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Pulmonology > Pulmonology Infectious Disease > Flashcards

Pulmonology Infectious Disease Flashcards

1
Q

Lower respiratory tract infection involving the bronchi without evidence of pneumonia that occurs in the absence of chronic obstructive pulmonary disease.

A

Acute Bronchitis

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2
Q

Is Bronchitis most commonly caused by viruses or bacteria?

A

Viruses

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3
Q

What viruses are the most common causes of acute Bronchitis?

A

Influenza A & B
Parainfluenza
Coronavirus
Rhinovirus

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4
Q

How long must a cough last for you to consider Bronchitis as a diagnosis?

A

At Least 5 days

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5
Q

How soon does acute Bronchitis usually resolve?

A

1 to 3 weeks

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6
Q

What bacteria is the most likely to cause a prolonged cough with Bronchitis?

A

Bordetella pertussis

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7
Q

What is the antibiotic of choice for Bronchitis due to Bordetella pertussis?

A

Azithromycin

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8
Q

What is a characteristic finding of Bronchitis due to Bordetella pertussis?

A

Posttusive Vomiting

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9
Q

What typically precedes Bronchitis?

A

Upper Respiratory Tract Infection

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10
Q

What is the cardinal symptom of acute Bronchitis?

A

Cough

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11
Q

Does the presence or color of purulent sputum predict whether or not the Bronchitis infection is caused by a bacteria or virus?

A

No

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12
Q

True or False:
For most patients, acute bronchitis is a self-limited illness that does not require specific diagnostic testing or treatment.

A

True

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13
Q

What are some concerning clinical features in a patient with Acute Bronchitis?

A

Inspiratory Whoop
Posttussive Emesis
High Fever

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14
Q

Testing for Acute Bronchitis is generally reserved for what?

A

Suspected Pneumonia
Uncertain Clinical Diagnosis
If the Results would change Management

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15
Q

How is Acute Bronchitis generally treated?

A

Mostly Supportive

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16
Q

An infection that inflames the air sacs in one or both lungs. These air sacs may fill with fluid or purulent material.

A

Pneumonia

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17
Q

What pathogen is the most common cause of Community Acquired Pneumonia?

A

Strep. pneumoniae

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18
Q

Type of pneumonia that is diagnosed outside the hospital in ambulatory patients who are not residents of nursing homes or other long-term care facilities.

A

Community Acquired Pneumonia

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19
Q

Community Acquired Pneumonia may also be diagnosed in previously ambulatory patients who develop symptoms within how many hours of being admitted to the hospital?

A

48 hours

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20
Q

What is the preferred diagnostic method to confirm pneumonia?

A

Chest X-Ray

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21
Q

For patients with possible pneumonia in an inpatient setting, what is required for diagnosis?

A

Chest X-Ray with Pulmonary Opacity

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22
Q

Hospitalized patients with pneumonia should have what testing performed in addition to a Chest X-Ray?

A

CBC and CMP
ABG if hypoxic

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23
Q

Type of pneumonia that usually shows lobar infiltrates and consolidation, or a round pneumonia with pleural effusion.

A

Bacterial Pneumonia

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24
Q

Type of pneumonia that usually shows diffuse, streaky infiltrates in the bronchi and hyperinflation.

A

Viral Pneumonia

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25
Q

Type of pneumonia that shows interstitial markings or bronchopneumonia.

A

Atypical Pneumonia

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26
Q

Hilar lymphadenopathy may indicate what pathologies?

A

Tuberculosis
Histoplasmosis
Malignant Neoplasm

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27
Q

When should hospitalization for patients with pneumonia be considered?

A

Infants under 6 months with bacterial pneumonia
Concern for a pathogen with increased virulence (MRSA)
Concern for the patient or caregiver to follow requests and assess symptom progression.
Patients with Comorbidities

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28
Q

What are the treatments of choice in patients with CAP?

A

Macrolides
Doxycycline
Amoxicillin

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29
Q

How long should patients with CAP be treated for?

A

At least 5 days

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30
Q

How long should patients with CAP who are being treated with ABX continue those ABX for?

A

Until afebrile for 48 - 72 hours

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31
Q

What makes a patient high-risk for drug resistance to CAP treatment?

A

ABX in last 90 days
65+ Years Old
Comorbidities
Immunosuppression
Exposure to a child in day care

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32
Q

What is the preferred treatment for a patient with CAP and a high-risk for drug resistance?

A

Macrolide + Becta Lactam
Respiratory Fluoroquinalone (Levo, Moxi, Gemi)

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33
Q

What is the preferred treatment for a patient with CAP that has been admitted to the ICU?

A

Anti-pneumococcal beta-lactam + Azithromycin or Fluoroquinalone
(Ceftriaxone + Azithromycin or Levofloxacin)

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34
Q

Who is the pneumococcal vaccine recommended for?

A

Age 65+
Immunocompromised
Chronic Illnesses

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35
Q

What vaccines are recommended to prevent CAP?

A

Pneumococcal Vaccine
Flu Vaccine
COVID Vaccine

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36
Q

What is the CRB-65 Score?

A

Confusion
Respiratory Rate ≥ 30
Blood Pressure (SBP < 90 or DBP ≤ 60)
Age ≥ 65 years old
(Score 1 point for each)

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37
Q

A CRB-65 Score of 0 would indicate what?

A

Likely suitable for home treatment

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38
Q

A CRB-65 Score of 3 or 4 would indicate what?

A

Urgent hospital admission

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39
Q

A CRB-65 Score of 1or 2 would indicate what?

A

Consider hospital referral

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40
Q

Pneumonia that occurs more than 48 hours after admission to the hospital or other health care facility and excludes any infection present at the time of admission.

A

Hospital Acquired Pneumonia (HAP)

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41
Q

Pneumonia that develops more than 48 hours following endotracheal intubation.

A

Ventilator Associated Pneumonia (VAP)

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42
Q

What are some of the risk factors for Nosocomial Pneumonia?

A
  • ABX in the previous 90 days
  • Acute care hospitalization for at least 2 days in the last 90 days.
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43
Q

What are the most common Gram (+) organisms that cause nosocomial pneumonias?

A

Staph. aureus (MSSA and MRSA)
Streptococcus

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44
Q

What are the most common Gram (-) organisms that cause nosocomial pneumonias?

A

Pseudomonas
Klebsiella
E. coli
Enterobacter

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45
Q

What organisms are most likely to cause VAP?

A

Stenotrophomonas maltophilia
Acinetobacter

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46
Q

Patients taking antacids, H2 blockers, PPIs or enteral feeding may have an increased risk of Nosocomial Pneumonias. Why might this be?

A

Gastric acid may play a protective role against the development of pneumonia.

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47
Q

What are the signs and symptoms of HAP?

A

Fever
Leukocytosis
Purulent Sputum
Worsening Respiratory Status

Two of those + new or progressive opacity on CXR = HAP

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48
Q

How long is nosocomial pneumonia usually treated for?

A

7 days

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49
Q

Pneumonia that usually occurs in people under 40 years old.

A

Mycoplasma pneumonia (Atypical PNA)

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50
Q

Atypical pneumonia is one of the most common pathogens associated with what other type of pneumonia?

A

CAP

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51
Q

What are the most common manifestations of a Mycoplasma pneumonia infection?

A

URI
Acute Bronchitis

52
Q

What is the most common cause of Walking Pneumonia?

A

Mycoplasma pneumonia

53
Q

How does Mycoplasma pneumonia infection often present?

A

Asymptomatically

54
Q

Is the onset of symptoms caused by Mycoplasma pneumonia rapid or gradual?

A

Gradual

55
Q

What is a common complaint that patients with Mycoplasma pneumonia have?

A

Chest Soreness
(due to persistent cough)

56
Q

What would you expect to see on a chest x-ray of a patient with Mycoplasma pneumonia?

A

Reticular Nodular Opacities
or
Patchy Consolidations

57
Q

What is the treatment of choice for Mycoplasma pneumonia?

A

Doxycycline
Azithromycin
Levofloxacin

58
Q

For a hospitalized non-ICU patient with Mycoplasma pneumonia, what is the treatment of choice?

A

Respiratory Fluoroquinalone
or
Beta-Lactam + Macrolide

59
Q

An atypical pneumonia that occurs from outbreaks of contaminated water.

A

Legionella pneumonia

60
Q

What are the characteristic symptoms of Legionella pneumonia?

A

Nausea + Vomiting + Diarrhea

61
Q

What are three tests that can be used to identify Legionella pneumonia?

A

Culture
Sputum PCR
Dieterle Silver Staining

62
Q

What is the treatment of choice for Legionella pneumonia?

A

Azithromycin
Clarithromycin
Levofloxacin

63
Q

Type of pneumonia that typically happens in people with altered consciousness.

A

Anaerobic pneumonia

64
Q

Name two risk factors for Anaerobic pneumonia.

A

Periodontal disease
Poor dental hygiene

65
Q

Where does Anaerobic pneumonia typically start in the lungs?

A

Dependent Lung Zones
(body position at the time of aspiration determines lung zone)

66
Q

Signs and Symptoms of Anaerobic Pneumonia include what?

A

Fever
Weight Loss
Malaise
Cough with foul-smelling sputum
Poor dentition

67
Q

How do you obtain a culture of a patient with Anaerobic pneumonia?

A

Transthoracic Aspiration
Thoracentesis
Bronchoscopy

68
Q

A thick-walled solitary cavity surrounded by consolidation and an air fluid level present on chest x-ray would be characteristic of what?

A

Lung Abscess

69
Q

Purulent pleural fluid with possible pleural locations on CXR or US would indicate what?

A

Empyema

70
Q

How is Anaerobic pneumonia treated?

A

B-Lactam + B-Lactamase Inhibitor
(Amoxicillin + Clavulanate)
(Piperacillin + Tazobactam)

71
Q

How long should you treat Anaerobic pneumonia for?

A

Until CXR improves
(typically more than 3+ weeks)

72
Q

How do you treat an Empyema?

A

Tube Thoracostomy
Open Pleural Drainage

73
Q

What is the most common cause of pneumonia in infants?

A

RSV

74
Q

What is the most common cause of pneumonia in children older than 5

A

Mycoplasma pneumoniae

75
Q

What is the most common bacterial cause of lobar pneumonia and occurs in children of any age outside the neonatal period?

A

Streptococcal pneumoniae

76
Q

What is the leading cause of hospitalization of children in the United States?

A

RSV

77
Q

When should pregnant women receive the RSV vaccine?

A

32 - 36 Weeks

78
Q

What adults should receive the RSV vaccine?

A

All Adults 75+
Adults 60 - 74 at increased risk

79
Q

Nirsevimab is recommended for infants that meet what criteria?

A

Less than 8 months of age
- Mother did not receive RSV vaccine
- Mother’s RSV vax status = unknown
- Infant born within 14 days of maternal RSV vaccination

80
Q

The CDC does not currently recommend Nirsevimab for anyone over what age?

A

20 months

81
Q

True or False:
Nirsevimab is recommended for some children (8 - 19 months) who are at increased risk for severe RSV disease and entering their second RSV season?

A

True

82
Q

Maternal RSV infection is associated with what major risk factor?

A

Prematurity

83
Q

Maternal RSV infection may cause what later consequence in life?

A

Airway Reactivity

84
Q

RSV generally only affects adults with what?

A

Comorbidities
Older Adults
Immunodeficient
Lung or Bone Marrow Transplant

85
Q

What is the pathophysiology of RSV?

A

Proliferation and necrosis of bronchiolar epithelium which produces obstruction and increased mucus secretion.

86
Q

Signs and Symptoms of RSV

A

Bronchiolitis
Wheezing
Cough
Cyanosis
Grunting (infant)
Retractions
Lethargy
Palpable Liver and Spleen

87
Q

What standards must be met for a Clinical diagnosis of bronchiolitis in RSV?

A

URI for 1 - 3 days followed by persistent cough
+ tachypnea or retractions
+ wheeze or crackles

88
Q

How is RSV testing usually done?

A

NOT ROUTINE
RT-PCR nasopharyngeal swab = Standard of Care
Rapid Antigen may be used in younger children

89
Q

What is the treatment for RSV?

A

Time
Hydration
Humidifier
Nasal Suction
Ribavirin if high risk

90
Q

Does RSV typically require bronchodilators, nebulized epinephrine, nebulized hypertonic saline, or ABX?

A

NO

91
Q

How long does RSV typically last in healthy children?

A

3 - 7 days

92
Q

What is the prognosis for most children with RSV?

A

Recovery without sequelae

93
Q

What is the preferred testing method when assessing for Tuberculosis?

A

Interferon-Gamma Release Assay

94
Q

What is the traditntal approach to testing for Latent Tuberculosis?

A

PPD
(Mantoux Test)

95
Q

What size in duration indicates a negative PPD test?

A

Less than 5 mm

96
Q

For a person with HIV or that has had an organ transplant, what size induration would indicate a positive TB test?

A

5 mm

97
Q

For a healthcare worker, what size induration would indicate a positive TB test?

A

10 mm

98
Q

For an average person, what size induration would indicate a positive TB test?

A

15 mm

99
Q

If a patient has a positive PPD test, what is the next step?

A

Chest X-Ray + Physical Exam

100
Q

What is the treatment for a person above the age of 2 with Latent TB?

A

Isoniazid + Rifapentine
Once Weekly for 3 months

101
Q

What is another possible treatment for patients with Latent TB who are HIV negative?

A

Rifampicin monotherapy
Daily for 4 months.

102
Q

Evaluation of Suspected TB infection includes what testing for screening and presumptive diagnosis?

A

Acid Fast Bacillus Smear (1 day return)
NAAT (1 day return)

103
Q

What is the Gold Standard test for diagnosis of TB?

A

Sputum Culture with M. tuberculosis
(6 - 8 Week Return)

104
Q

Treatment of Active TB that is drug resistant or for those receiving intermittent therapy requires what?

A

Directly Observed Therapy

105
Q

How is Active TB treated?

A

Rifampin
Isoniazid
Pyrazinamide
Ethambutol

106
Q

How long is Active TB treated for?

A

6 months

107
Q

Once the TB isolate is determined to be Isoniazid-sensitive, what medication can be discontinued?

A

Ethambutol

108
Q

Treatment of active TB must extend for how long after sputum cultures are negative?

A

3 months

109
Q

Patients with Active TB who cannot take Pyrazinamide should be treated for how long?

A

9 months

110
Q

Drug-Resistant TB is resistant to what medications?

A

Isoniazid or Rifampin

111
Q

Multi-drug resistant TB is resistant to what medications?

A

Isoniazid + Rifampin

112
Q

Type of TB infection that occurs due to lymphohematogenous spread and commonly involves multiple organs.

A

Miliary TB

113
Q

What population is Miliary TB most common in?

A

Children under 5
Immunocompromised kids

114
Q

Disseminated Miliary TB is characterized by what?

A

Two non-contiguous organ sites infected
- or -
Infection of the blood, bone marrow, or liver

115
Q

What is the classical hallmark of Miliary TB?

A

Miliary Mottling on Chest Radiograph

116
Q

Which TB medication can cause peripheral neuritis?

A

Isoniazid

117
Q

How is peripheral neuritis caused by Isoniazid treated?

A

Vitamin B6 (Pyridoxine)

118
Q

Which TB medication can cause hyperuricemia?

A

Pyrazinamide

119
Q

What is the current preferred method of testing for COVID-19?

A

NAAT Test (nasal swab)

120
Q

Invasive fungal respiratory disease that affects immunocompromised or critically ill patients.

A

Aspergillosis

121
Q

What organs are most frequently affected by Aspergillosis

A

Lungs
Sinuses
Brain

122
Q

What are the 3 clinical syndromes of Aspergillosis

A

Allergic
Chronic
Invasive

123
Q

How is Aspergillosis definitively diagnosed?

A

Tissue or Culture

124
Q

What would you see on a Chest CT of a patient with Aspergillosis?

A

Nodules
Wedge-Shaped Infarcts
Halo Sign

125
Q

What is the prophylaxis for patients at high risk of Aspergillosis?

A

Voriconazole
- or -
Posaconazole

126
Q

What is the treatment for Aspergillosis?

A

Voriconazole (IV)
6 - 12 Weeks

Pulmonology (6 decks)

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