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Respiratory II Exam 2 > Pneumonias and TB II CIS > Flashcards

Pneumonias and TB II CIS Flashcards

1
Q

Echocardiogram demonstrates tricuspid and mitral valve vegetations. The patient has severe dental carries. You strongly suspect some fastidious gram negative bacilli that are commonly found in the oropharynx.

What are we thinking are the critters here?

A

HACEK

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2
Q

Most likely cause of bronchiolitis in infants?

A

RSV

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3
Q

organism most commonly associated with COPD exacerbation

A

moraxella
H. flu
sometimes klebsiella in alcoholics

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4
Q

who typically gets mycoplasma?

A

college students, etc.

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5
Q

pseudomonas– who gets it?

A

nosocomial

and Cystic Fibrosis

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6
Q

some symptoms that go along with coccidio

A

erythema nodosum

violaceous nodules in the lung

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7
Q

a disorder that begins with flu like symptoms and then goes to liver, lungs and kidneys leading to renal failure

A

leptospirosis

(Wheel’s Disease)

agglutination antibodies

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8
Q

rickettsial organism, exposure to animal placentas

A

coxiella brunetti

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9
Q

tachyzoites that stain with H and E

A

toxoplasmosis

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10
Q

what stains positive to methenamine silver?

A

pneumocystis

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11
Q

which comes first, IgG or IgM?

A

IgM is followed by IgG

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12
Q

what kind of case would we expect cellular immunity with?

A

viral

HIV, for example

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13
Q

primary immune response to strep pneumo, e.g.?

A

humoral immunity

B cells develop an antibody

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14
Q

influenza– we get it every year because why?

A

minor changes associated with antigenic drift.

major reassortment of genome RNA would –> pandemic

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15
Q

at what CD4 count do we worry about pneumocystis?

A

200 or less

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16
Q

at what CD4 count do we worry about MAC?

A

50 or less

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17
Q

at what CD4 count to we worry about toxo?

A

less than 100

18
Q

rickettsia prowazecki is spread by

A

lice and flying squirrel

19
Q

TB drug that causes orange urine

A

Rifampin

20
Q

drug for anaerobes in suspected aspiration pneumonia

A

clindamycin

21
Q

previously negative TB test now has been exposed and has a 3 mm induration. What to do?

A

Retest in 6 months to a year.

5 mm would be abnormal here.

22
Q

what should we do with a stable patient who has a PE?

A

initiate anticoagulation therapy

23
Q

DIC is demonstrated by what?

A

anemia, low platelets, fibrin degradation products, prolonged PT, PTT, decreased fibrinogen

24
Q

most common EKG with pulmonary emoblism

A

sinus tachycardia

25
Q

Virchow’s triad

A

Hypercoagulability
Stasis
Endothelial damage

leads to DVT/ PE/ clots

26
Q

Well’s Clinical Likelihood of Pulmonary Embolism

A

Predisposing factors:
Previous VTE 1.5
Recent Surgery of immobilization 1.5
Cancer 1

Symptoms:
Hemoptysis 1

Signs:
Heart Rate > 100 bpm 1.5
Cliical signs of DVT 3

Clinical Judgement:
Alternative diagnosis less likely than PE 1.5

Clinical probability total points

Less than 2 is low
Moderate: 2-6
High: over 6

27
Q

testing when high vs low probability of PE

A

low probability: d dimer

moderate or high probability: V/Q perfusion scan

28
Q

heparin / warfarin and preganancy

A

no warfarin in pregnancy! teratogenic

29
Q

How does warfarin work?

A

vitamin K dependent coagulation factors-2, 7, 9, 10

Warfarin blocks them as well as protein C and protein S

30
Q

why don’t we start warfarin alone

A

it takes some time to kick in

starts with protein C, which makes patients hypercoagulable

thus we overlap with heparin for a few days

31
Q

Hypercoagulation workup

A 
lupus anticoagulant
factor 5 leiden
prothrombin G20210A mutation
antithrombin III deficiency
protein C and S deficiencies
32
Q

INH side effects

A

peripheral neuropathies

give B6

hepatotoxicity, check liver function tests

33
Q

pyramidazine side effects

A

hepatotoxicity, (hyperuricemia)

34
Q

rifampin side effects

A

CYP inducer
orange urine
hepatotoxicity

35
Q

ethambutol side effects

A

optic neuritis, red/green color blindness

36
Q

CURB-65

A

confusion
uremia over 20
respiratory rate over 30
Blood pressure under 90 / 60

age over 65

3 or more? hospitalization

37
Q

when do we use azithromycin

A

outpatient

38
Q

what should we use for inpatient pneumonia?

A

floroquinolone, e.g.

39
Q

when do we use oseltamivir?

A

influenza

40
Q

when do we use amphotericin B?

A

severe fungal infections

41
Q

when do we use itroconazole

A

oral agent for less severe fungal infections

Respiratory II Exam 2 (21 decks)

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