Pnuemonias and TB Part I, D KInder, CIS Flashcards
22 y.o bullous myringitis, right middle lobe infiltrate, non-productive cough, fever
mycoplasma pnuemonia
bullous myringitis
blood filled TM
how to test for mycoplasma pneumonia
cold agglutinins test. autoAb to RBC
obligate intracell organism to cause pneumonia
chlamydia spp
pneumonia from infected excrement from pigeons
histoplasmosis
bradycardia in relation to patient’s fever
pneumonia
what causes this
legionella
why does penicillin not work on mycoplasma
has no cell wall
fever, chills, yellow sputum previous splenectomy optochin sensitive \+ quelling reaction microbe?
streptococcus pneumonia
splenectomy patients are unable to protect against what organisms
encapsulated because B cell immunity is down
19 y.o college student
fever, dry cough, malaise, aches all over
mildly dec breath sounds b/l
cold agglutinins
mycoplasma pneumonia
40 y.o female nonproductive cough, low grade fever atypical pneumonia based on CXR complement Ab to Chlamydia psittaci most likely occupation? - cat breeder -homeless shelter worker -poultry farmer -cave explorer -wool sorter
poultry farmer
wool sorter disease pathogen
Bacillus anthracis
poultry farmer in central US, microbe?
histoplasmosis or psittaci
25 y.o M fever nonproductive cough hypotension CXR b/l infiltrates silver stain with foamy alveolar exudates predisposing condition?
AIDS
pneumocystis jirovecii
CD4<200
what organism causing pneumonia do you expect in sickle cell patient?
asplenic
encapsulated pathogens like strep pneuomnia
southwest US organisms
coccidiodes
drug used for chronic aspiration
clindamycin
45y.o F chills rigors, fever onset 2 days gram + encapsulated lancet shaped diplococci microbe?
strep pneumoniae
type microbe H influenza
gram - rod
vital signs legionella
high fever and bradycardia
alcoholism is assoc with what pneumonia-causing organism
klebsiella
56 y.o DM M with chronic sinusitis
Tx 8 weeks antibiotics does not get better
2 wks later dies from posterior erosion of organism into his brain
strongly suspect infection with what?
mucormycosis
fungus
common in DM
25 y.o M prostitute, IV drug abuse fever marked SOB hacking and non-productive, present for weeks PaO2 55 PaCO2 50 b/l infiltrates lower lobes wheeze and dec breath sounds. oral thrush what is most consistent with Dx? Acid fast organisms in sputum elevated cold agglutinins \+ methamine silver stain lung tissue decreased serium IgA \+ convalescent precipitans for histpolasmosis
pneumocystis jiroveci
+ silver stain of lung tissue
6 mo from kenya
runny nose, dry non-productive cough
hacking and progressively more frequent and severe
severe paroxysms assoc with cyanosis, plethoric facies, bulging eyes, protrusion of the tongue, and distention of the neck veins
bordetella pertussis
decreased IgA means what in patients
more prone to respiratory infections
croup microbe
parainfluenza
50 y.o M
ER with severe pneumonia
just returned from Howell MI air conditioning and heat engineer
40 pack yr and drinks 8-10 beers/night
culture on charcoal yeast extract has small gram - bacteria
best antibiotic?
legionella
erythromycin– macrolide
clindamycin is used to Tx what
anaerobic
Staph non resistant is Tx with what
methicillin or nafcillin
19 y.o african american M San Diego 5 week fever, nonproductive cough and SOB Tx for levofloxacin little response - HIV and PPD CXR R upper lobe infiltrate small painful rash and red bumps on lower extremities Dx test?
fungal serologic tests- coccidiodes mycosis
65 y.o M with acute respiratory failure
marked CO2 retention and hypoxemia
ventialor
became ill with signs sepsis, kussmaul breathing and signs of septic shock
CXR show diffuse b/l infiltrates that turned to marked in one day
greenish colored sputum noticed on suction
most likely organism?
Pseudomonas aeruginosa
gram negative faculative intracell bacterium transmitted by flea bites
yersinia pestis
36 y.o M with stage IV sarcoidosis with hemoptysis
CXR L upper lobe pleural thickening
CT shows free floating density- fungus ball
most likely fungus to cause fungus ball?
aspergillus flavus
45 y.o M fever malaise, fatigue sputum streaked with blood nonproductive pulse 60 b/l rales L lower lobe infiltrate concerned about legionnaires and order what test?
Urinary antigens
21 y/o F
+ PPD
asymptomatic
Tx?
INH 6 mo
4 mo infant, winter runny nose, fever, cough, wheezing daycare with children same Sx b/l rales wheezing and intercostal retractions with grunting most likley infecting oganism
RSV
70 t.o M
lobar pneumoniae
kidney shaped gram - diplococci
most likely organism?
Moraxella catarrhalis
Influenza B on cruis liner
no influenza A so far
medications for unvaccinated patients on ship?
oseltamivir
76 y.o american indian F
admitted for Tx CAP
in hospital Dx mycobacterium tb confirmed by AFB
began on 4 drug regimen then changed to different regimen 4 wks later from sensitivity data
eye complaint now from meds
most likely due to what medication?
ethambutol
44 y.o M with chronic pneumonia
night sweats, fever, weight loss, fatigue, cough, sputum hemoptysis and dyspnea
CXR left sub segmental lower lobe pneumonia
poorly responsive antibiotics
small nodular lesions on surface of arms and legs
travels and makes canoes from polyurethane foam
single broad based buds off yeast cells
most likely region where obtained this disease
louisiana
large yeast cells with single broad based buds
blastomyces dermatitidis
39 y.o Hx HIV
fever, cough, night sweats, 7 lb weight loss
hemoptysis CD4
Tx
INH, pyranizamide, rifampin, ethambutol
+PPD in healthy med student
10mm or larger
10mm + PPD fits what criteria
recent arrivals from endemic countries injection drug users residents at high risk settings mycobacterial lab personnel persons with clinical conditions that place them at high risk
15 mm +PPD test used for what
live in an area no knonw risk factors TB
21 y.o HIV+ M cough and weight loss
given provisional Dx PCP pnuemonia given low CD4 count
worsens
partner previously died from pulm TB
he has active pulm TB and put on 4 drug regimen
2 weeks later but on HAART and now complaining of unusual sensations
isoniazid but also streptomycin and ethambutol
21 y.o F SOB previously admitted for "flu" getting worse put on 15 lb, nonproductive cough rabbit hutches normal heart dec DLCO CXR normal CT diffuse hazy opacities without focal infiltrates Dx?
interstitial pulmonary fibrosis
cause of Q fever?
coxiella burnetti
42 y.o M archeologist, ancient ruin Western US
HA, productive cough, dyspnea, fatigue, achy joints night sweats
red painful lumps on legs
dec breath sounds and diffuse crackles
b/l hilar adenopathy with spherical coin lesion
- AFB and -PPD
Dx?
coccidiomycosis
16 y.o homeless for 6 mo, prostitution
cough low grade fever, malaise, diffuse abdominal pain and diarrhea
occasional hemoptysis
b/l cervical supraclavicular and inguinal lymphadenopathy
liver and spleen enlarged to palpation
diastolic rumble and Left lower sternal borader (increases intensity with inspiration)
R atrial P waves
needle tracks, CD4 50, blood and sputum cultures negative
Dx is associated with?
-abundant AFB with macrophages characteristic MAC
-abundant AFB characteristic mycobacterium TB
- + silver stains for cyst or trophozoite
- + Ab legionella
- + cold agglutinin test
abundant AFB within macrophages characteristic of MAC
71 y.o F acute dyspnea, cough, fever flu season, consolidation left lower lung field
most common cause post influenza pneumonia?
staph aureus
3 y.o from haiti high fever, sore throat and dsypnea with respiratory stridor drool from mouth, neck extended cannot swallow thumb sign on lateral neck view causative organism?
epiglottitis
H influenzae
