Pneumonia and TB Flashcards
1
Q
Case 10
- 22 year old college student with right middle lobe – streaky infiltrate on chest x-ray. She has a dry cough and temperature of 101 F. She has chills and headache. She has had three weeks of pro-dromal symptoms.
- Which of the following is a likely possibility in this patient?
- A. She will have an IgM autoantibody that is directed against the I antigen of red blood cells.
- B. This organism is an obligate intracellular that cause pneumonia.
- C. It is usually associated with the inhalation of infected excrement from pigeons
- D. It is associated with a relative bradycardia in relation to the patients fever.
- E. It is a Gram – rod that can cause both CAP and nosocomial pneumonia
A
Case 10
Which of the following is a likely possibility in this patient?
- A. She will have an IgM autoantibody that is directed against the I antigen of red blood cells. = its a mycoplasma pneumonia - its a atypical pneumonia presentation
- B. This organism is an obligate intracellular that cause pneumonia.
- C. It is usually associated with the inhalation of infected excrement from pigeons
- D. It is associated with a relative bradycardia in relation to the patients fever.
- E. It is a Gram – rod that can cause both CAP and nosocomial pneumonia
2
Q
Mycoplasma Pneumonia
A
- Most common pneumonia in young adults.
- Smallest free living organism
- No cell wall – No penicillin
3
Q
Mycoplasma Pneumonia
Clinical Manifestations
A
- Respiratory tract
- Pharyngitis, laryngitis, acute bronchitis, bronchopneumonia
- Skin and mucosa
- Maculopapular and vesicular exanthema, urticarial, purpura, erythema nodosum, erythema multiforme, Stevens-Johnson syndrome
- Central Nervous System
- Meningitis, meningoencephalitis, acute psychosis, cerebritis, Guillain-Barre syndrome
4
Q
Mycoplasma Pneumonia
Clinical Manifestations
Systems Affected
A
- Parenchymatous organs
- Pancreatitis, diabetes mellitus, non-specific reactive hepatitis, subacute thyroiditis
- Miscellaneous
- Hemolytic anemia, pericarditis, thromboembolism
5
Q
Case 11
- Your patient recently purchased an old chicken farm in Ohio where he had spent the previous few weeks cleaning out and moving the former chicken coop left behind by the previous owner. He became ill several days ago. He presents with fever, headache, malaise, and a non productive cough.
- His chest x-ray presents with bilateral hilar lymphadenopathy and diffuse reticulonodular infiltrates.
- Which of the following organisms is most likely the cause of his illness?
- A. Actinomyces israellii
- B. Aspergillus fumigatus
- C. Chlamydophila psittaci
- D. Coccidiodes immitis
- E. Histoplamsa capsulatum
A
- Which of the following organisms is most likely the cause of his illness?
- A. Actinomyces israellii
- B. Aspergillus fumigatus
- C. Chlamydophila psittaci
- D. Coccidiodes immitis
•E. Histoplamsa capsulatum
6
Q
Case 12
- 23 year old male has had a previous splenectomy two years ago as a result of an auto accident. You see him in the ER with chills, fever, cough, and chest pain. Sputum specimens are yellow in nature and yield optochin sensitive organisms with a positive quelling reaction.
- Which of the following is the most likely cause?
- A. Streptococcus pneumonia
- B. Eschericia coli
- C. Klebsiella pneumonia
- D. Yersinia pestis
- E. Candida albicans
A
Case 12
•Which of the following is the most likely cause?
•A. Streptococcus pneumonia
- B. Eschericia coli
- C. Klebsiella pneumonia
- D. Yersinia pestis
- E. Candida albicans
7
Q
Case 13
- 19 year old college student has a fever, a dry nonproductive cough and malaise. She “aches” all over. Her physical exam demonstrates mildly decreased breath sounds bilaterally. Her laboratory values demonstrate elevated “cold agglutinins”.
- Which of the following is the most likely responsible for her illness?
- A. Streptococcus pneumonia
- B. Haemophilus influenza
- C. Klebsiella pneumoniae
- D. Legionella pneumophila
- E. Mycoplasma pneumoniae
A
Case 13
- Which of the following is the most likely responsible for her illness?
- A. Streptococcus pneumonia
- B. Haemophilus influenza - Gram - pleomorphic Rod
- C. Klebsiella pneumoniae
- D. Legionella pneumophila - aquatic environments
•E. Mycoplasma pneumoniae
8
Q
Case 14
40 year old female presents with a nonproductive cough and low grade fever. You diagnose an atypical pneumonia based upon her chest x-ray. You correctly treat her with azithromycin. You diagnose psittacosis, based upon the presence of complement fixing antibodies to Chlamydia psittaci in her convalescent serum.
- Her most likely occupation is?
- A. Cat breeder
- B. Homeless shelter worker
- C. Poultry farmer
- D. Cave explorer
- E. Wool sorter
A
Case 14
- Her most likely occupation is?
- A. Cat breeder
- B. Homeless shelter worker
•C. Poultry farmer
- D. Cave explorer
- E. Wool sorter
9
Q
Case 15
- 25 year old male with fever, non-productive cough, and hypotension. His chest x-ray demonstrates bilateral interstitial infiltrates. BAL reveals cysts that are spherical in shape and stain with methenamine silver.
- Which predisposing condition accounts for this?
- A. He is most likely a sickle cell patient
- B. He resides in the Southwest United States
- C. He has AIDS
- D. He is an alcoholic
- E. He has problems with chronic aspiration
A
Case 15
- Which predisposing condition accounts for this?
- A. He is most likely a sickle cell patient - organism of concern encapsulated organisms
- B. He resides in the Southwest United States - coccidioidies mycosis
•C. He has AIDS - pneumcyctis jarvidii
- D. He is an alcoholic -klebsiella and asperationd and anerobes from the mouth
- E. He has problems with chronic aspiration
10
Q
Case 16
45 year old female who presents with chills, rigors, and fever. Onset was 2 days ago. Gram stain of her sputum demonstrates gram positive encapsulated, lancet shaped diplococci.
- Which of the following correctly names this organism?
- A. Haemophilus influenza
- B. Neisseria gonorrhaeae
- C. Pneumocystis carinii ( Jiroveci)
- D. Staphylococcus aureus
- E. Streptococcus pneumoniae
A
Case 16
- Which of the following correctly names this organism?
- A. Haemophilus influenza
- B. Neisseria gonorrhaeae
- C. Pneumocystis carinii ( Jiroveci)
- D. Staphylococcus aureus
•E. Streptococcus pneumoniae
11
Q
Case 17
- Patient brought to ER by ambulance. He is septic and appears to have pneumonia. His ETOH level is 0.2. Liver is enlarged and he has spider angiomata on his abdomen. He appears to be coming down with “Delirium Tremens” clinically. Physical exam reveals decreased breath sounds on the right side, and chest x-ray is compatible with right sided pneumonia, based upon findings of consolidation. His sputum exam demonstrates “currant jelly” appearing sputum.
- Which of the following is highest on your list of differentials?
- A. Legionella spp.
- B. Klebsiella pneumoniae
- C. Mycoplasma pneumoniae
- D. Pneumocystis jirovecii
- E. Streptococcus pneumoniae
A
Case 17
- Which of the following is highest on your list of differentials?
- A. Legionella spp.
•B. Klebsiella pneumoniae
- C. Mycoplasma pneumoniae
- D. Pneumocystis jirovecii
- E. Streptococcus pneumoniae
12
Q
Case 18
- 56 year old diabetic with chronic sinusitis. He does not respond to 8 weeks worth of antibiotic therapy. You have tried multiple antibiotics, but without results.
- Two weeks later her dies from posterior erosion of this organism into his brain.
- You should strongly suspect infection with ?
- A. Actinomyces
- B. Aspergillus
- C. Cryptococcus
- D. Mucor
- E. Pneumocystis
A
Case 18
- You should strongly suspect infection with ?
- A. Actinomyces
- B. Aspergillus
- C. Cryptococcus
•D. Mucor
•E. Pneumocystis
13
Q
Case 19
- 25 year old male prostitute with a history of IV drug abuse. He presents with fever and marked SOB. He describes his cough as hacking and non-productive. It has been present for weeks.
- His ABG demonstrates a PaO2 of 55 with a PaCo2 of 50. His chest x-ray demonstrates bilateral infiltrates in the lower lobes. Physical exam reveals a mild wheeze and decreased breath sounds. He has oral thrush.
- Which of the following is most consistent with his diagnosis?
- A. Acid fast organisms in his sputum
- B. Elevated cold agglutinins
- C. Positive methamine-silver stain of lung tissue
- D. Decreased serum IgA
- E. Positive convalescent precipitins for histoplasmosis
A
Case 19
- Which of the following is most consistent with his diagnosis?
- A. Acid fast organisms in his sputum
- B. Elevated cold agglutinins
•C. Positive methamine-silver stain of lung tissue
- D. Decreased serum IgA
- E. Positive convalescent precipitins for histoplasmosis
14
Q
Case 20
- 6 month old male who just emigrated from Kenya with his family. One week ago he developed a runny nose and a dry – non productive cough. For the past two days the cough has become “hacking” and progressively more frequent and severe. Between paroxysms of the cough, the child appears well to the parents.
- The parent bring him to the ER with a series of intense coughing during expiration, followed by a high-pitched inspiratory sound created by a forceful inspiration through a narrowed glottis. Severe paroxysms are associated with cyanosis, plethoric facies, bulging eyes, protrusion of the tongue, and distention of the neck veins.
A
Case 20
- You correctly believe the organism responsible for this is ?
- A. Corona virus
•B. B. pertussis - Etiology for whooping Cough
- C. Respiratory Syncytial Virus
- D. Parainfluenza viruses
- E. H. influenza
15
Q
Case 21
- 50 year old business man comes into ER with severe pneumonia. He just returned from Howell, Michigan where he is the chief air conditioning and heating engineer at a construction site for a new 500 room hotel complex. He has a history of smoking 40 pack years and drinks 8-10 beers per night. His chest x-ray shows marked consolidation of both lungs, predominantly in the lower fields. Culture on charcoal yeast extract medium grows out a small gram negative bacterium.
- Which of the following antibiotics is the most appropriate for this patient?
- A. Amphotericin B
- B. Bactrim DS
- C. Clindamycin
- D. Erythromycin
- E. Methicillin or Nafcillin
A
Case 21
- Which of the following antibiotics is the most appropriate for this patient?
- A. Amphotericin B
- B. Bactrim DS
- C. Clindamycin
•D. Erythromycin
•E. Methicillin or Nafcillin
16
Q
Question 22
- 19 year old, previously healthy, African-American male, navy recruit has been training in San Diego for the past 5 months doing mainly outdoor running and military training. He present with a 5 week history of fever, non-productive cough and SOB. He was treated with Levofloxacin for 10 days with little response. Tests are negative for HIV and PPD. Chest x-ray demonstrates a right upper lobe infiltrate. He exhibits a small, painful rash and red bumps on his lower legs.
- Which of the following tests is most likely to yield the correct diagnosis?
- A. Serologic test for Legionella antibodies
- B. Fungal serologic tests
- C. Urine antigen test
- D. Test of sputum for AFB
- E. Influenza A titers
A
Question 22
- Which of the following tests is most likely to yield the correct diagnosis?
- A. Serologic test for Legionella antibodies
•B. Fungal serologic tests
- C. Urine antigen test
- D. Test of sputum for AFB
- E. Influenza A titers
17
Q
Case 23
- 65 year old male patient who was hospitalized for acute respiratory failure. He came in with marked CO2 retention and severe hypoxemia. He was placed on a ventilator. On day five of his hospitalization, he became profoundly ill, with signs of sepsis, Kussmaul’s breathing, and evidence of septic shock. (Kussmaul’s breathing - deep breathing assoc w/acidosis)
- Chest x-ray on day 5 demonstrated diffuse bilateral, patchy pulmonary infiltrates
- On day 6, the chest x-ray demonstrated marked bilateral infiltrates.
- The patient’s sputum is copious with “greenish” colored sputum noted on suctioning.
- Which of the following is the most likely organism?
- A. Gram negative bacillus that is one of the most common causes of nosocomial pneumonia will be found.
- B. Gram negative facultative intracellular bacterium that is transmitted by flea bites
- C. In 1988, the initial homology studies indicated that this organism is a fungus rather than a protozoan
- D. This patient’s CD4 count is less that 200 and he should be placed on Septra DS prophylaxis
- E. This infection is most likely from a gram negative coccobacillary rod that, if typable is encapsulated.
A
Case 23
•Which of the following is the most likely organism?
•A. Gram negative bacillus that is one of the most common causes of nosocomial pneumonia will be found.
- B. Gram negative facultative intracellular bacterium that is transmitted by flea bites
- C. In 1988, the initial homology studies indicated that this organism is a fungus rather than a protozoan
- D. This patient’s CD4 count is less that 200 and he should be placed on Septra DS prophylaxis
- E. This infection is most likely from a gram negative coccobacillary rod that, if typable is encapsulated.
25
Q
Case 2
- 44 year old male is evaluated for a chronic pneumonia. Over the past 6 months he has had recurrent episodes of fever, night sweats, weight loss, fatigue, cough, sputum production, hemoptysis, and dyspnea.
- Chest x-ray demonstrates a left sub-segmental lower lobe pneumonia that has been poorly responsive to antibiotics.
- Additionally, he has small, nodular lesions on the surface of his arms and legs that have appeared over the last few months.
- He travels extensively for work and is currently on a business trip far from home. He is an avid hunter and enjoys the outdoors. He also makes canoes at home out of polyurethane foam.
- Aside from an unexplained anemia, the patient’s preliminary laboratory work is unremarkable.
- After an extensive workup, the patient receives a bronchoalveolar lavage, and excisional biopsy of one of the lesions, and a bone marrow biopsy. A wet mount of the bronchoalveolar lavage fluid shows large, multinucleated yeast cells with refractile walls.
- Stains of the skin biopsy and bone marrow reveal multiple large yeast cells with reproduction via single, broad based buds. Multiple pyogenic granulomas are seen on bone marrow and lung pathology specimens.
- Given this patient’s disease, which of the following is the geographic location where he is most likely ot have acquired this disease?
- A. Seattle, WA
- B. Bangkok, Thailand
- C. Bakersfield, California
- D. Bogalusa, Louisiana
- E. Santa Fe, New Mexico
A
Case 2
Given this patient’s disease, which of the following is the geographic location where he is most likely ot have acquired this disease?
- A. Seattle, WA
- B. Bangkok, Thailand
- C. Bakersfield, California
•D. Bogalusa, Louisiana
•E. Santa Fe, New Mexico
26
Q
Case 3
- 39 year old prison inmate with a history of HIV is brought to the emergency department because of fevers, cough, night sweats that drench his sheets, a 7 pound weight loss, and hemoptysis over the last 6 days. His CD4 count is 300. His temperature is 39.0 C (102.2F), blood pressure is 120/70 mm Hg, pulse is 113/min, and respirations are 28/min. His oxygen saturation is 91% on room air. Physical examination reveals marked temporal wasting, tachycardia without murmur, and rhonchi in the right upper lobe bi Chest x-ray is shown. His PPD skin test is 5mm. A sputum examination confirms you diagnosis but cultures are still pending.
- Which of the following is the most appropriate next step in this patient’s care?
- A. Begin therapy with isoniazid, pyrazinamide, ciprofloxacin, and streptomycin
- B. Begin therapy with isoniazid, pyrazinamide, and rifampin
- C. Begin therapy with isoniazid, pyrazinamide, rifampin, and ethambutol
- D. Begin therapy with trimethoprim-sulfamethoxazole
- E. Wait for treatment until you have sputum specimen confirmation
A
Case 3
- Which of the following is the most appropriate next step in this patient’s care?
- A. Begin therapy with isoniazid, pyrazinamide, ciprofloxacin, and streptomycin
- B. Begin therapy with isoniazid, pyrazinamide, and rifampin
- C. Begin therapy with isoniazid, pyrazinamide, rifampin, and ethambutol
- D. Begin therapy with trimethoprim-sulfamethoxazole
- E. Wait for treatment until you have sputum specimen confirmation
27
Q
Reading the PPD
A
- 5 mm or more is positive in
- HIV positive person
- Recent close contacts of TB case
- Persons with nodular or fibrotic changes on chest x-ray consistent with old healed TB
- Patients with organ transplants and other immunosuppressed patients
39
Q
what are these?
A
Roth Spots
from endocardial septic emboli
Physical finding of endocarditis
40
Q
What kind of lesion is this?
A
Osler’s Nodes
from endocardial septic emboli
Physical finding of endocarditis
41
Q
What is this?
A
Janeway Lesions
from endocardial septic emboli
Physical finding of endocarditis
42
Q
What is this?
A
Splinter Hemorrhages
from endocardial septic emboli
Physical finding of endocarditis
