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PNA, Tuberculosis Flashcards

1
Q

Most common cause of Typical PNA

A

Strep PNA

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2
Q

Atypical causes of PNA

A

Mycoplasma PNA, Chlamydophila PNA, Legionella, Viral

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3
Q

Sx of Typical PNA

A

Fever
Productive cough
Pleuritic CP
Dyspnea

Severe chills with violent shaking is assoc w: STREP PNA (the most common type)

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4
Q

Sx of Atypical PNA

A

low grade fever
dry cough
extrapulm sx: muscle ache, n/v/d, pharyngitis

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5
Q

H. influenza
Klebsiella
Staph aureus are all types of

A

Typical PNA

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6
Q

PE of Typical PNA (classic)

A

Tachypnea, tachycardic

Consolidation: bronchial breath sounds, dull to percussion, increased tactile fremitus, egophony, rales

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7
Q

PE of Atypical PNA

A

often normal!! may have crackles/rales

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8
Q

Keep in mind when taking PE of a Diabetic, Immunocomp, or old pt in which you suspect PNA

A

Physical exam may be normal

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9
Q

With an effusion, PNX, or obstructive pattern..

what will Fremitus and Breath sounds be like?

A

Decreased

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10
Q

H flu
Klebsiella
Staph

and STREP PNA

A

Typical PNA

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11
Q

Most common cause of CAP
Chills and violent Rigor
Blood rusty sputum

gram + diplococci

A

Strep PNA

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12
Q

Extremes of Age: SUPER YOUNG or SUPER OLD
immunocomp
underlying pulm dz

A

H. influenzae

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13
Q

Superimposed infection AFTER a VIRAL infection
or Hospital acquired
CXR: bilateral, multi-lobar, abscesses- cavitary lesions YIKES

A

Staph Aureus

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14
Q

Severe alcoholism
super sick pt, chronic illness- DM

Purple colored sputum!!! (currant jelly)
CXR cavitary lesions hallmark (not specific)

A

Klebsiella

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15
Q

Which two types of Typical PNA can show cavitary lesions on CXR?

A

Staph Aureus

Klebsiella

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16
Q

Most common cause of Atypical “walking” PNA

A

Mycoplasma PNA

what Pap had!!!

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17
Q

Mycoplasma PNA (atypical) sx

A

HA, fatigue, fever then —-> dry cough

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18
Q

Complication of Mycoplasma PNA

A

Cold Autoimmune hemolytic ANEMIA

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19
Q

Dx of Mycoplasma PNA

A

CXR: Reticulonodular, diffuse, patchy, interstitial infiltrates

PCR: cold agglutinins

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20
Q

Tx for PNA

A

Z pack most common- Azithromycin (a macrolide)

or

Doxy

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21
Q

Tx for PNA

A

Azithromycin “Z pack” or

Doxy

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22
Q

Legionella PNA

atypical

A

assoc with WATER sources
not spread person to person

fever, chills, sob, DRY cough, and GI SX !!! this is unique- watery diarrhea

other complications: Low NA, increased LFT, Neuro sx (HA, confusion)

Tx: Azithromycin or FluoroQ (Levofloxacin)

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23
Q

Legionella unique traits

A

Water
no person to person spread
GI SX!!- diarrhea
Hyponatremia, Liver fx test, Neuro sx

Treat with Azithro or FluoroQ (Levofloxacin)

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24
Q

What is the cutoff of someone going into hospital to determine if its Community Acquired “CAP” or Hospital Acquired?

A

CAP: outside of hospital or within 48 hrs
HAP: after 48 hrs of being in hospital

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25
If hospital acquired, what are common organisms?
Pseudomonas and MRSA
26
Most common pathogens causing diff types of PNA
Typical: Strep Atypical: Mycoplasma Hospital: Pseudomonas, MRSA
27
Beta lactams
PCNS | Cephalosporins
28
Beta lactam used to treat PNA
Ceftriaxone (Rocephin)
29
Anti-pseudomonal beta lactams used to treat PNA | remember pseudomonas is a common cause of Hospital acquired PNA
Need Anti pseudomonal beta lactam + Aminoglycoside or FluoroQ
30
Example of tx for Hospital acquired PNA | with anti-pseudomonal coverage
Piperacillin/Tazobactam (anti-pseud beta lactam) + Levofloxacin (fluoroQ)
31
Anti-pseudomonal Beta lactams
Piperacillin/Tazobactam Ceftazadime Cefepime
32
Aminoglycosides
Amikacin Gentamicin Tobramycin
33
CURB65 criteria- when deciding whether to admit a PNA patient or not
``` Confusion Uremia >30 Resp rate >30 BP low, systolic <90 or diastolic <60 Age >65 ``` If at least 2 are present, ADMIT!!!
34
Histoplasmosis (caused by oval yeast) tx
``` Itraconazole (mild-mod dz) or Amphotericin B (severe) ```
35
Pneumococcal vaccines PCV13 and PPSV23
PCV13: part of 4 dose series--> 2, 4, 6, and 12 mo PPSV23: all adults 65 and older, and younger pts with inc risk
36
If you are over the age of 65, which Pneumococcal vaccine should you receive?
PPSV23
37
SOB on exertion (and O2 sat drops) Dry cough Fever Most common HIV opportunistic infection
PCP Pneumocystis PNA
38
Tx of PCP
Bactrim x 21 days if HIV+, can add Prednisone if pt is hypoxic
39
Primarily Rapidly progressive TB (tuberculosis)
often Children Contagious Clinical progression
40
Chronic- Latent infection
not contagious
41
Secondary Reactivation of TB
waning immune defenses Old, HIV, Steroid use, CA Localize in Apex/upper lobes with Cavitary lesions CONTAGIOUS
42
Clinical sx of TB
cough, fever, night sweats, CP, HEMOPTYSIS Extrapulm (can affect any organ): Scrofula (irritated and inflamed lymph nodes), Pott's dz (Tb of spine, arthritis), pericarditis, adrenal gland
43
CXR of Primary TB
middle/lower lobe consolidation
44
CXR of Reactivated TB
upper lobe (apical) fibrocavitary dz
45
Tx of TB "RIPE!"
Rifampin Isoniazid Pyrazinamide Ethambutol for 2 months followed by 4 mo continued Rifampin and Isoniazid
46
How long total is tx for Active TB?
6 months 2 mo with the 4 drugs 4 mo with the 2 drugs (Rifampin and Isoniazid)
47
What 2 drugs do you continue for the last four mo of TB treatment?
Rifampin | Isoniazid
48
Tx of Latent TB
Isoniazid and Pyridoxine x 9 months
49
SE of Rifampin
Orange colored secretions
50
Classic Primary TB on CXR
Lower lobe consolidation
51
Classic Reactivation TB on CXR
Infiltrates and cavitation in upper lobe/apices
52
Most common cause of Acute Bronchitis
VIRAL
53
Often ppl with Acute Viral Bronchitis
appear better than they feel really feel like crap (cough, no fever, chest wall tender, wheezing, mild dyspnea)
54
When to get CXR if pt is coming in with Bronchitis like sx?
if any are present: - fever - tachy x2 - consolidation on chest exam OR cough >3 weeks
55
Symptomatic tx for Acute Viral Bronchitis
Hydrate and rest - NSAIDs - Ipratropium "Atrovent" (SAMA) - Antitussive - Albuterol inhaler - OTC stuff like cough drops, hot tea, honey
56
Pertussis WHOOPING cough is an example of when Bronchitis is bacterial
URI 1-2 wks WHOOP cough 2-6 wks, posttussive emesis cough gradually resolves, up to 6 wks
57
Pertussis "whooping cough" tx is NOT TO IMPROVE PTS CONDITION, but rather decrease transmission (make sure pt knows this)
Azithromycin "Z pack" or Bactrim
58
Complicated CAP
Beta lactam (Amox-Clav "Augmentin") + Macrolide (Azithro "Z pack") OR FluoroQ (Levofloxacin)
59
PCP tx
Bactrim and Prophylaxis Bactrim recommended in HIV pts with CD4 count <200
60
Aspiration will likely be seen in what lobe?
Right LOWER lobe d/t leaking down from R main bronchus
61
Tx for Aspiration PNA
Piperacillin/Tazobactam
62
Lung Anatomy
``` Trachea Primary bronchi Secondary bronchi Tertiary bronchi Bronchioles ```
63
Solitary Pulmonary Nodule
Small <3 cm "coin lesion" most are benign, smooth, well defined edges
64
4 Main types of Lung CA
Small cell -Oat cell Non-small cell - Adeno - Squamous cell - Large cell
65
Small cell Lung CA "Oat cell" Oat Cell is Highly Aggressive
Central airway Large hilar mass with BULKY mediastinal adenopathy cough, SOB, weight loss HIGHLY AGGRESSIVE- often METS
66
Large hilar mass w bulky adenopathy Compression on central airway HIGHLY AGGRESSIVE
Small/ Oat cell
67
If Non-small cell Lung CA, what type is the most common?
Adenocarcinoma Arise frm Mucous glands or any Epithelial cell in/distal to terminal bronchioles Mets to distant organs
68
Squamous cell carcinoma
Central or Main bronchus more likely to cause HEMOPTYSIS (bloody cough) Mets to REGIONAL lymph nodes can cavitate
69
Large cell lung CA
Mets to distant organs | AGGRESSIVE w rapid doubling times
70
CA a/w: SVC syndrome and Paraneoplastic syndrome? (SIADH, Cushings, Eaton-lambert)
Small Cell lung CA/ Oat cell pushing on the central stuff highly aggressive
71
Adenocarcinoma
peripherally distant METS Thrombophlebitis, clubbing
72
Squamous cell SLOW GROWING
CENTRAL BRONCHI Hemoptysis (blooody cough) SLOWER growing May cavitate
73
Large cell
Aggressive, fast growing | dx of exclusion
74
Sx of Lung CA
``` Cough Weight loss SOB CP Hemoptysis (squamous cell) ```
75
Sx that Lung CA has spread Intrathoracically
Pleural effusion Pericardial effusion Hoarseness to voice SVC syndrome
76
SVC syndrome- compression of the vena cava Small/Oat cell
``` SOB Facial swelling Head fullness Dilated neck veins Prominent vein pattern on chest Dysphagia ```
77
Gold standard to diagnose SVC syndrome
Superior veno cavogram
78
Pancoast syndrome
Tumor in superior sulcus compressing Brachial plexus and Cervical sympathetic nerves Shoulder > forearm, scapula, and finger pain SAME SIDE of tumor
79
Horner's syndrome
Injury of sympathetic nerves of face Miosis-pupil constriction Anhidrosis- lack sweating Ptosis-droopy
80
Pancoast syndrome | shoulder
Rib destruction Atrophy of hand muscles Pain in C8, T1, T2 nerve roots
81
Paraneoplastic syndrome side effect of having CA
Altered immune response to the tumor - bood - endocrine - neuro
82
Blood effects of Paraneoplastic syndrome
``` HyperCa2+ (bone destruction) Anemia Leukocytosis (too much) Thrombocytosis (too much) Hypercoag ```
83
Endocrine effects of Paraneoplastic syndrome
HyperCa2+ | Excess HCG production (gynecomastia, milky nipple discharge)
84
SIADH | often w small/oat cell
Hyponatremia | Irritable, restless, personality change, confusion, coma, seizure, respiratory arrest
85
Cushing's syndrome | often w small/oat cell
Muscle weakness, weight loss, HTN, Hirsutism, oseoporosis
86
Neuro effects of Paraneoplastic syndrome
Eaton Lambert | Immune mediated at the NMJ defective release of Ach, muscle weakness, decreased DTRs
87
Most common site of Lung CA METS
Liver #1 Bone Adrenal glands Brain
88
TMN staging system
T- primary tumor N- node involvement M- distant mets
89
Tx of Small cell/Oat cell lung CA
Chemo regardless of stage relapse is common
90
Non-small cell lung CA
SURGERY until get to Stage 4, then need to consider Palliative radiation or Combo chemo
91
Who to screen for Lung CA
Low density Chest CT - Current smoker age 55-74 with 30 pack yr hx - quit within 15 yr - 20 pack yr hx and 1 additional risk factor
92
Rx drugs for Smoking cessation
Zyban (wellbutrin) Chantix (varenicline) Nicotine replacement OTC nicotine (gum)

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