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ID > Pulm Infections > Flashcards

Pulm Infections Flashcards

1
Q

Who should receive sequential 13-valent then 23-valent pneumococcus vaccine?

A

Everyone age 65 and over

First PCV13, then the PPSV23 6-12 months later

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2
Q

Who should only receive the PPSV23 (23-valent pneumococcus vaccine)?

A

Age under 65 but current smoker or has medical conditions (e.g., diabetic, COPD)

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3
Q

Reticulonodular pattern on CXR (interstitial infiltrate)

Can also have macular/vesicular rash, nonexudative pharyngitis

A

Mycoplasma pneumonia? (Usually 2-3 weeks)

If longer, think miliary TB!

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4
Q

Side effect of rifampin

A

Turns body fluids orange and induces CYP450

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5
Q

Side effect of ethambutol

A

optic neuritis

E is for Eyes

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6
Q

Side effect of isoniazid

A

Peripheral neuropathy, hepatitis (elevated LFTs which should self-resolve)

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7
Q

Give what along with isoniazid (INH)?

A

Vitamin B16 to prevent peripheral neuropathy

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8
Q

Painful genital ulcer with erythematous base, well-demarcated borders, purulent exudate

A

Hemophilia ducreyi (chancroid)

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9
Q

Risks for what kind of pneumonia?
Foul-smelling sputum, poor dentition
Recent upper airway instrumentation (ET or NG tube)

A

Aspiration (anaerobic organisms)

-> Clindamycin

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10
Q

Young person with recent flu

Now with high fever, productive cough w/ hemoptysis, leukopenia, multilobar cavitary infiltrates

A

Secondary bacterial pneumonia with community-acquired MRSA (predilection for young pts, in whom this is otherwise rare)

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11
Q

PPD cut-offs

A

5mm for HIV+ or immunosuppressed or prior infection or known contacts

10mm for contact risk factors
15mm for normal ppl

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12
Q

Recent travel, or contaminated water
Pneumonia
Fever, bradycardia (relative to fever), confusion, diarrhea
Hyponatremia, hepatic dysfunction, hematuria, proteinuria
Sputum gram stain: many neutrophils but no organisms

A 
Legionella pneumophila (intracellular gram neg rod)
Pneumonia + GI + CNS

Note: If infiltrate is bilateral, think PJP?

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13
Q

How to confirm dx of Legionnaire’s disease?

A

Urine antigen testing

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14
Q

How to treat Legionella

A

Fluoroquinolone or macrolide

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15
Q

Immunosuppressed

CXR diffuse bilateral interstitial infiltrates w ground-glass

A

Pneumocystis jiroveci

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16
Q

Suspect PJP, but induced sputum doesn’t yield diagnosis, what to do?

A

Get sample from bronchoscopy with bronchoalveolar lavage

17
Q

What infections can mimic sarcoidosis? (Hilar lymphadenopathy, even noncaseating granulomas)

A

Dimorphic fungi: histoplasma, blastomyces, coccidioides

Remember endemic regions!

18
Q

Aspiration pneumonia —> which lobe?

A

Lower right lobe

19
Q

Endemic region for coccidioidomycosis?

A

Southwestern US

20
Q

Endemic region for blastomycosis?

A

Great Lakes, Mississippi River and Ohio River basins

Wisconsin has highest infection rate

21
Q

Few months of fever, night sweats, weight loss
CXR shows upper lobe consolidation
Skin: well-circumscribed, verrucous, crusted lesions
Lytic lesions in bones
Lives in Wisconsin

A

Blastomycosis (fungus)

22
Q

What does it mean to have “latent TB”

A

Positive PPD+ but no signs/symptoms of active disease (clear CXR)

23
Q

How to treat latent TB?

A

9 months of isoniazid (INH) with pyridoxine (vitamin B6)

24
Q

Immune compromised
Lung nodules, brain abscess-> seizures
Cultures grow gram+, partially acid-fast, filamentous, branching rods

A

Nocardia

25
Q

Treatment of nocardia

A

TMP-SMX

26
Q

Sulfur granules

A

Actinomyces

27
Q

CAP + arthralgias, erythema nodosum, erythema multiforme

Arizona

A

Coccidioides

28
Q

What is Td/Tdap rec for adults?

A

Tdap once, then Td booster every 10 years

29
Q

Mild pulmonary
Big violet warts
Can also involve bone (osteomyelitis) and prostate (prostatic is, epididymo-orchitis)
Wisconsin

A

Blastomycosis

30
Q

Pneumonia
Alcoholic
Currant-jelly sputum

A

Klebsiella

-> third gen cephalosporin

31
Q

Cavitary infiltrate in upper lobe + calcification of nearby lymph node

A

Ghon complex (TB)

32
Q

Pruritic papule, lymphadenopathy -> black Eschar
Can cause hemorrhagic mediastinitis
CXR can show widened mediastinum

A

Anthrax

Tx: cipro + doxy + 2 additional abx for at least 14 days

ID (12 decks)

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