Pneumonias and TB II CIS

Question 1

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?

Answer 1

HACEK

Question 2

Most likely cause of bronchiolitis in infants?

Answer 2

RSV

Question 3

organism most commonly associated with COPD exacerbation

Answer 3

moraxella
H. flu
sometimes klebsiella in alcoholics

Question 4

who typically gets mycoplasma?

Answer 4

college students, etc.

Question 5

pseudomonas– who gets it?

Answer 5

nosocomial

and Cystic Fibrosis

Question 6

some symptoms that go along with coccidio

Answer 6

erythema nodosum

violaceous nodules in the lung

Question 7

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

Answer 7

leptospirosis

(Wheel’s Disease)

agglutination antibodies

Question 8

rickettsial organism, exposure to animal placentas

Answer 8

coxiella brunetti

Question 9

tachyzoites that stain with H and E

Answer 9

toxoplasmosis

Question 10

what stains positive to methenamine silver?

Answer 10

pneumocystis

Question 11

which comes first, IgG or IgM?

Answer 11

IgM is followed by IgG

Question 12

what kind of case would we expect cellular immunity with?

Answer 12

viral

HIV, for example

Question 13

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

Answer 13

humoral immunity

B cells develop an antibody

Question 14

influenza– we get it every year because why?

Answer 14

minor changes associated with antigenic drift.

major reassortment of genome RNA would –> pandemic

Question 15

at what CD4 count do we worry about pneumocystis?

Answer 15

200 or less

Question 16

at what CD4 count do we worry about MAC?

Answer 16

50 or less

Question 17

at what CD4 count to we worry about toxo?

Answer 17

less than 100

Question 18

rickettsia prowazecki is spread by

Answer 18

lice and flying squirrel

Question 19

TB drug that causes orange urine

Answer 19

Rifampin

Question 20

drug for anaerobes in suspected aspiration pneumonia

Answer 20

clindamycin

Question 21

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

Answer 21

Retest in 6 months to a year.

5 mm would be abnormal here.

Question 22

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

Answer 22

initiate anticoagulation therapy

Question 23

DIC is demonstrated by what?

Answer 23

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

Question 24

most common EKG with pulmonary emoblism

Answer 24

sinus tachycardia

Question 25

Virchow's triad

Answer 25

Hypercoagulability Stasis Endothelial damage leads to DVT/ PE/ clots

Question 26

Well's Clinical Likelihood of Pulmonary Embolism

Answer 26

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

Question 27

testing when high vs low probability of PE

Answer 27

low probability: d dimer moderate or high probability: V/Q perfusion scan

Question 28

heparin / warfarin and preganancy

Answer 28

no warfarin in pregnancy! teratogenic

Question 29

How does warfarin work?

Answer 29

vitamin K dependent coagulation factors-2, 7, 9, 10 Warfarin blocks them as well as protein C and protein S

Question 30

why don't we start warfarin alone

Answer 30

it takes some time to kick in starts with protein C, which makes patients hypercoagulable thus we overlap with heparin for a few days

Question 31

Hypercoagulation workup

Answer 31

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

Question 32

INH side effects

Answer 32

peripheral neuropathies give B6 hepatotoxicity, check liver function tests

Question 33

pyramidazine side effects

Answer 33

hepatotoxicity, (hyperuricemia)

Question 34

rifampin side effects

Answer 34

CYP inducer orange urine hepatotoxicity

Question 35

ethambutol side effects

Answer 35

optic neuritis, red/green color blindness

Question 36

CURB-65

Answer 36

confusion uremia over 20 respiratory rate over 30 Blood pressure under 90 / 60 age over 65 3 or more? hospitalization

Question 37

when do we use azithromycin

Answer 37

outpatient

Question 38

what should we use for inpatient pneumonia?

Answer 38

floroquinolone, e.g.

Question 39

when do we use oseltamivir?

Answer 39

influenza

Question 40

when do we use amphotericin B?

Answer 40

severe fungal infections

Question 41

when do we use itroconazole

Answer 41

oral agent for less severe fungal infections