Pnuemonias and TB Part II, D KInder, CIS

Question 1

Hanta virus is transmitted how

Answer 1

urine droppings of deer mice

Question 2

phases hanta virus

Answer 2

incubation
febrile
hypotensive
oliguric
diuretic
convalescent

Question 3

Tx hanta

Answer 3

supportive care

Question 4

27 y.o heroin addict with fever night sweats, weight loss, cough, abdominal pain, diarrhea
HSM, abdominal tenderness
II/VI systolic murmur
multiple b/l infiltrates, b/l rales
30 pack year
hematuria
CD4 175 
PPD 5 mm erythema, 4 mm induration (- PPD)

Answer 4

probably has endocarditis

staph aureus

Question 5

25 y.o sheep rancher with 10 days high fever
HA chills malaise dry non-productive cough
segmental opacities on CXR
Hepatomegaly
inc AST ALT

Answer 5

coxiella burnetti

intracell pathogenic bacteria similar to rickettsia but with genetic and physiologic differences

Question 6

HACEK are what type microbe

Answer 6

gram - bacilli

Question 7

6 mo with low grade fever, wheezing and coughing, diminished appetite
mid january

Answer 7

bronchiolitis secondary to RSV

Question 8

34 y.o emigrant from sweden, 10 yr sandblaster
BCG vaccine
had INH for 6 mo because PPD was 10mm but stopped at 2 mo
now has small fibrotic changes at apex both lungs
next step

Answer 8

start INH prophylaxis from begining

Question 9

58 y.o M chronic cough clear sputum
30 pack year
PFTS obrstructive lung disease
acute exacerbation COPD
dec paO2 to 50 mmHg PaCO2 is 60mmHg
suspect chest infection and prescribe zpak

Answer 9

moraxella catarrhalis

Question 10

36 y.o farm worker with hemoptysis
from MExico up through california
hacking cough, nodules on pretibial area
3 cm thin walled cavity in L upper lobe on CXR with no surrounding infiltrate
PPD 4 mm induration

Answer 10

coccidiomycosis

Question 11

56 y.o HIV M
recent bouts candidiasis
dyspnea non productive cough, fever HA confusion
CXR diffuse interstitial infiltrate
PaO2 50mmHg
CT show ring like abscesses
CD 40
pet cat at home

Answer 11

toxoplasmosis gondii

tachyzoites that stain with H and E

Question 12

rickettsia like organism often transmitted with exposure to infected placentas and birth fluids of sheep and other mammals

Answer 12

coxiella burnetti

Question 13

disorder with flu Sx that resolves and comes back affecting liver, lungs, kidneys that leads to renal failure

Answer 13

leptospirosis

Question 14

what organism do you see with methanamine silver staining

Answer 14

pneumocystic jiroveci

Question 15

36 y.o smoking F
chills fever, rigor,productive cough
consolidation and rusty colored sputum
elevated WBC
unable to obtain sputum stain/culture
dec breath sounds
What is organism and what is primary response to this organism?

Answer 15

humoral immunity is primary response- B cell immunity

Strep pneumonia

Question 16

Normal immune responses have what Ig first

Answer 16

IgM followed by IgG

Question 17

33 y.o M rural veterinarian
flu like Sx, jaundice with HSM, CXR show patchy alveolar infiltrations
BUN and Cr increased
red cell casts in urine
suspect organism assoc with animal urine

Answer 17

leptospirosis

agglutination Ab

Question 18

SARS related travel

Answer 18

china, taiwan

Question 19

70 y.o F with temperature, minor chills, HA, myalgia
dry cough, non productive
mild rates clears with deep cough
same type of virus that affecter her this time last year
suspect that organism changed how

Answer 19

minor changes with antigenic drift

Question 20

patient with immune thrombocytopenic purpura
failure to prednisone
ITP stable for 5 years
sudden onset chills rigors cough and fever
splenectomy
has infection because what?

Answer 20

no longer to produce opsonizing IgG Ab to encapsulating organism
strep penumonia

Question 21

25 y.o M with CD4 200

PE normal, lungs CTA, PPD negative

Answer 21

prophylactic Bactrim

if allergic to sulfa–> give dapsone, pentamidine (inhalation)

Question 22

35 y.o chicken farmer in WV
flulike illeness, arthralgias, non productive cough
11 mm induration skin PPD
b/l nodules and hilar lymphadenopathy
Dx

Answer 22

positive serology for histoplasmosis

Question 23

66 y.o M withc CHF
insulin, amiodarone, lasix and digoxin
low grade fever and cough
dec breath sounds, II/VI murmur radiating to carotids
petichaie upper and lower extremities
pale, HSM and lymphadenopathy
\+ kernigs

Answer 23

N meningitides

Question 24

prophylaxis for neisseria meningitidis

Answer 24

rifampin

Question 25

orange urine is Side effect of what drug

Answer 25

rifampin

Question 26

81 y.o F with altered mental status
coughing fit
non insudlin dependent DM
CVA in past
low BP
pulse 97
low fever
type of pneumonia?
antibiotic

Answer 26

aspiration

clindamycin

Question 27

27 y.o post office worker
flu like then non productive cough chest discomfort
worsened
pleural effusion widened mediastinum
low temp high HR

Answer 27

bacillus anthracis

Question 28

what are the encapsulated bacteria

Answer 28

Step pneumonia
N meningitidis
Klebsiella
H influenza
Salmonella influenzae
Cryptococus
Pseudomonas
Some Nasty Killers Have Some Capsulated Protection

Question 29

7 y.o boy from pakistan 1 yr ago
Dx with active TB and Tx properly
mother PPD - with normal CXR but 3 mm induration
what should be next step?

Answer 29

retest in 6 mo to a year

Question 30

47 y.o M snores loudly and stops breathing in sleep for last 6 mo
overweight and falls asleep while driving
BP 170/100
ENT small tonsils and large tongue
next step?

Answer 30

nasal CPAP and life style changes

Question 31

60 y.o M in ER acute onset chest pain
pain is sharp
long H asthma
10 yrs had superficial thrombophlebitis in L leg
\+ homans normal CXR
pH 7.45 on room air

Answer 31

DVT PE

Question 32

classic presentation fat embolism

Answer 32

long bone fracture

Question 33

most common fining PE

Answer 33

sinus tachy