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Midterm (AGPC 4) > Pulmonary Infections > Flashcards

Pulmonary Infections Flashcards

1
Q

What is the most common cause of CAP?

A

strep pnemoniae

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2
Q

Best initial test for CAP?

A

CXR

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3
Q

After confirming diagnosis of CAP, what is the best next step?

A

Assess severity

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4
Q

CURB-65 tool + clinical judgment

A
  • tells severity
    1. confusion
    2. uremia (BUN > 19mg/dl)
    3. Respiratory distress (RR > 30/min)
    4. BP low (SBP <90mmghg)
    5. > 65 y.o
  • 0 to 1 = home
  • > 2 = hospital
  • SOB, hypotension, confusion = no perfusion = hospital
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5
Q

No comorbidities, no previous antibiotics CAP tx

A

Macrolides (azithromycin, clarithromycin, erythromycin) or Doxycycline x 5 days

  • do not stop until afebrile for 48 hrs
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6
Q

Comorbidities, treated with abx in past 3 months CAP tc

A

Respiratory FQ (levofloxacin 750mg, moxifloxacin, gemifloxacin) or Beta-Lactam (high dose of amoxicillin, amoxicillin/clavulanate, cefuroxime) + Macrolide or Doxycycline

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7
Q

Intermediate Risk - PPSV 23 vaccine

A
  • younger adults (<65 y/o) with comorbid condition:
    1. cigarette smokers
    2. chronic heart disease
    3. chronic lung disease
    4. asthma
    5. DM
    6. chronic liver disease
    7. alcoholism
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8
Q

High Risk - PCV13 followed by PPSV23

A
  • adults >65 y/o

- immunocompromising conditions (HIV, cancer, anatomic asplenia, CSF leak)

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9
Q

TB bacteria facts

A
  • Mycobacterium tuberculosis

- transmitted through droplets

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10
Q

Increased risk for TB

A
  • recent (<5 yr) immigrant from developing countries
  • HIV positive
  • prisoners
  • Homeless/urban poor/ IVDU
  • healthcare workers
  • impaired cell immunity (DM, organ transplant, cancer)
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11
Q

2 risk factors fro TB

A
  • immunosuppressed

- living in crowded conditions

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12
Q

Latent TB

A
  • infected but body is successful in containing org
  • NOT INFECTIOUS
  • NO SYMPTOMS
    • ppd
  • 10% risk of reactivation
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13
Q

Secondary (Reactivated) Infection

A
  • caused by stress on immune system
  • INFECTIOUS
  • symptomatic
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14
Q

Diagnostic Tests for ACTIVE TB

A
  1. CXR/ CT chest: SUGGESTIVE but not diagnostic&raquo_space; isolate
  2. Sputum acid-fast stain: Not very sensitive or specific. Makes PRESUMED dx and reflects high infectivity&raquo_space; initiate treatment pending culture
  3. Sputum culture: “Gold standard”, takes 4-6 weeks, required for confirmation of the diagnosis and for drug susceptibility testing
  4. PPD or IGRA: For screening of asymptomatic individuals at risk, not for dx symptomatic patients
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15
Q

Tx : TB

A 
RIPE ( at least 6 months): 
•	Rifampin ( RIF) 
•	Isoniazid ( INH) 
•	Pyrazinamide ( PZA) 
•	Ethambutol ( ETM)
  • Can start Tx based on positive acid fast stain
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16
Q

Side effects of TB medication

A

RIF: red color of secretion, causes contraceptive fx
INH: peripheral neuropathy (give pyridoxine - B6), washes out B6 -
PZA: Hepatotoxic
ETM: optic neuritis/color vision

all medications are hepatotoxic

17
Q

When is PPD indicated?

A 
•	To screen asymptomatic patients at risk for latent TB:
	Recent immigrants ( 5 years) 
	Immunosuppressed 
	Prisoners 
	Health care workers (done every year to detect recent infection)
	Homeless 
	Nursing home residents
	Alcoholics  
	Close contact with TB patients
18
Q

When do you read a PPD

A

48 hours

19
Q

PPD: When is it positive?

A 
> 5 mm induration 
•	HIV
•	Organ transplant recipients 
•	Steroid users 
•	Close contact of those w/ ACTIVE TB 
> 10 mm induration 
•	Recent immigrants Prisoners 
•	Health care workers
•	Homeless 
•	Nursing home residents
•	Alcoholics  
> 15 mm induration 
No risk factors (should not be screened)
20
Q

Positive PPD: What is the next best step?

A

CXR to r/o TB

21
Q

Recommended tx for latent TB (PPD positive, CXR neg, no symptoms)

A
  • INH for 9 months (especially for patients who have converted from negative to positive within 2 years)
  • No need to repeat PPD test in patients with positive PPD
22
Q

PPD

A

Skin test
Two visits
May cross react w/ BCG (depends on time when BCG given)

23
Q

IGRA

A

Blood test
One visit ( compliance, comfort)
More specific. Do not cross react w. BCG
Not approved in children < 5 y

24
Q

Pertussis (clinical findings)

A

paroxysmal cough and posttussive vomiting

25
Q

Pertussis (Dx test)

A

no sensitive tests at time of symptoms

26
Q

Pertussis: Important facts

A
  • Gram-negative bacteria Bordetella pertussis

- spread via respiratory droplets

27
Q

Pertussis: natural history

A

Early ( catarrhal) phase (6 days) - non-specific sx. Dx tests are most specific in this period!

Paroxysmal phase (6 weeks) – 
In children- cough paroxysms, a vigorous inspiration causes the "whooping" sound, post-tussive vomiting.
 In adolescents or adults - just prolonged cough, +/- posttussive vomiting.

Convalescent phase (6 weeks)

28
Q

Diagnostic tests for pertussis

A
  1. CXR: Usually negative. Done to r/o pneumonia
  2. Culture: Requires specific medium. 7-10 days, sensitivity declines after 2 weeks, w/ recent abx use
  3. NAAT (by PCR): Sensitivity declines after 4 weeks and with recent abx use.
  4. Serology: Not useful in acute period
29
Q

best initial therapy for pertussis

A

Azithromycin ( Z-pack) – for 5 days
Reduces spread!
Treat close contacts

30
Q

Who should be vaccinated against pertussis?

A
  • 19 and older: Tdap as a single booster regardless of timing of Td
  • pregnant women every pregnancy

Midterm (AGPC 4) (6 decks)

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