Pneumonias and TB II CIS Flashcards
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?
HACEK
Most likely cause of bronchiolitis in infants?
RSV
organism most commonly associated with COPD exacerbation
moraxella
H. flu
sometimes klebsiella in alcoholics
who typically gets mycoplasma?
college students, etc.
pseudomonas– who gets it?
nosocomial
and Cystic Fibrosis
some symptoms that go along with coccidio
erythema nodosum
violaceous nodules in the lung
a disorder that begins with flu like symptoms and then goes to liver, lungs and kidneys leading to renal failure
leptospirosis
(Wheel’s Disease)
agglutination antibodies
rickettsial organism, exposure to animal placentas
coxiella brunetti
tachyzoites that stain with H and E
toxoplasmosis
what stains positive to methenamine silver?
pneumocystis
which comes first, IgG or IgM?
IgM is followed by IgG
what kind of case would we expect cellular immunity with?
viral
HIV, for example
primary immune response to strep pneumo, e.g.?
humoral immunity
B cells develop an antibody
influenza– we get it every year because why?
minor changes associated with antigenic drift.
major reassortment of genome RNA would –> pandemic
at what CD4 count do we worry about pneumocystis?
200 or less
at what CD4 count do we worry about MAC?
50 or less
at what CD4 count to we worry about toxo?
less than 100
rickettsia prowazecki is spread by
lice and flying squirrel
TB drug that causes orange urine
Rifampin
drug for anaerobes in suspected aspiration pneumonia
clindamycin
previously negative TB test now has been exposed and has a 3 mm induration. What to do?
Retest in 6 months to a year.
5 mm would be abnormal here.
what should we do with a stable patient who has a PE?
initiate anticoagulation therapy
DIC is demonstrated by what?
anemia, low platelets, fibrin degradation products, prolonged PT, PTT, decreased fibrinogen
most common EKG with pulmonary emoblism
sinus tachycardia
Virchow’s triad
Hypercoagulability
Stasis
Endothelial damage
leads to DVT/ PE/ clots
Well’s Clinical Likelihood of Pulmonary Embolism
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
testing when high vs low probability of PE
low probability: d dimer
moderate or high probability: V/Q perfusion scan
heparin / warfarin and preganancy
no warfarin in pregnancy! teratogenic
How does warfarin work?
vitamin K dependent coagulation factors-2, 7, 9, 10
Warfarin blocks them as well as protein C and protein S
why don’t we start warfarin alone
it takes some time to kick in
starts with protein C, which makes patients hypercoagulable
thus we overlap with heparin for a few days
Hypercoagulation workup
lupus anticoagulant factor 5 leiden prothrombin G20210A mutation antithrombin III deficiency protein C and S deficiencies
INH side effects
peripheral neuropathies
give B6
hepatotoxicity, check liver function tests
pyramidazine side effects
hepatotoxicity, (hyperuricemia)
rifampin side effects
CYP inducer
orange urine
hepatotoxicity
ethambutol side effects
optic neuritis, red/green color blindness
CURB-65
confusion
uremia over 20
respiratory rate over 30
Blood pressure under 90 / 60
age over 65
3 or more? hospitalization
when do we use azithromycin
outpatient
what should we use for inpatient pneumonia?
floroquinolone, e.g.
when do we use oseltamivir?
influenza
when do we use amphotericin B?
severe fungal infections
when do we use itroconazole
oral agent for less severe fungal infections
