Pulm Infections Flashcards
Who should receive sequential 13-valent then 23-valent pneumococcus vaccine?
Everyone age 65 and over
First PCV13, then the PPSV23 6-12 months later
Who should only receive the PPSV23 (23-valent pneumococcus vaccine)?
Age under 65 but current smoker or has medical conditions (e.g., diabetic, COPD)
Reticulonodular pattern on CXR (interstitial infiltrate)
Can also have macular/vesicular rash, nonexudative pharyngitis
Mycoplasma pneumonia? (Usually 2-3 weeks)
If longer, think miliary TB!
Side effect of rifampin
Turns body fluids orange and induces CYP450
Side effect of ethambutol
optic neuritis
E is for Eyes
Side effect of isoniazid
Peripheral neuropathy, hepatitis (elevated LFTs which should self-resolve)
Give what along with isoniazid (INH)?
Vitamin B16 to prevent peripheral neuropathy
Painful genital ulcer with erythematous base, well-demarcated borders, purulent exudate
Hemophilia ducreyi (chancroid)
Risks for what kind of pneumonia?
Foul-smelling sputum, poor dentition
Recent upper airway instrumentation (ET or NG tube)
Aspiration (anaerobic organisms)
-> Clindamycin
Young person with recent flu
Now with high fever, productive cough w/ hemoptysis, leukopenia, multilobar cavitary infiltrates
Secondary bacterial pneumonia with community-acquired MRSA (predilection for young pts, in whom this is otherwise rare)
PPD cut-offs
5mm for HIV+ or immunosuppressed or prior infection or known contacts
10mm for contact risk factors
15mm for normal ppl
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
Legionella pneumophila (intracellular gram neg rod) Pneumonia + GI + CNS
Note: If infiltrate is bilateral, think PJP?
How to confirm dx of Legionnaire’s disease?
Urine antigen testing
How to treat Legionella
Fluoroquinolone or macrolide
Immunosuppressed
CXR diffuse bilateral interstitial infiltrates w ground-glass
Pneumocystis jiroveci
Suspect PJP, but induced sputum doesn’t yield diagnosis, what to do?
Get sample from bronchoscopy with bronchoalveolar lavage
What infections can mimic sarcoidosis? (Hilar lymphadenopathy, even noncaseating granulomas)
Dimorphic fungi: histoplasma, blastomyces, coccidioides
Remember endemic regions!
Aspiration pneumonia —> which lobe?
Lower right lobe
Endemic region for coccidioidomycosis?
Southwestern US
Endemic region for blastomycosis?
Great Lakes, Mississippi River and Ohio River basins
Wisconsin has highest infection rate
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
Blastomycosis (fungus)
What does it mean to have “latent TB”
Positive PPD+ but no signs/symptoms of active disease (clear CXR)
How to treat latent TB?
9 months of isoniazid (INH) with pyridoxine (vitamin B6)
Immune compromised
Lung nodules, brain abscess-> seizures
Cultures grow gram+, partially acid-fast, filamentous, branching rods
Nocardia
