Mehlman. pneumonia 03-11 (3) Flashcards
Lobar pneumonia = mo/s?
Strep pneumoniae
Lobar pneumonia CP?
right lower lobe consolidation with dullness to percussion
Bilateral interstitial pneumonia (aka atypical pneumonia) in immunocompetent patients = mos?
Mycoplasma
Lobar pneumonia where they say “interstitial markings” and Strep pneumo isn’t listed -> answer = mos?
Mycoplasma (the word “interstitial” wins over
location).
Bilateral interstitial / “ground-glass” pneumonia in AIDS patient = mos?
Pneumocystis jirovecii pneumonia (PJP).
Lobar pneumonia in AIDS patient = mos?
Strep pneumo, not PJP
Bacterial pneumonia specifically post-influenza infection?
staph aureus
Bilateral pneumonia + low Hb or (+) Coombs test = mos?
Mycoplasma -> can cause cold agglutinins, which means IgM against RBCs -> hemolysis).
Pneumonia + hyponatremia and/or diarrhea -> mos?
Legionella
Pneumonia + business conference or residential home (implies air conditioners) -> mos?
Legionella
Pneumonia in 3-wk-old neonate who had conjunctivitis 1-2 weeks ago = mos?
Chlamydia trachomatis (the STI; drains through nasolacrimal duct to lungs).
Pneumonia in newborn first few days of life
+ gram (+) cocci = mos?
Group B Strep (Strep agalactiae), which is gram (+) cocci.
Pneumonia in newborn first few days of life + gram (+) rods = mos?
Listeria.
Pneumonia in newborn first few days of life + gram (-) rods = mos?
E. coli
Pneumonia + rabbits = mos?
Francisella.
Pneumonia + bird keeper = mos?
Chlamydia psittaci.
Pneumonia + southwest US and/or earthquake dust = mos?
Coccidioides.
Patients who have lung cancer are prone to obstructive pneumonias (on 2CK)
.
Pneumonia in CF = mos?2
Pseudomonas or S. aureus
Pneumonia in patient with central venous catheter + right upper lobe lesion –> answer = mos? on nbme
Staph epidermidis (on NBME). Cather = biofilms
USMLE wants for pneumonia CP?2
adventitious/bronchial (i.e., abnormal) breath
sounds + tactile fremitus (air vibrates due to movement through infective consolidation within alveoli
Community-acquired pneumonia (CAP) empiric Tx = ? on 2CK buvo
azithromycin on 2CK (on NBME). This covers the atypicals (Mycoplasma, Legionella, Chlamydia) as well as S. pneumo.
If patient has been on antibiotics in the past 3 months or has severe lung disease –> what can be first line abs?
Levofloxacin (respiratory fluoroquinolone)
CAP that results in sepsis or septic shock -> abs?
give ceftriaxone (if listed, choose cefotaxime for peds)
Nosocomial pneumonia (i.e., hospital- or ventilator-acquired) requires coverage for? 2 mos
MRSA and Pseudomonas
Nosocomial pneumonia. what abs want usmle?
vancomycin PLUS either ceftazidime (a 3rd-gen cephalosporin) or cefepime (a 4th-gen ).
For fungal pneumonia Tx?
fluconazole.
For fungal pneumonia + fungemia (high fever, chills) = Tx?
Amphotericin B
NBME for 2CK wants you to know what needs to be done in all patients with pneumonia who are septic?
sputum culture, followed by blood cultures
Septic pneumonia patient.
What they do in this patient is give you patient who has sputum culture performed, then they ask what should be done next for diagnosis?
blood culture.
If you get Pneumocystis pneumonia, Dx?
bronchoalveolar lavage
If you get a patient who has CXR or CT showing cavitary lesions in the lungs filled with a mass (likely Aspergillus fungus ball), they want what confirmatory test?
“open lung biopsy”
When a pneumonia fully resolves and USMLE asks why the CXR is normal after the fact, the answer is?
“maintenance of integrity of basement
membranes”
2CK wants you to know that pneumonias can occur in patients distal to areas of lung obstructed by tumors.
.
Patient has tumor + distal pneumonia. why?
“endobronchial obstruction”
NBME wants you to know rituximab (monoclonal antibody against CD20 on B cells) increases the risk of…
bacterial pneumonia
What medication inc. risk of bacterial pneumonia?
rituximab (monoclonal antibody against CD20 on
B cells)
NBME wants you to know rituximab (monoclonal antibody against CD20 on B cells) increases the risk of bacterial pneumonia. This makes sense, since B
cells are required for antibody production as part of humoral immunity against bacteria.
.
HIV + pneumo.
Lobar?
Strep. pneumonia
HIV + pneumo.
Bilateral?
PJP
Right lower lobe consolidation with dullness to percussion –> Strep pneumo. Treat empirically with?
Azithro.
Bilateral interstitial infiltrates in immunocompetent patient –> Mycoplasma or PJP. But the USMLE wants PJP. What Dx, What Tx?
Do BAL to Dx, then Tx with TMP-SM.
Bilateral interstitial infiltrates in immunocompetent patient –> Mycoplasma or PJP. But the USMLE wants PJP. IF patient is already on PJP proph –> it cannot be PJP then. What mos and Tx?
So the assumption would be Mycoplasma –> give azithro
