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BECOM III - Exam 3 > Stillwell lectures for pulm > Flashcards

Stillwell lectures for pulm Flashcards

1
Q

common cold `

A
  • usually VIRAL -> rhinovirus, influenza virus
  • purulent nasal discharge does NOT mean bacterial infection
  • Afrin/Otrivan used SHORT term to prevent RHINITIS MEDICAMENTOSA
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2
Q

pharyngitis

A
  • usually VIRAL -> Adenovirus, rhinovirus, coronavirus
  • bacterial -> GAS, Diphtheria (myocarditis, bull neck, nerve palsies; NOT scrape off)
  • fungal -> Candida scrapes off
  • diagnose w/ throat culture -> NO tests if you are going to treat anyway
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3
Q

conjunctivitis, coryza, cough, diarrhea, ulcerative lesions

A

suggests VIRAL instead of bacterial infection

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4
Q

Peritonsillar/Parapharyngeal abscesses

A
  • usually polymicrobial
  • UVULAR deviation
  • hot potato mouth
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5
Q

odontogenic infections

A
  • dental carries caused by STREP MUTANS
  • acute ulcerative gingivitis -> caused by Fusobacterium & non-syphilitic spirochetes
  • Ludwig angina -> elevation of mouth, gland swelling, trismus
  • Actinomyces -> lumpy jaw and sulfur granules
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6
Q

stomatitis

A
  • HSV, Enteroviruses, Angular chelitis from CANDIDA

- stomatitis + ulcers -> symptoms in HIV patients

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7
Q

HPV

A

subtype 16 -> oropharyngeal SCC and cervical cancer

  • squamous cell papilloma -> CAULIFLOWER
  • verruca vulgaris -> PARSNIPS
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8
Q

Parotitis/Sialadenitis

A
  • caused by MUMPS virus

- caused by STAPH AUREUS in NOSOCOMIAL setting

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9
Q

Sinusitis

A
  • usually VIRAL -> many
  • bacterial -> Strep pneumo, H. influenza, Moraxella
  • fungal -> MUCORMYCOSIS in immunodeficient & uncontrolled diabetics
  • Pott’s puffy tumor
  • cavernous sinus thrombosis w/ septic thrombophlebitis -> CN6 most affected
  • NO benefit in treating w/ antibiotics if not improving 7-10 days or less -> follow up in week
  • treat w/ amoxicillin-cluvalonic acid
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10
Q

Otitis Media

A

-bacterial -> strep pneumo, H. influenza, Moraxella

  • acute -> BACTERIAL
  • serous -> NOT infectious -> do not use antibiotics; use decongestants
  • blisters on tympanic membrane -> bullous myringitis
  • risk of cholesteatoma and mastoiditis
  • treat w/ amoxicillin
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11
Q

Otitis Externa

A
  • caused by staph or GAS

- diabetics -> PSUEDOMONAS aeruginosa -> MALIGANT otitis externa

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12
Q

Facial cellulitis

A
  • GAS in adults
  • H. influenza in children

-erysipelas -> bright red, sharp margins

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13
Q

Epiglottis

A
  • caused by strep pneumo and H. influenza
  • do NOT inspect back of throat if suspected -> spasm & compress airway
  • THUMBPRINT sign
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14
Q

Croup (laryngotracheobronchitis)

A

-caused by PARAINFLUENZA virus

  • barking cough
  • STEEPLE sign

-treat w/ steroids

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15
Q

Lemierre’s syndrome

A

-caused by FUSOBACTERIUM necrophorum -> thrombophlebitis of IJV

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16
Q

Infectious Esophagitis

A
  • caused by GERD or Candida
  • treat w/ FLUCONAZOLE for Candida
  • COBBLESTONE w/ Candida
  • if HSV -> multinucleated giant cells
  • if CMV -> Owl’s eye
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17
Q

Infected Cervical Lymphadenitis

A
  • usually Staph or Strep - also bartonella, tularensis, myc. TB
  • POSTERIOR cervical lymphadenopathy w/ African trypanosomiasis if from Africa -> WINTERBOTTOM sign
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18
Q

Infectious Conjunctivitis “pinkeye”

A
  • usually VIRAL -> Adenovirus
  • Pre-auricular adenopathy
  • chlamydia trachomatis in mom -> blindness in newborns
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19
Q

Infectious Keratitis (cornea)

A
  • bacteria (most common) -> Staph aureus and Pseudomonas
  • viral -> Adenovirus (SUBCORNEAL infiltrate) or HSV (DENDRITIC ulcers)
  • amoebic -> Acanthamoeba in contacts
  • parasite -> Onchocerca volvulus
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20
Q

Atelectasis

A
  • usually UNILATERAL

- caused by obstruction (resorption), contraction, extra/intrapulmonary compression

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21
Q

Bronchiectasis

A
  • caused by pneumonia, smoking, CF, kartagener
  • bacteria -> H. influenza and Pseudomonas***
  • SIGNET RING sign & TREE IN BUD
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22
Q

Kartagener Syndrome aka Primary Ciliary Dyskinesia

A

-defects in DYNEIN arms

  1. Bronchiectasis
  2. Chronic Rhinos-sinusitis
  3. Situs inversus w/ dextrocardia

also infertility

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23
Q

Cor Pulmonale

A

-COPD/chronic bronchitis -> vasoconstriction of pulmonary artery due to low O2 -> dilation/hypertrophy of RV

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24
Q

most common causes of community acquired pneumonia (CAP)?

A

strep pneumonia and H. influenza

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25
Q

does the immune response or the pathogen kill you in pneumonia?

A

IMMUNE RESPONSE to the pathogen

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26
Q

lobes affected in aspiration pneumonia

A

SUPERIOR segment of right lower lobe and POSTERIOR segment of right upper lobe

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27
Q

what is the cause of Miliary pneumonia?

A

TB***

-MILLET SEEDS

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28
Q

what causes lobular (patchy) pneumonia?

A

Staph aureus

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29
Q

CAP - Strep pneumo

A
  • gram + DIPLOCOCCI
  • # 1 cause of CAP
  • RUSTY SPUTUM
  • LANCET shaped
  • strains sensitive to penicillin –> MIC =.06
  • intermediate -> MIC .12-1
  • resistant -> MIC >/=2

-treat with vancomycin

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30
Q

CAP - H. influenza

A
  • gram neg. COCCOBACILLUS

- beta lactamase producers

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31
Q

CAP - Moraxella

A
  • gram neg DIPLOCOCCI
  • looks like N. gonorrhea on gram stain
  • beta lactamase producer
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32
Q

CAP - staph aureus

A
  • lobar infiltrates become necrotizing
  • see cavity pneumatocoeles and lung abscesses
  • PLV toxin
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33
Q

CAP - Klebsiella

A
  • ALCOHOLICS
  • reddish JELLY sputum
  • BULGING FISSURE SIGN

-gram neg rod w/ CAPSULE -> treat w/ Cefipime

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34
Q

CAP - cystic fibrosis (CF) patients

A

caused by Staph aureus, Pseudomonas, Burkholderia cepacia

35
Q

atypical pneumonia - Mycoplasma pneumonia

A
  • CROWDED places
  • pathy infiltrates on chest Xray -> looks WORSE than patient

-treat w/ macrolides, tetracyclines, quinolones

36
Q

atypical pneumonia - Chlamydophila pneumonia

A

ASTHMATIC syndrome -> bronchospasm, wheezing

-treat same as M. pneumonia

37
Q

atypical pneumonia - Legionella**

A
  • can live in amoeba
  • BCYE agar
  • CONTAMINATED water
  • Faget sign and hyponatremia (SIADH)
  • URINE for legionella antigen
  • L. micdadei -> PONTIAC FEVER

-treat w/ quinolone and macrolide

38
Q

atypical pneumonia - viral pneumonia

A
  • RSV and parinfluenza virus -> infants/children
  • influenza -> adults
  • metapneumovirus -> SEVERE pneumonia
39
Q

atypical pneumonia - Tularemia

A
  • hilar lymphadenopathy -> nodular and lobar infiltrate

- sudden outbreak in ER settings

40
Q

atypical pneumonia - Q fever

A
  • placenta birth products, abatoir workers

- treat w/ doxycycline

41
Q

causes of post-influenza bacterial pneumonia

A

Strep pneumo #1

Staph aureus #2

42
Q

PERTUSSIS**

A
  • “whooping cough” 100 days
  • cough SYNCOPE, cough EMESIS
  • Bordet Gengou or Regan-Lowe Charcoal Blood agars

-treat with MACROLIDES

43
Q

PROCALCITONIN***

A
  • acute phase reactant

- higher in bacterial infections, and lower in viral infections

44
Q

Pneumonia treatment***

A
  • healthy person -> Macrolide
  • chronic disease, asplenia, immunosuppressed -> Quinolone
  • inpatient, non-ICU -> Quinolone, ceftriaxone/macrolide, ceftriaxone/doxycycline
  • inpatient, ICU -> ceftriaxone + quinolone
45
Q

when do you do follow up chest x ray after pneumonia?

A

> 1 month after pneumonia treatment to make sure mass was not obscured by infiltrate

46
Q

what kind of organisms are seen in Nosocomial pneumonias?

A

-MDR organisms -> mix of aerobes and anaerobes

47
Q

HAP/Nosocomial pneumonia pathogens

A
  • Gram neg organisms #1 (Pseudomonas, Klebsiella, Enterobacter) -> MacConkey agar
  • Staph aureus -> blood agar
  • Anaerobes in aspirations & strep, enterococci,haemophilus -> chocolate agar
  • Gram neg rods (nonfermenters) -> Pseudomonas > Acinetobacter > Stenotrophomonas
48
Q

most powerful predictor in parapneumonic effusion (complicated pneumonia)

A

LOW pH <7.20

-sterile

49
Q

Nosocomial pneumonia treatment

A
  • beta lactam w/ broad gram neg coverage

- vancomycin or linezolid to cover MRSA, MSSA

50
Q

Aspiration pneumonia treatment

A
  • Clindamycin for anaerobes ABOVE the diaphragm that are gram +
  • Metronidazole for anaerobes BELOW the diaphragm that are gram NEG
51
Q

why do you want to de-escalate the antibiotics when possible?

A

-prevent C. difficile colitis

52
Q

what drug do you NOT use in pulmonary infections

A

DAPTOMYCIN -> inactivated by surfactant

53
Q

most common typical mycobacteria?

A

M. tuberculosis (TB)

54
Q

what atypical mycobacteria does NOT grow on culture?

A

M. leprae

-have to biopsy

55
Q

the most common atypical mycobacteria

A

M. Avium complex (MAC)

56
Q

Mycobacterial Stain

A

-ACID FAST bacilli (ZN, Kinyoun, Fite, Fluorochrome)

57
Q

Mycobacterial cultures

A

-Lowenstein-Jensen media (3-8 weeks to grow)

58
Q

Latent TB

A

dormant, not active, asymptomatic, ready to activate, NOT passed to others

-ISONIAZID is drug of choice

59
Q

symptoms of TB

A
  • chronic cough
  • night sweats
  • weight loss (anorexia)
  • hemoptysis
  • amphoric breath sounds
60
Q

Host response to M. TB

A

CELL MEDIATED immunity -> CASEATING granulomas

61
Q

pulmonary infection from M. TB

A
  • apical and posterior segments of UPPER lobes
  • hemoptysis from Rasmussen’s aneurysm or aspergilloma
  • miliary TB disseminates -> MILLET seeds on chest xray
62
Q

pathology of TB

A
  • Gohn lesion/complex
  • Ranke complex
  • Simon’s foci
  • apical scarring
  • upper lobe infiltrates and cavitations
63
Q

TB skin test

A

-given 0.1 ml intradermally -> measure INDURATION 2-3 days after

to have POS test:
>/= 15mm -> healthy people

> /= 10mm -> high risk (DM, children <4 y/o

> /= 5mm -> recent contact w/ TB or X-ray of past TB, HIV+, transplants

64
Q

what can you get a false POS TB skin test with?

A

M. BOVIS

-BCG vaccine does NOT give false +

65
Q

Mycobacterium avium complex (MAC)

A

Lady Windermere Syndrome in white women -> pectus excavatum, hour glass chest on imaging, scoliosis, MV prolapse

66
Q

what do you do if you suspect UPPER lobe infiltrative or cavitary lung process?

A

think TB until proven otherwise

-isolation with special N95 masks and ventilated room w/ outdoor air

67
Q

Actinomycosis

A
  • spread through fascial planes -> “wooden texture”
  • extend through chest wall -> SINUS TRACTS
  • SULFUR granules -> lumpy jaw
  • 45 degree branching, CONTINUOUS strands

-treat w/ Penicillin

68
Q

Nocardia

A
  • N. Brasiliensis (skin/soft tissue) and N. Asteroides (non-cutaneous invasive)
  • AFB +
  • travel to the BRAIN -> brain abscess
  • 90 degree branching, BEADS

-treat with TMP-SMX

69
Q

Histoplasmosis

A
  • bird and bat quano
  • disrupt soil -> aerosolized
  • mycelial -> yeast in body
  • caseating or non-caseating granulomas
  • BUCKSHOT calcifications
  • yeasts w/I MACROPHAGES
  • acute -> erythema nodosum, Histoplasmoma -> itraconazole (6-12 weeks)
  • chronic -> itraconazole (12-24 months)
  • disseminated -> AIDS patients -> oropharyngeal and GI ulcers -> amphotericin B and itraconazole
70
Q

Bastomycosis

A
  • dogs can get
  • mycelia -> yeast in body
  • BROAD based, single budding
  • Pneumonia is common presentation
  • ulcerative lesions
  • like to go to BONE

-treat with itraconazole or amp.B

71
Q

Actinomyces vs. Nocardia

A
  • both show up on gram or silver stain
  • only Nocardia on AFT stain
  • both are gram neg rods
72
Q

what organism can colonize the oral cavity with Actinomyces?

A

Aggregatibacter actinomycetemcomitans (aka Actinobacillus)

-Ag grows on culture, Actino does NOT

73
Q

2 organisms that have erythema nodosum

A
  1. Histomplasmosis

2. TB

74
Q

Coccidioidomycosis

A
  • mycelia -> yeast in body
  • SPHERULES
  • THIN walled CAVITATIONS
  • skin lesions
  • can go to brain (meningitis) -> FLUCONAZOLE
75
Q

Cryptococcus

A
  • C. Neoformans, C. Gattii
  • latent in granulomas
  • polysaccharide CAPSULE with NARROW based budding
  • MUCICARMINE stain
  • Cryptocomma
  • meningitis and skin lesions

-treat with LIPOSOMAL amphotericin B > Fluconazole

76
Q

Penicilliosis/Talaromycosis

A
  • Immunocompromised (AIDS) patients from SE Asia
  • looks like Histo in Macs
  • SAUSAGE and SEPTATE

-treat with Liposomal Amphotericin B -> itraconazole

77
Q

Paracoccidioidomycosis

A
  • MULBERRY lesions

- MULTIPLE budding yeasts

78
Q

Aspergillosis

A
  • Gang sign
  • Aspergilloma (fungus ball)
  • HALO sign
  • Galactomannan on blood test
  • Silver stain -> 45 branching and are SEPTATE
  • Bronchopulmonary Aspergillosis -> bronchiectasis

treat with VORICONAZOLE

79
Q

Mycomycosis (Zygomycosis)

A
  • black, dead tissue/eschars
  • Silver stain -> broad, NON-SEPTATE 90 degree branching
  • fatal hemoptysis
80
Q

Pneumocystis pneumonia (PJP/PCP)

A
  • most common in HIV +
  • sputum on GMS stain
  • TEA CUPS and PING PONG balls
  • SPONTANEOUS pneumothorax

-treat/prophylaxis with TMP-SMX

81
Q

Candida Pneumonia

A
  • chemotherapy induced NEUTROPENIA
  • treat with amph. B +/- Flucytosine
  • C. krusei -> fluconazole RESISTANT, voriconazole sensitive
  • C. AURIS -> treat with ECHINOCANDINS**
82
Q

Paragonimiasis

A
  • lung fluke

- cause HEMOPTYSIS

83
Q

Nematodes (roundoworms)

A
  1. Ascaris Lumbricoides
  2. Ancyclostoma duodenal and Necator Americanus (hookworm)
  3. Toxocara canis and cati (larva migrans)
  4. Strongyloides stercoralis
  • EOSINOPHILIA -> Charcot-Leyden crystals
  • Loeffler syndrome
84
Q

Strongyloidiasis

A
  • HYPERINFECTION syndrome

- treat with Ivermectin

BECOM III - Exam 3 (8 decks)

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