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PANCE 2.0 > Pulmonology #6 (PNA #2, Tuberculosis) > Flashcards

Pulmonology #6 (PNA #2, Tuberculosis) Flashcards

1
Q

What are the 2 criteria to classify PNA as community-acquired PNA?

A

-Acquired outside the hospital setting OR within 48 hours of hospital admission

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2
Q

Hospital acquired PNA occurs ________ and is usually caused by _____, or _______

A

> 48 hours after hospital admission

-MRSA
-Pseudomonas

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3
Q

Management of CAP Outpatient

A

Macrolides (-mycin) or Doxy

-Fluoroquinolones if recent ABX use

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4
Q

Management of CAP Inpatient

A

B-lactam (Ceftriaxone, Unsayn) + Macrolide or Doxy OR broad spectrum fluoroquinolone (-oxacin)

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5
Q

Aspiration PNA, MCC by ________, has increased incidence with periodontal disease. What are some symptoms associated with this condition?

A

-Anaerobes

-MC in right lower lobe
-Foul-smelling sputum (rotten egg smell)

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6
Q

Treatment for aspiration PNA

A

-Ampicillin-Sulbactam (first line) or Amoxicillin-Clavulanate

Alternative: Metronidazole + Amoxicillin or Pen G

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7
Q

Treatment for HAP

A

-Anti Pseudomonal B-lactam + either anti-pseudomonas AG or FQ (Piper/Tazo, Ceftazidime, Cefepime + -acin or -oxacin)

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8
Q

If MRSA is suspected with HAP, what should you add to the treatment?

A

Vanco or Linezolid

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9
Q

If Legionella is suspected with HAP, what should you add to the treatment?

A

Levofloxacin or Azithromycin

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10
Q

What is the CURB-65 score and what are the points?

A

Criteria for admission with PNA

-Confusion
-Uremia (>30 mg/dL)
-RR < 30
-BP (SBP < 90 or DBP < 60)
-Age > 65

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11
Q

How do you transmit Histoplasmosis?

A

Inhalation of soil containing bird and bat droppings in the Mississippi and Ohio River Valleys

-Also seen with demolition, spelunkers, excavators

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12
Q

Risk factors for Histoplasmosis?

A

Immunocompromised states

-AIDS defining illness if CD4 <150

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13
Q

Although most patients with Histoplasmosis are asymptomatic, it does present as atypical PNA occasionally (fever, nonproductive cough, myalgias). Also, if disseminated, what are some symptoms?

A

Can mimic TB with hepatosplenomegaly, oropharyngeal ulcers, bloody diarrhea, adrenal insufficiency

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14
Q

Diagnostics for histoplasmosis

A

-Antigen testing via sputum (PCR) or urine
-Cultures are most specific

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15
Q

Treatment for Histoplasmosis

A

-Asymptomatic: no treatment
-Mild-Moderate: Itraconazole
-Severe: Amphotericin B

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16
Q

What is the schedule for the PCV-13 vaccine?

A

2, 4, 6, and 12-15 months of age

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17
Q

Who gets the PCV 23 vaccine?

A

All adults 65 and older or younger patients with conditions that increase the risk for developing complications from a PNA infection

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18
Q

True or False: Pregnancy is NOT a contraindication to the PNA vaccine?

A

True. Pregnant women can still get it

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19
Q

What are risk factors for Pneumocystis PNA (PCP)?

A

Immunocompromised states
Most common opportunistic infection in HIV (CD4 < 200)

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20
Q

What is the classic triad of symptoms for PCP PNA?

A

-DOE (MC)
-Fever
-Nonproductive cough

21
Q

What is true about the oxygen desaturation with PCP PNA?

A

Desaturation with ambulation

22
Q

DOC for PCP PNA

A

Trimethoprim-Sulfamethoxazole x 21 days

23
Q

If the patient is HIV + and hypoxic, what drug should be added?

A

Prednisone

24
Q

On CXR, what is seen with PCP PNA?

A

Diffuse bilateral interstitial infiltrates (but may be normal)

25
Q

What is seen on labs with PCP PNA?

A

Increased LDH (> 200), increased beta-D-glucan

26
Q

What is the prophylaxis for PCP PNA in a patient with HIV?

A

Bactrim if CD4 < 200

27
Q

Risk factors for TB

A

-Close contact with an infected person
-Crowded conditons
-Healthcare workers
-Immunosuppression (DM, HIV)

28
Q

What is needed in chronic (latent TB) to show infected but not infectious?

A
    • PPD
      -No symptoms
      -No imaging findings of active infection
29
Q

With secondary/reactivation TB, where are the imaging findings usually positive?

A

Apex/upper lobes with cavitary lesions (due to increased O2 content in apices)

30
Q

What are symptoms of TB?

A

-Cough (productive or nonproductive)
-Hemoptysis
-Fever, chills, night sweats, chest pain
-Cervical lymph nodes (scrofula)
-Pott’s disease (vertebrae)
-Miliary TB
-Pericarditis

31
Q

True or False: TB can affect any organ?

A

True

32
Q

What is Pott’s Disease?

A

TB of the vertebrae

33
Q

What is TB of the cervical lymph nodes?

A

Scrofula

34
Q

A CXR is often the initial test ordered for TB. Explain the differences in location for findings based on reactivation, primary TB, and miliary TB.

A

-Reactivation: Apical (upper lobe)
-Primary: middle/lower lobe consolidation
-Miliary: millet-seed nodular lesions 2-4 mm

35
Q

Regarding sputum acid-fast staining, what must be done to rule out TB?

A

3 samples taken on 3 consecutive days must be negative to rule out TB

Only one + sample is needed to rule in TB

36
Q

However, what is more sensitive that sputum staining?

A

NAAT

37
Q

Management of active TB

A

4 drug therapy (RIPE) for 2 months followed by 4 months of RI = 6 month total treatment

38
Q

What drug can used instead of Ethambutol

A

Streptomycin

RIPE or RIPS

39
Q

Adverse effects of Rifampin

A

-Thrombocytopenia
-Orange colored secretions (tears, urine)

40
Q

Adverse effects of Isoniazid

A

-Hepatitis
-Peripheral Neuropathy

41
Q

Peripheral neuropathy, associated with Isoniazid, is prevented by giving the patient ______ as well.

A

Pyridoxine (B6)

42
Q

Adverse effects of Pyrazinamide

A

Hepatitis and Hyperuricemia
Photosensitive rash

43
Q

Adverse effects of ethambutol

A

-Optic neuritis
-Red/green color blindness
-Peripheral neuropathy

44
Q

Adverse effects of Streptomycin

A

-Ototoxicity
-Nephrotoxicity

45
Q

For latent TB infection, what is the treatment?

A

INH + Pyridoxine (with B6) x 9 months

OR

Rifampin x 4 months

46
Q

Explain the rules for a positive PPD test in TB

A

> 5: HIV or immunosuppressed, close contact with TB infected, CXR shows old/healed TB

> 10: all other high-risk populations (healthcare)

> 15: everyone else, no known risk factors for TB

47
Q

What are some reasons for false positive on a TB test?

A

Within 2-10 years of the BCG vaccine

Improper reading

Cross reaction with an atypical (MAC)

48
Q

What are some positives with the Interferon Gamma Release Assay TB Test

A

-Blood test with improved specificity
-Not affected by BCG vaccine

PANCE 2.0 (62 decks)

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