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ABIM Pulmonary Boards - Jackie > 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
Q

Histologic appearance of PJP

A
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26
Q

Mucor on histology

A
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27
Q

Which bacteria and Treatment for carbapenemase producing organisms?

A

Ecoli (CTX-M), Klebsiella (KPC), enterobacter

tx: ceftazidime-avibactam or meropenem-vaborbactam

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28
Q

Treatment of beta lactamase producing ecoli (ie CTX-M)?

A

Carbapenem

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29
Q

How to tell CAP vs. coccidiomycosis?

A

Hilar LAD
increased Eos
skin changes- erythema nodosum

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30
Q

Treatment for Coccidiomycosis?

A

immunocompetent–> obs
sx >6wk –> treat
Immunosuppressed, DM or HIV -> Fluconazole
(second line itraconazole)
Severe dz: ampho B

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31
Q

How to diagnose Cocci?

A

antigen test (urine or serum)
** cross reacts with histo and blasto

32
Q

Diagnosis of NTM?

A

2 positive sputum cultures (one is not enough)

33
Q

Treatment for M. Avium

A

3 times a week macrolide/ethambutol/rifamycin (check for resistance to macrolide 23S rRNA.

stop abx after 12mo Cx neg

34
Q

Tx for M. Kansasii

A

Isoniazid, rifampin, ethambutol
Stop Abx after 1yr cx neg

35
Q

Diagnostic test for aspergillus if pt is high risk with neg serum antigen

A

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
Q

What causes false + of galactomannan test

A

beta lactams, histo, rice/pasta, plasmalyte

37
Q

Treatment for IPA

A

Voriconazole

Isavuconazole
Posaconazole

38
Q

Presentation of Blasto

A

Chronic PNA 3w-3m after exposure
Skin findings (verrucous, ulcerative)
Osteomyelitis

39
Q

Treatment of Blasto

A

Mild sx – obs
mild to mod –> itraconazole 6-12mo
Severe-> ampho B 1-2wk then itraconazole
CNS dz-> ampho
Preg-> ampho

40
Q

Histoplama histology

A
41
Q

Treatment of Cystic echinococcosis

A

Complicated by cyst rupture–> Albendazole

42
Q

Pulmonary manifestations of strongyloidiasis

A

pulmonary infiltrates with eosinophilia
asthma without infiltrates hemoptysis due to alveolar hemorrhage
hyperinfection syndrome

Tx Ivermectin

43
Q

Pulmonary Manifestations of paragonimiasis

A

Recurrent hemoptysis
Pleural effusion
Hydropneumo
cysts

Tx Praziquantel

44
Q

Symptoms and presentation of pulmonary cystic echinococcosis

A

Contact with dogs
usually liver then lungs
Cough, CP, dyspnea, hemoptysis
PTX, pleural eff, empyema, eos if rupture cyst

tx abendazole

45
Q

Def and Treatment for refractory MAC

A

Def: sputum cx + after 6mo tx (azithromycin, rifampicin and ethambutol)

Tx: Adding inhaled amikacin liposome suspension
treat for 12 mo after clear cx

46
Q

Treatment after contact with MDR TB pt

A

Presume pt has MDR LTBI
Tx: Levofloxacin or moxifloxacin for 6-12mo

NOT pyrazinamide b/c lots to SE

47
Q

Treatment for MAC

A

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
Q

When to treat for NTM

A

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
Q

LTBI treatment

A

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
Q

SE of Rifampin

A

Liver injury
Orange body fluid
Drug interactions (birth control! HIV meds)

51
Q

SE INH

A

Liver injury
peripheral neuropathy
Drug induced lupus

52
Q

SE PZA

A

Liver injury

53
Q

Ethambutol SE

A

Optic neuropathy

54
Q

Tx pan susceptible TB

A

6mo INH, RIF, ETH, PZA
then drop ethambutol when sus confirmed and continued others for 2 mo

55
Q

When to treat TB for 9 mo vs 6mo

A
  • 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
Q

Treating TB in HIV+ pt

A

TB meds 1st then ART 2 wks after

use Rifabutin

57
Q

Presentation of Lemierre Syndrome

A

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
Q

How to diagnose Lemierre syndrome

A

Head and neck imaging

tx pip/tazo or carbapenem or CTX + metro for 4 wks

59
Q

Treatment for severe monkey pox

A

Tecovirimat for 14 days (2nd line Cidofocir)

treat if severely ill (airway involvement, dissemination, encephalitis) or underlying immunosupression

60
Q

mpox presentation

A

Immunocompromised, MSM

Rash in anogenital area with variable stages of development and can spread to mucosal areas

dx with PCR

61
Q

Treatment for mild mpox

A

if sx mild then usually self-limited so tx outpt with pain control and prevention of skin infections

62
Q

Positive beta d glucan and neg glactomannan in pt with bilateral pulm infiltrates

A

PJP

63
Q

Beta-d glucan positive in…

A

PJP
aspergillus (has +GM) and candida
maybe with histo, fusarium, cocci

Neg in mucor (-GM), crypto (may have +GM), blasto

64
Q

Causes of false + in beta d glucan

A

-pseudomonas
-HD using cellulose membranes
-IVIG
-some albumin compounds
-use of cellulose filters for IV admin
-gauze used to pack serosal surfaces

65
Q

Tick bite leads to anaphylaxis from contact with…

A

Red meat, milk products
Alpha-gal syndrome

66
Q

Treatment of nocardia if CNS involvement and immunocompromised pt

A

Bactrim, meropenem and amikacin for 6 weeks IV then switch to PO bactrim, minocycline and/or amox/clauv for total 6-12mo

67
Q

Treatment of nocardia with mild to mod infection

A

Sufonamide (bactrim)

If sulfa allergy –> minocycline

68
Q

Tx actinomycosis

A

Penicillin

if allergic–> tetra cycline, erythromycin, clinda

69
Q

Risks for actinomyces

A

poor dentition
Etoh use (aspiration)
Male

70
Q

Presentation and dx of actinomycosis

A

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
Q

Dx nocardia

A

Culture with BAL
If immunocompromized +smear = dz
PCR

72
Q

Presentation of nocardia

A

Mostly pulmonary
spreads via blood so CNS involvement

73
Q

Why do pts with CF get more NTM?

A
  • Structural lung dz
  • dysfunction of CF transmembrane conductance regulator protein
74
Q

Empiric treatment for lung abscess

A

Amp/sulbactram IV

Cover anaerobes and microaerophilic strep

75
Q
A

ABIM Pulmonary Boards - Jackie (11 decks)

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