Micro Flashcards
Pneumonia
Fatigue, cough, fever
Productive or not`
Crackles
Pneumonia
What do present with pneumonia
CXR
Treat atypical
Macrolides..azithromycin and clarithromycin
Treat ambulatory
Macrolides….doxycycline if cant tolerate
Increased risk of drug resistance
Fluoroquinolones or macrolide and beta lactam
Treat hospitalized
Fluoroquinolones
Treat ICU
Fluoroquinolone and lactam
Add piperacillin or a PE EM for pseudomonas coverage
Mycoplasma pneumonia and chlamydia pneumoniae atypical
Follow URI
Except chlamydia have hoarse voice
Legionella pneum atypical
More severe
Age of walking pneumona
Younger
Follow UIR\RI
Procalcitonin
Precursor that becomes elevated in proinflammatory stimuli, espicially those bacterial in origin
Curb
Confusion 1 BUN>20 1 RR>30 1 BP<90/60 1 Over 65 1
01-outpatient
2-short inpatient or supervise
3-5 ICU
Legionella
Water loving aerobic flagellate gram negative bacillus
Treat legionella
Levofloxacin
Fast fermented OH KEE
Klebsiella, E. coli, enterobacter
Slow fermenters
Citrobacter serratia
Who gets pneumococcal van
Over 65
Asplenic
2-64 with risk factors
Contraindications to pneumococcal vax
Allergic anaphylaxis
Fever inflamed turbinates
Adenovirus
Rales and altered mental status, coughing fit right hear border obscured coughing at dinner last night
Aspiration pneumonia…anaerobic more indolent clindamycin amoxicillin.
S aureus
Follows the flu! Bad can just die…
Burkholderia
G1 bacillus, cat positive, non lactose fermenter. BC agar. CF. On hospital equipment and irrigation systems. Hard to treat
Leptospirosis
Spirochete. High fever…HA, aspetic meningitis, severe myalgia. Hepatitis with jaundice renal failure with nephritis, subconjunctical hemorrhage. Rodents cattle, horse, goats,
Chlamydia psittacosis
Obligate intracellular gram neg, no cell wall
Birds
Epistaxis and splenomegaly…need good history
Procalcitonin elevated in what
Bacteria
Smokers
Moraxella, HI
After influenza
S aureus
Francisella tularensis
Hunters, rabbit exposure
Gram negative aerobic abrupt onset of nonspecific
Fever chills
Ulceroglandulas dr-most common. Single lesion at a tick bite site with a central Escher with assx. Adenopathy. Pulmonary tularemia-pleural effusions pacification patterns
Eat rabbit not cooked inhale..drink
Salmon sputum
S aureus
VAP
ET intubation with 2 of fever, leukocytosis or pursuant sputum
New or progressive opacity on CXR
HA
Hospital over 48 hours
HCAP
Hospitalized for at least 2 days within 90 days or in last 30 daysL nursing home, dialysis or family member with MDR
Treat hospital
Vancomycin, CMC CMP,
MTB
Weakly g+, nonmotile, aerobic
Primary TB
Aerosol droplets, low fever, hilar lymphadenopathy->can get pleural effusions
Lobes-middle and lower, healing=calcification
Healing fibrosis causes latency
What if no healing
Primary progressive TB
Military T
Spread wide and far
Secondary T
Deactivation
Most common
Fever chilled, cough, weight loss night sweats
Apical posterior , pulmonary cavitation
What do when present with secondary T
CXR< PPD< morning sputum
Over 5 mm
HIV, close contact with active infection
CXR with fibrotic changes consistent with TB
Immunosuppression (TNF a inhibitors)
10
Silicosis, DM, chronic renal failure… under 4
14
Healthy over 4
What is in PPD
Purified protein of MTB
BCG vaccine
M Boris
False positive TST test
PPD
Type IV related
Auramine rhodamine
Sensitive initial
Ziehl neelsen stain
Specific
India ink
Capsule
What do with patient
Negative pressure ventilation
How treat latent
9 months INH
Normal treat
6 months with monthly sputum samples
T thoracentesis
Positive adenosine deaminase and IFN gamma
TB spondylitis
Potts
AIDS weak fever cough
MTB
AFV-acid fast bacillus, aerobic slow growing, facultative intracellular, caseating granulomas, cord factor, sulfatides, siderphores
Scrofula
Lymphadentis most common extra pulm
Mycobacterium Kanasii
No person person like Tb
Older with underlying lung disease or smokers
Men
Midwest, south west,
Similar to TB ,
Older smokers-cavitary lesions apex
Women with chronic cough bronchiectasis in mid lune
50% die if untreated
18 months on 4 drugs
Invasive aspergillosis
Hemorrhagic infarction
Necrotizing bronchopneumonia
Aspergillus TB
Live in cavity! With hemoptysis
Picornavirus
Rhinovirus
+SsRNA rhiniovirus
Nonenveloped
Destroyed by stomach acid
Coronavirus
As+RNA
Helical enveloped
Common cold SARS
MERS and SARS and zoonotic
Stain BT
Carbofuscin red
