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Year 2 Resp Exam 2 > Pnuemonias and TB Part I, D KInder, CIS > Flashcards

Pnuemonias and TB Part I, D KInder, CIS Flashcards

1
Q

22 y.o bullous myringitis, right middle lobe infiltrate, non-productive cough, fever

A

mycoplasma pnuemonia

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2
Q

bullous myringitis

A

blood filled TM

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3
Q

how to test for mycoplasma pneumonia

A

cold agglutinins test. autoAb to RBC

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4
Q

obligate intracell organism to cause pneumonia

A

chlamydia spp

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5
Q

pneumonia from infected excrement from pigeons

A

histoplasmosis

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6
Q

bradycardia in relation to patient’s fever
pneumonia
what causes this

A

legionella

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7
Q

why does penicillin not work on mycoplasma

A

has no cell wall

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8
Q 
fever, chills, yellow sputum
previous splenectomy
optochin sensitive
\+ quelling reaction
microbe?
A

streptococcus pneumonia

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9
Q

splenectomy patients are unable to protect against what organisms

A

encapsulated because B cell immunity is down

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10
Q

19 y.o college student
fever, dry cough, malaise, aches all over
mildly dec breath sounds b/l
cold agglutinins

A

mycoplasma pneumonia

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11
Q 
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
A

poultry farmer

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12
Q

wool sorter disease pathogen

A

Bacillus anthracis

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13
Q

poultry farmer in central US, microbe?

A

histoplasmosis or psittaci

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14
Q 
25 y.o M
fever nonproductive cough
hypotension
CXR b/l infiltrates
silver stain with foamy alveolar exudates
predisposing condition?
A

AIDS
pneumocystis jirovecii
CD4<200

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15
Q

what organism causing pneumonia do you expect in sickle cell patient?

A

asplenic

encapsulated pathogens like strep pneuomnia

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16
Q

southwest US organisms

A

coccidiodes

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17
Q

drug used for chronic aspiration

A

clindamycin

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18
Q 
45y.o F
chills rigors, fever
onset 2 days
gram + encapsulated lancet shaped diplococci
microbe?
A

strep pneumoniae

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19
Q

type microbe H influenza

A

gram - rod

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20
Q

vital signs legionella

A

high fever and bradycardia

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21
Q

alcoholism is assoc with what pneumonia-causing organism

A

klebsiella

22
Q

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?

A

mucormycosis
fungus
common in DM

23
Q 
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
A

pneumocystis jiroveci

+ silver stain of lung tissue

24
Q

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

A

bordetella pertussis

25
Q

decreased IgA means what in patients

A

more prone to respiratory infections

26
Q

croup microbe

A

parainfluenza

27
Q

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?

A

legionella

erythromycin– macrolide

28
Q

clindamycin is used to Tx what

A

anaerobic

29
Q

Staph non resistant is Tx with what

A

methicillin or nafcillin

30
Q 
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?
A

fungal serologic tests- coccidiodes mycosis

31
Q

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?

A

Pseudomonas aeruginosa

32
Q

gram negative faculative intracell bacterium transmitted by flea bites

A

yersinia pestis

33
Q

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?

A

aspergillus flavus

34
Q 
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?
A

Urinary antigens

35
Q

21 y/o F
+ PPD
asymptomatic
Tx?

A

INH 6 mo

36
Q 
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
A

RSV

37
Q

70 t.o M
lobar pneumoniae
kidney shaped gram - diplococci
most likely organism?

A

Moraxella catarrhalis

38
Q

Influenza B on cruis liner
no influenza A so far
medications for unvaccinated patients on ship?

A

oseltamivir

39
Q

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?

A

ethambutol

40
Q

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

A

louisiana

41
Q

large yeast cells with single broad based buds

A

blastomyces dermatitidis

42
Q

39 y.o Hx HIV
fever, cough, night sweats, 7 lb weight loss
hemoptysis CD4

A

Tx

INH, pyranizamide, rifampin, ethambutol

43
Q

+PPD in healthy med student

A

10mm or larger

44
Q

10mm + PPD fits what criteria

A 
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
45
Q

15 mm +PPD test used for what

A

live in an area no knonw risk factors TB

46
Q

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

A

isoniazid but also streptomycin and ethambutol

47
Q 
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?
A

interstitial pulmonary fibrosis

48
Q

cause of Q fever?

A

coxiella burnetti

49
Q

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?

A

coccidiomycosis

50
Q

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

A

abundant AFB within macrophages characteristic of MAC

51
Q

71 y.o F acute dyspnea, cough, fever flu season, consolidation left lower lung field
most common cause post influenza pneumonia?

A

staph aureus

52
Q 
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?
A

epiglottitis

H influenzae

Year 2 Resp Exam 2 (33 decks)

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