Pulm. aspergilosis + myastenia crisis 10-28 (1)

Question 1

ch. aspergillosis. diagnosis. criteria?

Answer 1

Diagnosis is made by the presence of all 3 of the following:
a. >3 months of symptoms: i. Fever ii. Weight loss iii. Fatigue iv. Cough v. Hemoptysis vi. Dyspnea

b. Cavitary lesion(s) containing debris, fluid, or an aspergilloma (fungus ball)

c. Positive Aspergillus IgG serology

Question 2

CHRONIC PULMONARY ASPERGILLOSIS. in what population?

Answer 2

It is seen in immunocompetent patients with a history of pulmonary disease (eg, cavitary TB)

Question 3

allergic aspergillosis (ABPA)
risk factors and pathogenesis.

Answer 3

Structural airway disease (eg asthma, CF)
fungal spore colonization –> Th2 based sensitization –> allergic inflammation

Question 4

allergic aspergillosis (ABPA). clinical - asthma control?

Answer 4

difficult to control asthma, thick sputum

Question 5

allergic aspergillosis (ABPA). chest imaging?

Answer 5

fleeting infiltrates, bronchiectasis, bronchial mucoid impaction

Question 6

allergic aspergillosis (ABPA). aspergillus sensitization? 3

Answer 6

elevated serum IgE (>1000 IU/ml)
Positive aspergillus skin test and/or IgE
Suggestive: eosinophilis, positive aspergillus IgG

Question 7

allergic aspergillosis (ABPA). treatment? 3

Answer 7

systemic glucocorticois –> decr. allergic inflammation
Antifungal drugs (eg variconazole) –> decr spore burden
Treatment of underlying asthma (eg bronchodilators)

Question 8

Invasive pulm. aspergillosis. classic triad?

Answer 8

fever, pleuritic chest pain, hemoptysis

Question 9

Invasive pulm. aspergillosis. diagnosis? 4

Answer 9

sputum stain/culture
Serum biomarkers for cell wall components
CT scan
Bronchoscopy with BAL lavage

Question 10

Invasive pulm. aspergillosis. CT scan -?

Answer 10

i. Nodules with surrounding ground-glass opacities (“halo sign”Ϳ

Question 11

Invasive pulm. aspergillosis. Bronchoscopy with BAL lavage -?

Answer 11

i. This test is done when noninvasive testing is inconclusive

Question 12

Invasive pulm. aspergillosis. treatment? 2

Answer 12

Treatment:
a. 1-2 weeks of IV voriconazole + echinocandin (eg, caspofungin)
b. Later, patient is transitioned to prolonged therapy with oral voriconazole alone

Question 13

neutropenic assoc with what 2 infections?

Answer 13

pseudomonas
aspergillus

Question 14

invasive vs chronic table.
invasive risk factors?

Answer 14

Immunocompromise (NEUTROPENIA, HIV, glucocorticoids)

Question 15

invasive vs chronic table.
chronic risk factors?

Answer 15

Lung disease/damage (CAVITARY TUBERCULOSIS)

Question 16

invasive vs chronic table.
invasive findings?

Answer 16

TRIAD: fever, chest pain, hemoptysis
Pulm. nodules with halo sign
positive cultures
positive cell wall biomarkers (galactomannan, beta-D-glucan)

Question 17

invasive vs chronic table.
chronic findings?

Answer 17

> 3 MONTHS: weight loss, cough, hemoptysis, fatigue
Cavitary lesion +/- FUNGUS BALL
Positive ASPERGILLUS IgG serology

Question 18

invasive vs chronic table.
invasive treatment?

Answer 18

voriconazole +/- caspofungin

Question 19

invasive vs chronic table.
chronic treatment? 3

Answer 19

Resect aspergilloma (if possible)
AZOLE medication (voriconazole)
Embolization (if severe hemoptysis)

Question 20

Simple aspergilloma (fungus ball in preexising lung cavity) is a form of chronic pulmonary aspergillosis but is usually quiscent with occasional hemoptysis

Answer 20

.

Question 21

myastenic crisis. precipitating factors?

Answer 21

Infection or surgery
pregnancy of childbirth
tapering of immunosuppressive drugs
medications (AMG, BAB, Mg, CCB)

Question 22

myastenic crisis. symptoms?

Answer 22

incr. generalized and oropharyngeal weakness

respiratory insufficiency/dyspnea

Question 23

myastenic crisis. management?

Answer 23

Elective intubation
Plasmapheresis or IVIG as well as corticosteroids

Question 24

myastenic crisis.
intubation - elective. criteria?

Answer 24

Elective intubation
i. It should be performed in patients with impending respiratory failure

ii. Objective measurements that indicate impending respiratory failure are as
follows:
1. Reduced vital capacity of lungs
2. Respiratory acidosis