Unusual infections, Bonchiectasis, CF

Question 1

Romanowsky staining positive for what infection?

Answer 1

Nocardia

Question 2

Buzz word: “sulfur granule”

Answer 2

Actinomyces

Question 3

Buzz word” Gram positive and weakly AFB positive

Answer 3

Nocardia

Question 4

Treatment for nocardia?

Answer 4

Bactrim. If severe, add second agent

Question 5

Treatment for actinomyces?

Answer 5

PCN

Question 6

Biggest risk factor for actinomyces infection?

Answer 6

aspiration

Question 7

Nocardia on CT has cavitation + what?

Answer 7

nodules

Question 8

Actinomyces on CT has cavitation + what?

Answer 8

bronchiectasis, LAD, pleural disease, local invasion

Question 9

Etiology of focal bronchiectasis?

Answer 9

• Necrotizing pneumonia
• Bronchial atresia
• Mechanical obstruction (FB, external compression, stenosis)

Question 10

Etiology of central bronchectiasis?

Answer 10

ABPA, cartilage syndromes

Question 11

Etiology of upper lobe bronchiectasis?

Answer 11

CF, sarcoid, post-radiation

Question 12

Etiology of middle lobe bronchiectasis?

Answer 12

Immotile cilia syndrome, NTM/MAC

Question 13

Etiology of lower lobe bronchiectasis?

Answer 13

Post-infection, chronic aspiration, fibrotic lung disease, post-transplant, HIV

Question 14

Class I-V of CF mutations?

Answer 14

• I: no functional CFTR made
• II: misfolded CFTR doesn’t get to surface
• III: CFTR on surface doesn’t work.
• IV: Ion channel in CFTR is faulty
• V: Insufficient CFTR quantity

Question 15

Sweat chloride level to diagnose CF?

Answer 15

• Cl > 60
• Cl 40-59 with 1 CFTR mutation and strong suspicion / FHx
• 2 CFTR mutations
• If Cl < 30, very unlikely

Question 16

Three pulmonary infections in CF associated with worse prognosis?

Answer 16

• MRSA
• Psuedomonas
• Burkholderia

Question 17

All CF patients should get what therapies?

Answer 17

• Dornase alfa
• Inhaled 3% saline
• Inhaled mannitol as second line if failed above

Question 18

When should CF patients get antibiotics?

Answer 18

• If known colonizer, give suppressive chronic ppx

- Treat pseudomonas, maybe MRSA

Question 19

Avoid which therapies for CF?

Answer 19

Chronic steroids, ICS, leukotrine inhibitors

Question 20

Prognosis for transplanted lungs in CF?

Answer 20

Good. Transplant does not develop CF. Must have bilateral.

Question 21

Treatment for non-CF bronchiectasis to reduce exacerbations?

Answer 21

macrolides