Pnuemonias and TB Part II, D KInder, CIS Flashcards
Hanta virus is transmitted how
urine droppings of deer mice
phases hanta virus
incubation febrile hypotensive oliguric diuretic convalescent
Tx hanta
supportive care
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)
probably has endocarditis
staph aureus
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
coxiella burnetti
intracell pathogenic bacteria similar to rickettsia but with genetic and physiologic differences
HACEK are what type microbe
gram - bacilli
6 mo with low grade fever, wheezing and coughing, diminished appetite
mid january
bronchiolitis secondary to RSV
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
start INH prophylaxis from begining
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
moraxella catarrhalis
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
coccidiomycosis
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
toxoplasmosis gondii
tachyzoites that stain with H and E
rickettsia like organism often transmitted with exposure to infected placentas and birth fluids of sheep and other mammals
coxiella burnetti
disorder with flu Sx that resolves and comes back affecting liver, lungs, kidneys that leads to renal failure
leptospirosis
what organism do you see with methanamine silver staining
pneumocystic jiroveci
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?
humoral immunity is primary response- B cell immunity
Strep pneumonia
Normal immune responses have what Ig first
IgM followed by IgG
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
leptospirosis
agglutination Ab
SARS related travel
china, taiwan
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
minor changes with antigenic drift
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?
no longer to produce opsonizing IgG Ab to encapsulating organism
strep penumonia
25 y.o M with CD4 200
PE normal, lungs CTA, PPD negative
prophylactic Bactrim
if allergic to sulfa–> give dapsone, pentamidine (inhalation)
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
positive serology for histoplasmosis
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
N meningitides
prophylaxis for neisseria meningitidis
rifampin
orange urine is Side effect of what drug
rifampin
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
aspiration
clindamycin
27 y.o post office worker flu like then non productive cough chest discomfort worsened pleural effusion widened mediastinum low temp high HR
bacillus anthracis
what are the encapsulated bacteria
Step pneumonia N meningitidis Klebsiella H influenza Salmonella influenzae Cryptococus Pseudomonas Some Nasty Killers Have Some Capsulated Protection
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?
retest in 6 mo to a year
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?
nasal CPAP and life style changes
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
DVT PE
classic presentation fat embolism
long bone fracture
most common fining PE
sinus tachy
