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ABIM Pulmonary Boards > Pulmonary Infections > Flashcards

Pulmonary Infections Flashcards

1
Q

Most common viral cause of mild URI and lower respiratory tract illness

A

Human Metapneumovirus

Kids and adults
Can cause bronchiolitis or PNA
Hard to distinguish from RSK or influenza
(late winter and early spring)
fever uncommon in adults, wheezing common

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2
Q

adenovirus serotype 14 causes?

A

Severe pneumonia
ARDS

in residential facilities and military bases

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3
Q

Treatment for severe pneumonic tularemia

A

Gentamycin (aminoglycoside) - can be monitored

Moderate dz- use fluoroquinolones

Pleural fluid with lymph predominance
Presents as CAP that does not respond

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4
Q

When to initiate flu antivirals in pregnant pt?

A

w/in 48 hrs of illness onset
empirically treat with oseltamavir

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5
Q

How does a Quant gold work?

A

delayed hypersensitivity

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6
Q

Which NTBM can cause false positive on quant gold?

A

M. kansasii, M. szulgai, M. marinum

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7
Q

Treatment for Babesia

A

Atovaquone and azithromycin

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8
Q

What is the def of a ventilator associated condition (VAC)?

A

> 48 hr on vent with initial improvement then FiO2 increases by 20% OR PEEP increases by 3+ for 2 days

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9
Q

What defines a infection related ventilator complication (IVAC)?

A

VAC (increased vent requirements 2d) + temp or increased WBC + new abx for 4d

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10
Q

What defines a possible ventilator associated pneumonia (PVAP)?

A

IVAC + culture sent or purulent secretions AND positive cultures or other tests

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11
Q

What is a ventilatory associated tracheobronchitis (VAT) vs VAP

A

VAT has all the symptoms of VAP but no imaging infiltrate

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12
Q

When to stop abx for VAP?

A

completed 7 day course
Procal decreased
if BAL <10^4 cells

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13
Q

Risk factors for MDR VAP?

A

Prior IV abx w/in 90 days
unit rate MRSA >20%
+ Screening or colonization

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14
Q

Treatment for VAP if no MDR risk factors

A

Pip/tazo (pseudomonas)
Cefepime (GNR)

Maybe
Levo (s. pneumonia)

(if structural lung dz need 2 anti-pseudomonal)

Consider adding coverage for MSSA (cefazolin, nafcillin or cephalexin)

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15
Q

Treatment for VAP iso MDR risk factors?

A

Vancomycin or Linezolid

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16
Q

Risk factors for pseudomonas VAP and when to start empiric treatment?

A

Abx in 90 days prior
unit rate >10% or unknown
Structural lung dz
need for continued vent support or shock

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17
Q

Empiric treatment for pseudomonal VAP?

A

Dual therapy

Pip/Tazo OR Cefepime OR Carbapenems OR Aztreonam
AND
Aminoglycoside (amikacin, gent, tobra) OR FQs OR Polymyxins (Colistin, polymyxin B)

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18
Q

Treatment for Acinetobacter sensitive to only polymyxins?

A

IV polymyxin + Inhaled colistin

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19
Q

pseudomonas resistance mechanisms for beta lactams

A

Amp-C-type cephalosporinase

Class A serine beta lactamases (PSE, CARB, TEM)
Class A serine ESBL (TEM, SHV, CTX-M, PER, VEB)
Class D ESBL- OXA types

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20
Q

pseudomonas resistance mechanisms for fluroquinolones

A

DNA gyrase and Topoisomerase IV

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21
Q

Which preventative measure decreases duration of MV, LOS and mortality related to VAP

A

Oral care without chlorhexidine
Minimize sedation
PT/OT
elevated HOB
early feeding

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22
Q

prevention of VAP iso low prevalence of abx resistant org?

A

Selective oral or digestive decontamination.

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23
Q

Treatment of CNS or disseminated Cryptococcus?

A

1) induction with ampho B and flucystosine until 2 wk after cx neg
2) 8 weeks high dose fluconazole
3) 1 year low dose fluconazole

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24
Q

Cause and Treatment of Psittacosis (parrot dz)?

A

Chlamydophila psittaci

tetracycline or Doxy

hepatosplenomegaly, hemoptysis, rash, bradycard, epistaxis, Mono like

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25
Histologic appearance of PJP
26
Mucor on histology
27
Which bacteria and Treatment for carbapenemase producing organisms?
Ecoli (CTX-M), Klebsiella (KPC), enterobacter tx: ceftazidime-avibactam or meropenem-vaborbactam
28
Treatment of beta lactamase producing ecoli (ie CTX-M)?
Carbapenem
29
How to tell CAP vs. coccidiomycosis?
Hilar LAD increased Eos skin changes- erythema nodosum
30
Treatment for Coccidiomycosis?
immunocompetent--> obs sx >6wk --> treat Immunosuppressed, DM or HIV -> Fluconazole (second line itraconazole) Severe dz: ampho B
31
How to diagnose Cocci?
antigen test (urine or serum) ** cross reacts with histo and blasto
32
Diagnosis of NTM?
2 positive sputum cultures (one is not enough)
33
Treatment for M. Avium
3 times a week macrolide/ethambutol/rifamycin (check for resistance to macrolide 23S rRNA. stop abx after 12mo Cx neg
34
Tx for M. Kansasii
Isoniazid, rifampin, ethambutol Stop Abx after 1yr cx neg
35
Diagnostic test for aspergillus if pt is high risk with neg serum antigen
Galactomannan antigen in BAL (GM index >1 good spec, >0.5 better sen) Culture (Sputum>blood) Beta d glucan non specific PCR - cant tell active disease from colonization or dead fungi
36
What causes false + of galactomannan test
beta lactams, histo, rice/pasta, plasmalyte
37
Treatment for IPA
Voriconazole Isavuconazole Posaconazole
38
Presentation of Blasto
Chronic PNA 3w-3m after exposure Skin findings (verrucous, ulcerative) Osteomyelitis
39
Treatment of Blasto
Mild sx -- obs mild to mod --> itraconazole 6-12mo Severe-> ampho B 1-2wk then itraconazole CNS dz-> ampho Preg-> ampho
40
Histoplama histology
41
Treatment of Cystic echinococcosis
Complicated by cyst rupture--> Albendazole
42
Pulmonary manifestations of strongyloidiasis
pulmonary infiltrates with eosinophilia asthma without infiltrates hemoptysis due to alveolar hemorrhage hyperinfection syndrome Tx Ivermectin
43
Pulmonary Manifestations of paragonimiasis
Recurrent hemoptysis Pleural effusion Hydropneumo cysts Tx Praziquantel
44
Symptoms and presentation of pulmonary cystic echinococcosis
Contact with dogs usually liver then lungs Cough, CP, dyspnea, hemoptysis PTX, pleural eff, empyema, eos if rupture cyst tx abendazole
45
Def and Treatment for refractory MAC
Def: sputum cx + after 6mo tx (azithromycin, rifampicin and ethambutol) Tx: Adding inhaled amikacin liposome suspension treat for 12 mo after clear cx
46
Treatment after contact with MDR TB pt
Presume pt has MDR LTBI Tx: Levofloxacin or moxifloxacin for 6-12mo NOT pyrazinamide b/c lots to SE
47
Treatment for MAC
Mild to mod non-cavitary dz --> azithro/ethambutol/rifampin 3 x wk Cavitary or severe dz--> daily Very severe-> amikacin or other aminoglycoside IV for 1st 8-12wk
48
When to treat for NTM
pulm or systemic sx consistent imaging (nodules or cavitary opacities, bronchiectasis esp middle lobe) exclusion of other dx and + testing from 2 sputum cx, 1 BAL cx, biopsy w/ +cx, or pleural fluid +cx
49
LTBI treatment
Rifampin daily 4mo INH +rifampin daily 3mo Rifapentin + INH qweek x 12 dose 2nd line: INH daily 6-9mo (good if on birth control)
50
SE of Rifampin
Liver injury Orange body fluid Drug interactions (birth control! HIV meds)
51
SE INH
Liver injury peripheral neuropathy Drug induced lupus
52
SE PZA
Liver injury
53
Ethambutol SE
Optic neuropathy
54
Tx pan susceptible TB
6mo INH, RIF, ETH, PZA then drop ethambutol when sus confirmed and continued others for 2 mo
55
When to treat TB for 9 mo vs 6mo
- Inability to tolerate PZA - extensive cavitary dz - persistent wt loss and + cx beyond 2mo tx also to reduce risk of relapse or if BMI is low.
56
Treating TB in HIV+ pt
TB meds 1st then ART 2 wks after use Rifabutin
57
Presentation of Lemierre Syndrome
Also called septic thrombophlebitis of IJ infection with fusobacterium necrophorum occurs 1-3wks after typical pharyngitis - throat pain, fever, rigors, dysphagia - septic emboli - cough, dyspnea, pleurisy and hemoptysis Lung nodules that can cavitate
58
How to diagnose Lemierre syndrome
Head and neck imaging tx pip/tazo or carbapenem or CTX + metro for 4 wks
59
Treatment for severe monkey pox
Tecovirimat for 14 days (2nd line Cidofocir) treat if severely ill (airway involvement, dissemination, encephalitis) or underlying immunosupression
60
mpox presentation
Immunocompromised, MSM Rash in anogenital area with variable stages of development and can spread to mucosal areas dx with PCR
61
Treatment for mild mpox
if sx mild then usually self-limited so tx outpt with pain control and prevention of skin infections
62
Positive beta d glucan and neg glactomannan in pt with bilateral pulm infiltrates
PJP
63
Beta-d glucan positive in...
PJP aspergillus (has +GM) and candida maybe with histo, fusarium, cocci Neg in mucor (-GM), crypto (may have +GM), blasto
64
Causes of false + in beta d glucan
-pseudomonas -HD using cellulose membranes -IVIG -some albumin compounds -use of cellulose filters for IV admin -gauze used to pack serosal surfaces
65
Tick bite leads to anaphylaxis from contact with...
Red meat, milk products Alpha-gal syndrome
66
Treatment of nocardia if CNS involvement and immunocompromised pt
Bactrim, meropenem and amikacin for 6 weeks IV then switch to PO bactrim, minocycline and/or amox/clauv for total 6-12mo
67
Treatment of nocardia with mild to mod infection
Sufonamide (bactrim) If sulfa allergy --> minocycline
68
Tx actinomycosis
Penicillin if allergic--> tetra cycline, erythromycin, clinda
69
Risks for actinomyces
poor dentition Etoh use (aspiration) Male
70
Presentation and dx of actinomycosis
intact immune pt Usually non-pulm invades chest wall (destroys facial plane) confused for lung CA and TB dx: tissue--> sulfur granules, granulomas, fibrosis Stain with papauiculaou
71
Dx nocardia
Culture with BAL If immunocompromized +smear = dz PCR
72
Presentation of nocardia
Mostly pulmonary spreads via blood so CNS involvement
73
Why do pts with CF get more NTM?
- Structural lung dz - dysfunction of CF transmembrane conductance regulator protein
74
Empiric treatment for lung abscess
Amp/sulbactram IV Cover anaerobes and microaerophilic strep
75

ABIM Pulmonary Boards (11 decks)

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