon or Tspot (+)

and 3x Sputum (-) for TB…

A

Active TB is R/O

Proceed with Tx for LATENT TB (LTBI)

62
Q

Latent TB Tx

A

Isoniazid + Rifampin

63
Q

Which TB Rx causes dark urine (redish-orange)

A

Rifampin

64
Q

Which TB Rx causes peripheral neuropathy?

A

Isoniazid

65
Q

If CXR/ Quantiferon or Tspot (+)
and 3x Sputum (+) for TB…

What is the Tx regiment called?

A

Active TB

highly communicable
Directly Observed Tx

66
Q

What ABX should negate a vision test?

A

Ethambutol

67
Q

First line TB Tx (4)

for how long?

A

R- Rifampin
I- Isoniazid
P- Pyrazinamide
E- Ethambutol

6mo!
9mo if pregnant

68
Q

Which TB Rx are hepatotoxic?

A

R.I.P.E (all of them)

69
Q

Which TB Tx should NOT be used in HIV pts?

A

Rifampin

70
Q

When to substitiute TB Tx? which class?

A

Strain resistance/1st line Rx not tolerated

Flouroquinolones (-), (+)

71
Q

Which TB Rx causes ear/kidney damage?

A

Streptomycin

72
Q

Which TB Rx do you NOT use w/pregnant pts?

A

Streptomycin & pyrazinamide

73
Q

Which TB Rx causes birth control to not work?

A

Rifampin

74
Q

Intitial phase time for TB Rx?

A

2mo

75
Q

Continuation phase time for TB Rx?

A

4mo

76
Q

Which TB Rx negates a test for ischicara?

A

Ethambutol

77
Q

Pregnancy Tb Rx?

Time?

A

Rifampin
Isoniazid
Ethambutol

9mo

78
Q

CAP Tx?

1st line & 2nd line

A 
Tx:  KNOW THIS
NL pt (no comorbids/ MRSA/ pseudomonas): 
Amoxicillin 1g TID
OR
Doxycycline 100mg BID

Comorbids: (Augmentin or Cephalosporin) + Macrolide
or only Flouroquinolone

79
Q

Mycoplasmic pna Tx (3)

A

Tx:
Macrolides (+), (-)
Flouroquinolones, (+), (-)
Tetracyclines (+), MRSA

80
Q

Aspiration pna Tx? (2 choices)

A

Tx:

Pipericillin/Tazo (Zosyn) or Clindamycin -Lincosamide (+), (anaerobes)

81
Q

most frequent atypical mycobacterial infection in US

A

Mycobacterium avium

82
Q

Mycobacterium avium risk factors

A

Ubiquitous in water & soil

Immunocompromised hosts
Female, caucasian

83
Q

Atypical Mycobacterium Sx

A

chronic cough, sputum production and fatigue, fever less common

84
Q

Disorder of large bronchi characterized by permanent abnormal dilation and destruction

Caused by recurrent inflammation/infection of aiways

A

Bronchiectasis

85
Q

50% of cases of bronchiectasis caused by

A

Cystic Fibrosis

86
Q

Main sx of Bronchiectasis (___ w/______)

Preceeding Hx of ___?

A

Chronic productive (copious sputum) cough with dyspnea and wheezing

Preceeding history of recurrent pulmonary infection or inflammation

87
Q

Abnormal membrane chloride channel causes abnormal mucus production and viscocity causes obstructions

A

Cystic Fibrosis

88
Q

Empiric Tx for Bronchiectasis (while waiting for Cx)?

A

Flouroquinolones (-), (+)

89
Q

In respiratory tract, inadequate hydration impairs mucociliary function= damaged mucociliary elevator

Results in chronic lung infections

A

Cystic Fibrosis

90
Q

What other organ can be affected by CF?

A

Pancreas (Cl- membrane channel)

91
Q

Pulmonary toilet technique

A

Pounding on someone’s back to loosen mucous

92
Q

Drug of choice for Stenotrophomonas m. (Cystic Fibrosis)

A

Bactrim (-), MRSA

93
Q

CF Bugs (4)

A

STENOTROPHOMONAS A.
PSEUDOMONAS

Staph a
Burkholderia c.

94
Q

Drug classes of choice for Pseudomonas in CF (5)

A 
Cefepime (4th gen cephalosporin) (-),(+)
Flouroqionolones (-), (+)
Pipercillin/taxobacta (zosyn) 
Carbapenims (NOT ERTAPENIM!!!!!!!!!) (-)
Aminoglycosides (-)
95
Q

Incubation 2-5 days
Affects mucous membranes of upper respiratory tract
Gradual onset with low grade fever, sore throat, DIFFICULTY SWALLOWING, malaise, loss of appetite

A

Diptheria

96
Q

Hallmark Feature of Diptheria

A

appearance of PSEUDOMEMBRANE
typically grayish color

cuts off the airway!

97
Q

Description of pseudomembrane of Diptheria

A 
Firm
Fleshy to gray in color
Adherent
Bleeds after attempt to dislodge
Fatal airway obstruction can occur
98
Q

Diptheria Toxin Tx? Bug Tx?

A

Equine Antitoxin (Balto!)

ABX:
Erythromycin (+),(-) or PCN

99
Q

Prevention of Diptheria children, adults?

A

kids- DTaP

adults- TDaP

100
Q

Which carbapenims can you use for Pseudomonas covrage in CF?

A 
Carbapenims: (-)
Doripenim
Imipenim
Meropenim
NOT ERTAPENIM!!!
101
Q

CF Epmiric ABX add on while waiting for Cx?

A

Vancomycin (+), MRSA

102
Q

Ability to appear well but have severe hypoxia is seen in (2)

A

PJP

COVID

103
Q

Ground glass opacity in CT is seen in (2)

A

PJP

COVID

104
Q

Covid Rx for admitted, ill pts (2)

A

Remdisivir + Dexamethazone

105
Q

Covid Rx for outpt treatment (2)

A

Molnuprivir + Monoclonal AB

106
Q

Dexamethazone as a covid Tx

A

More beneficial than prednisone, etc.

Tamps down the Cytokine storm, decreases progression to ARDS.

107
Q

What Tx has fallen out of favor- not working for COVID

A

convalescent plasma

108
Q

Monoclonal AB vs. Convalescent plasma

A

Monoclonal AB- manufactured AB to COVID

Convalescent plasma- from donors

109
Q

what 3 structures of spike protein makes COVID a ‘Wily little virus’

A

Sugar coating- hide from detection
Flexible stock- grabs other cells
Receptor binding domain

110
Q

2 important structures of COVID

A
  1. Spike protein

2. Nucleocapsid protein

111
Q

3 types of COVID vaccines

A

Genetic-mRNA
Vector vaccines
Protein subunit vaccines

112
Q

why should we not worry about mRNA becoming incorporated into cellular DNA?

A

it dissolves so quickly.

Cannot last long enough to develop reverse transcriptase.

113
Q

Instructs human cells to make a protein that is unique to the virus (spike protein)

Cells make copies of the protein for B and T cell recognition

A

mRNA vaccine

Pfizer/Moderna

114
Q

Contain viruses engineered to carry coronavirus genes

Illicit B and T cell response by recognition of viral proteins

A

Vector Vaccine

Johnson&Johnson

115
Q

Contain coronavirus proteins but no genetic material

Nanoparticle for delivery

T and B cell response by recognizing foreign protein

A

Protein Subunit Vaccine

Novavax

116
Q

COVID Rx that inhibits RNA dependent RNA polymerase-prevents replication

A

MOA

117
Q

Covid Outpt Rx

inhibits COVID replication by introducing typing errors during viral RNA replication

use w/in 5d of sx onset

A

Molnipiravir

118
Q

Pts who are EMERGENCY approved to use Molnipravir

meet 2 criteria

A
  1. outpt

2. pt’s w/ HIGH RISK to develop severe disease

119
Q

Theoretical concern from Molnupiravir

A

2/2 theoretical concern of introducing harmful mutations in human DNA

-concern for fetus in pregnant women

120
Q

Covid Outpt Rx

Protease inhibitor

from Pfizer

use w/in 3d of sx onset

A

Paxlovir

121
Q

Covid Rx

target spike protein

use w/in 10d of sx onset

A

Monoclonal AB

122
Q

Criteria for eligibility for Monoclonal AB

A
  1. Test COVID positive
  2. Onset of symptom within 10 days
  3. Not hospitalized or on oxygen due to COVID infection
  4. At risk of severe disease-65 years old or more, 5. Obesity BMI 25 or more, pregnancy
  5. Underlying conditions-LOTS!!!!!!
123
Q

What to know about Viral Mutations

A

Virus mutate/evolve in order to continue replicating, ideally WITHOUT killing off a host.

124
Q

Original type of a virus is called the

A

Wild Type

125
Q

Boosters now recommended in pts

A

> 18yo

126
Q

Covid Testing:

Standard test (screening test)

Good for ACTIVE infection

Will pick up variants but doesn’t necessarily differentiate variants

A

PCR

127
Q

Covid Testing:

Rapid at home tests

Not as high of accuracy when compared to PCR

Should pick up variants

A

Ag

128
Q

Covid Testing:

Determines previous infection

Not reliable in determining vaccine efficacy

A

Antibody

129
Q

Predominant COVID Strain in Colorado as of 12/08/21

A

Delta

130
Q

2 ways to measure how Colorado is doing with COVID

A
  1. Hospitalizations

2. % positives (want to be below 5%)

Finals (24 decks)

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