Pulmonology Infectious Disease Flashcards
(126 cards)
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
2
Q
Is Bronchitis most commonly caused by viruses or bacteria?
A
Viruses
3
Q
What viruses are the most common causes of acute Bronchitis?
A
Influenza A & B
Parainfluenza
Coronavirus
Rhinovirus
4
Q
How long must a cough last for you to consider Bronchitis as a diagnosis?
A
At Least 5 days
5
Q
How soon does acute Bronchitis usually resolve?
A
1 to 3 weeks
6
Q
What bacteria is the most likely to cause a prolonged cough with Bronchitis?
A
Bordetella pertussis
7
Q
What is the antibiotic of choice for Bronchitis due to Bordetella pertussis?
A
Azithromycin
8
Q
What is a characteristic finding of Bronchitis due to Bordetella pertussis?
A
Posttusive Vomiting
9
Q
What typically precedes Bronchitis?
A
Upper Respiratory Tract Infection
10
Q
What is the cardinal symptom of acute Bronchitis?
A
Cough
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
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
13
Q
What are some concerning clinical features in a patient with Acute Bronchitis?
A
Inspiratory Whoop
Posttussive Emesis
High Fever
14
Q
Testing for Acute Bronchitis is generally reserved for what?
A
Suspected Pneumonia
Uncertain Clinical Diagnosis
If the Results would change Management
15
Q
How is Acute Bronchitis generally treated?
A
Mostly Supportive
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
17
Q
What pathogen is the most common cause of Community Acquired Pneumonia?
A
Strep. pneumoniae
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
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
20
Q
What is the preferred diagnostic method to confirm pneumonia?
A
Chest X-Ray
21
Q
For patients with possible pneumonia in an inpatient setting, what is required for diagnosis?
A
Chest X-Ray with Pulmonary Opacity
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
23
Q
Type of pneumonia that usually shows lobar infiltrates and consolidation, or a round pneumonia with pleural effusion.
A
Bacterial Pneumonia
24
Q
Type of pneumonia that usually shows diffuse, streaky infiltrates in the bronchi and hyperinflation.
A
Viral Pneumonia
25
Type of pneumonia that shows interstitial markings or bronchopneumonia.
Atypical Pneumonia
26
Hilar lymphadenopathy may indicate what pathologies?
Tuberculosis
Histoplasmosis
Malignant Neoplasm
27
When should hospitalization for patients with pneumonia be considered?
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
28
What are the treatments of choice in patients with CAP?
Macrolides
Doxycycline
Amoxicillin
29
How long should patients with CAP be treated for?
At least 5 days
30
How long should patients with CAP who are being treated with ABX continue those ABX for?
Until afebrile for 48 - 72 hours
31
What makes a patient high-risk for drug resistance to CAP treatment?
ABX in last 90 days
65+ Years Old
Comorbidities
Immunosuppression
Exposure to a child in day care
32
What is the preferred treatment for a patient with CAP and a high-risk for drug resistance?
Macrolide + Becta Lactam
Respiratory Fluoroquinalone (Levo, Moxi, Gemi)
33
What is the preferred treatment for a patient with CAP that has been admitted to the ICU?
Anti-pneumococcal beta-lactam + Azithromycin or Fluoroquinalone
(Ceftriaxone + Azithromycin or Levofloxacin)
34
Who is the pneumococcal vaccine recommended for?
Age 65+
Immunocompromised
Chronic Illnesses
35
What vaccines are recommended to prevent CAP?
Pneumococcal Vaccine
Flu Vaccine
COVID Vaccine
36
What is the CRB-65 Score?
Confusion
Respiratory Rate ≥ 30
Blood Pressure (SBP < 90 or DBP ≤ 60)
Age ≥ 65 years old
(Score 1 point for each)
37
A CRB-65 Score of 0 would indicate what?
Likely suitable for home treatment
38
A CRB-65 Score of 3 or 4 would indicate what?
Urgent hospital admission
39
A CRB-65 Score of 1or 2 would indicate what?
Consider hospital referral
40
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.
Hospital Acquired Pneumonia (HAP)
41
Pneumonia that develops more than 48 hours following endotracheal intubation.
Ventilator Associated Pneumonia (VAP)
42
What are some of the risk factors for Nosocomial Pneumonia?
- ABX in the previous 90 days
- Acute care hospitalization for at least 2 days in the last 90 days.
43
What are the most common Gram (+) organisms that cause nosocomial pneumonias?
Staph. aureus (MSSA and MRSA)
Streptococcus
44
What are the most common Gram (-) organisms that cause nosocomial pneumonias?
Pseudomonas
Klebsiella
E. coli
Enterobacter
45
What organisms are most likely to cause VAP?
Stenotrophomonas maltophilia
Acinetobacter
46
Patients taking antacids, H2 blockers, PPIs or enteral feeding may have an increased risk of Nosocomial Pneumonias. Why might this be?
Gastric acid may play a protective role against the development of pneumonia.
47
What are the signs and symptoms of HAP?
Fever
Leukocytosis
Purulent Sputum
Worsening Respiratory Status
Two of those + new or progressive opacity on CXR = HAP
48
How long is nosocomial pneumonia usually treated for?
7 days
49
Pneumonia that usually occurs in people under 40 years old.
Mycoplasma pneumonia (Atypical PNA)
50
Atypical pneumonia is one of the most common pathogens associated with what other type of pneumonia?
CAP
51
What are the most common manifestations of a Mycoplasma pneumonia infection?
URI
Acute Bronchitis
52
What is the most common cause of Walking Pneumonia?
Mycoplasma pneumonia
53
How does Mycoplasma pneumonia infection often present?
Asymptomatically
54
Is the onset of symptoms caused by Mycoplasma pneumonia rapid or gradual?
Gradual
55
What is a common complaint that patients with Mycoplasma pneumonia have?
Chest Soreness
(due to persistent cough)
56
What would you expect to see on a chest x-ray of a patient with Mycoplasma pneumonia?
Reticular Nodular Opacities
or
Patchy Consolidations
57
What is the treatment of choice for Mycoplasma pneumonia?
Doxycycline
Azithromycin
Levofloxacin
58
For a hospitalized non-ICU patient with Mycoplasma pneumonia, what is the treatment of choice?
Respiratory Fluoroquinalone
or
Beta-Lactam + Macrolide
59
An atypical pneumonia that occurs from outbreaks of contaminated water.
Legionella pneumonia
60
What are the characteristic symptoms of Legionella pneumonia?
Nausea + Vomiting + Diarrhea
61
What are three tests that can be used to identify Legionella pneumonia?
Culture
Sputum PCR
Dieterle Silver Staining
62
What is the treatment of choice for Legionella pneumonia?
Azithromycin
Clarithromycin
Levofloxacin
63
Type of pneumonia that typically happens in people with altered consciousness.
Anaerobic pneumonia
64
Name two risk factors for Anaerobic pneumonia.
Periodontal disease
Poor dental hygiene
65
Where does Anaerobic pneumonia typically start in the lungs?
Dependent Lung Zones
(body position at the time of aspiration determines lung zone)
66
Signs and Symptoms of Anaerobic Pneumonia include what?
Fever
Weight Loss
Malaise
Cough with foul-smelling sputum
Poor dentition
67
How do you obtain a culture of a patient with Anaerobic pneumonia?
Transthoracic Aspiration
Thoracentesis
Bronchoscopy
68
A thick-walled solitary cavity surrounded by consolidation and an air fluid level present on chest x-ray would be characteristic of what?
Lung Abscess
69
Purulent pleural fluid with possible pleural locations on CXR or US would indicate what?
Empyema
70
How is Anaerobic pneumonia treated?
B-Lactam + B-Lactamase Inhibitor
(Amoxicillin + Clavulanate)
(Piperacillin + Tazobactam)
71
How long should you treat Anaerobic pneumonia for?
Until CXR improves
(typically more than 3+ weeks)
72
How do you treat an Empyema?
Tube Thoracostomy
Open Pleural Drainage
73
What is the most common cause of pneumonia in infants?
RSV
74
What is the most common cause of pneumonia in children older than 5
Mycoplasma pneumoniae
75
What is the most common bacterial cause of lobar pneumonia and occurs in children of any age outside the neonatal period?
Streptococcal pneumoniae
76
What is the leading cause of hospitalization of children in the United States?
RSV
77
When should pregnant women receive the RSV vaccine?
32 - 36 Weeks
78
What adults should receive the RSV vaccine?
All Adults 75+
Adults 60 - 74 at increased risk
79
Nirsevimab is recommended for infants that meet what criteria?
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
The CDC does not currently recommend Nirsevimab for anyone over what age?
20 months
81
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?
True
82
Maternal RSV infection is associated with what major risk factor?
Prematurity
83
Maternal RSV infection may cause what later consequence in life?
Airway Reactivity
84
RSV generally only affects adults with what?
Comorbidities
Older Adults
Immunodeficient
Lung or Bone Marrow Transplant
85
What is the pathophysiology of RSV?
Proliferation and necrosis of bronchiolar epithelium which produces obstruction and increased mucus secretion.
86
Signs and Symptoms of RSV
Bronchiolitis
Wheezing
Cough
Cyanosis
Grunting (infant)
Retractions
Lethargy
Palpable Liver and Spleen
87
What standards must be met for a Clinical diagnosis of bronchiolitis in RSV?
URI for 1 - 3 days followed by persistent cough
+ tachypnea or retractions
+ wheeze or crackles
88
How is RSV testing usually done?
NOT ROUTINE
RT-PCR nasopharyngeal swab = Standard of Care
Rapid Antigen may be used in younger children
89
What is the treatment for RSV?
Time
Hydration
Humidifier
Nasal Suction
Ribavirin if high risk
90
Does RSV typically require bronchodilators, nebulized epinephrine, nebulized hypertonic saline, or ABX?
NO
91
How long does RSV typically last in healthy children?
3 - 7 days
92
What is the prognosis for most children with RSV?
Recovery without sequelae
93
What is the preferred testing method when assessing for Tuberculosis?
Interferon-Gamma Release Assay
94
What is the traditntal approach to testing for Latent Tuberculosis?
PPD
(Mantoux Test)
95
What size in duration indicates a negative PPD test?
Less than 5 mm
96
For a person with HIV or that has had an organ transplant, what size induration would indicate a positive TB test?
5 mm
97
For a healthcare worker, what size induration would indicate a positive TB test?
10 mm
98
For an average person, what size induration would indicate a positive TB test?
15 mm
99
If a patient has a positive PPD test, what is the next step?
Chest X-Ray + Physical Exam
100
What is the treatment for a person above the age of 2 with Latent TB?
Isoniazid + Rifapentine
Once Weekly for 3 months
101
What is another possible treatment for patients with Latent TB who are HIV negative?
Rifampicin monotherapy
Daily for 4 months.
102
Evaluation of Suspected TB infection includes what testing for screening and presumptive diagnosis?
Acid Fast Bacillus Smear (1 day return)
NAAT (1 day return)
103
What is the Gold Standard test for diagnosis of TB?
Sputum Culture with M. tuberculosis
(6 - 8 Week Return)
104
Treatment of Active TB that is drug resistant or for those receiving intermittent therapy requires what?
Directly Observed Therapy
105
How is Active TB treated?
Rifampin
Isoniazid
Pyrazinamide
Ethambutol
106
How long is Active TB treated for?
6 months
107
Once the TB isolate is determined to be Isoniazid-sensitive, what medication can be discontinued?
Ethambutol
108
Treatment of active TB must extend for how long after sputum cultures are negative?
3 months
109
Patients with Active TB who cannot take Pyrazinamide should be treated for how long?
9 months
110
Drug-Resistant TB is resistant to what medications?
Isoniazid or Rifampin
111
Multi-drug resistant TB is resistant to what medications?
Isoniazid + Rifampin
112
Type of TB infection that occurs due to lymphohematogenous spread and commonly involves multiple organs.
Miliary TB
113
What population is Miliary TB most common in?
Children under 5
Immunocompromised kids
114
Disseminated Miliary TB is characterized by what?
Two non-contiguous organ sites infected
- or -
Infection of the blood, bone marrow, or liver
115
What is the classical hallmark of Miliary TB?
Miliary Mottling on Chest Radiograph
116
Which TB medication can cause peripheral neuritis?
Isoniazid
117
How is peripheral neuritis caused by Isoniazid treated?
Vitamin B6 (Pyridoxine)
118
Which TB medication can cause hyperuricemia?
Pyrazinamide
119
What is the current preferred method of testing for COVID-19?
NAAT Test (nasal swab)
120
Invasive fungal respiratory disease that affects immunocompromised or critically ill patients.
Aspergillosis
121
What organs are most frequently affected by Aspergillosis
Lungs
Sinuses
Brain
122
What are the 3 clinical syndromes of Aspergillosis
Allergic
Chronic
Invasive
123
How is Aspergillosis definitively diagnosed?
Tissue or Culture
124
What would you see on a Chest CT of a patient with Aspergillosis?
Nodules
Wedge-Shaped Infarcts
Halo Sign
125
What is the prophylaxis for patients at high risk of Aspergillosis?
Voriconazole
- or -
Posaconazole
126
What is the treatment for Aspergillosis?
Voriconazole (IV)
6 - 12 Weeks
