Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSKCC Pulmonary APP onboarding > Week 4 - Immunocompromised Host > Flashcards

Week 4 - Immunocompromised Host Flashcards

1
Q

Name three risk factors that make a host immunocompromised:

A

1) chemotherapy
2) immunosuppresive drugs (systemic steroids, post-transplant drugs, rheumatologic meds)
3) acquired immunodeficiency (AIDS, post-splenectomy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the three categories of acquiring PNA?

A

1) community acquired
2) hospital acquired
3) ventilator associated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are two clinical parameters that gauge severity of PNA?

A

PSI (pneumonia severity index), CURB-65

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe typical vs atypical PNA presentation

A
  • typical: fever, rigors, chills, productive cough, pleurisy, dyspnea
  • atypical: low-grade fevers without typical PNA sxs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the main pathogens of CAP?

A

Streptococcus pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumoniae, Haemophilus influenzae, Legionella, viral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the main pathogens of VAP?

A

Gram negatives (Pseudomonas aeruginosa, E coli, Klebsiella, Acinetobacter) and S aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the most common pulmonary infections in the early stages of immunosuppression?

A

Bacterial, isolated commonly are Legionella, Mycoplasma and Chlamydia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the predominant viral agents in early stages on immunosuppression?

A

Rhinovirus, adenovirus, coronavirus, influenza, ESV, parainfluenza (post-transplant, include CMV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the most frequent opportunistic pulmonary pathogen in the ICH?

A

Pneumocystis jiroveci is the most frequent, also Aspergillus fumigatus, Candida albians, Cryptococcus neoformans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

For non-resolving PNAs, what noninfectious etiologies must be considered?

A

Organizing pneumonia, drug-toxicity, cardiac causes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What types of pathogens most commonly cause lobar/bronchopneumonia?

A

Bacterial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What types of pathogens most commonly cause interstitial pneumonias?

A

Viral, parasitic, fungal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Radiographically, what constitutes a lobar pneumonia?

A

Homogenous consolidation with air bronchogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How long does radiologic resolution of a PNA lag behind the clinical improvement of a patient?

A

6-8 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Radiographically, what constitutes a bronchopneumonia

A

patchy appearance with peribronchial thickening and poorly defined airspace opacities. Airbronchograms typically absent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the CT findings of severe staph infection?

A

Lobar enlargement with bulging interlobular fissures c/b abscess/cavitation/pneumoatocele/empyema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What pathogens typically cause an interstitial PNA image?

A

The atypical bugs: Legionella, Mycoplasma, Chlamydia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the typical radiographic appearance of Legionella?

A

Patchy, localized infiltrate in the lower lobes +/- hilar adenopathy +/- pleural effusion. Rarely with cavitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the typical radiographic appearance of Mycoplasma pneumoniae?

A

Unilateral, multilobar, or bilateral +/- pleural effusion in 20% of pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the five categories of pulmonary aspergillosis?

A

1) aspergilloma (saphrophytic)
2) ABPA (hypersensitivity)
3) chronic necrotizing (semi-invasive)
4) Airway-invasive
5) IPA (invasie pulmonary aspergillosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What virus accounts for the majority of viral PNAs in immunoCOMPETENT hosts?

A

Influenza A/B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What viral PNAs are ICH pts more suspectible to?

A

CMV, HSV, measles, adenovirus

23
Q

T/F - the diagnosis of viral PNA can be made on the basis of radiographic appearance alone

A

FALSE - viral PNA chest imaging is variable and overlapping

24
Q

What infections are typically reactivation?

A

TB, PCP, toxoplasmas gondii, VZV – hx is key in diagnosis

25
Q

Humoral immunodeficiency increases risk of what kind of pathogen?

A

Encapsulated bacteria (S aureus, S pneumoniae, H influenza, PJP)

26
Q

Cell-mediated or T-cell defects increases risk of what kind of pathogens?

A

Opportunists (CD4< 100 = viral and fungal ,CD4>100 PCP and mycobacterium)

27
Q

s/p splenectomy or hyposplenism pts are predisposed to what kinds of pathogens?

A

Encapsulated bacteria (S aureus, S pneumoniae, H influenza)

28
Q

What types of pathogens are ICH pts more likely to have in early vs late neutropenia?

A

Early: bacterial, late: viral or fungal predominates

29
Q

What is the air bronchogram sign?

A

represents consolidation – opacification of the air spaces but the bronchioles (air tracks) can still be visualized

30
Q

What is the bulging fissure sign?

A

in conjunction with air bronchogram suggests pneumonia, usually upper lobe Klebsiella and pneumococcal infections. DDx neoplasia, large abscesses, infected bullae

31
Q

What is the silhoutte sign?

A

obscuring of normal air interfaces of the thorax (thoracic aperture, thoracic wall, paramediastinal spaces, and pericardiac spaces)

32
Q

What is the feeding veseel sign?

A

indicates septic emboli when cavtating or noncavtating nodules are associated with a pulmonary vessel

33
Q

What is the air fluid level sign?

A

Suggestive of abscess or empyema, mainly caused by S aureus and Klebsiella

34
Q

What is the split pleural sign?

A

Normally suggestive of empyema, can also be seen with hemothorax, pleurodesis, post-lobectomy

35
Q

T/F – ground glass opacities (GGOs) are very specific for lung infection

A

FALSE - can represent infection, vasculitis, ILD, pulmonary congestion. More helpful is the distribution

36
Q

GGOs with central/upper lobe predominance sparing the subpleural spaces is indicative of what infection?

A

PCP

37
Q

Why is the tree-in-bud sign signify pathology?

A

These are terminal bronchioles and should not be able to be perceived on CT scan because of their thin walls/caliber

38
Q

What is the halo sign?

A

Is always suggestive of invasive aspergillosis with neutropenic fever – it is a good prognostic indicator for response to therapy

39
Q

What is the air crescent sign?

A

Separation of the necrotic infective fungal mass by a crescent air space in response to therapy – suggests good response

40
Q

What is monad’s sign?

A

Air crescent sign resulting from secondary fungal infection with mycetoma (fungal ball) in a preexisting cavity – this is a bad sign requiring surgical vs other intervention

41
Q

What is crazy paving sign?

A

Due to alveolar opacity resulting from exudates accompanied by septal thickening leading to “pedestrian path pattern” – usually seen in pulmonary aveolar proteinosis but is not pathognomonic

42
Q

What are contraindications to bronchoscopy

A

1) results won’t change mgmt

43
Q

What are minor complications of flex bronch?

A

laryngospasm, bronchospasm, epistaxis, transient hoarseness, fever, nausea, cough, mild airway bleeding

44
Q

What are major complications of flex bronch?

A

severe airway hemorrhage, PTX, severe hypercapnia/hypoxemia, arrhythmias, seizure, cardiac arrest

45
Q

What is the reported incidence of major complications from flex bronch?

A

1-5%, with most major complications 2/2 TBBx

46
Q

What is the mortality associated with flexible bronch?

A

Rare, <0.04%

47
Q

There are few absolute contraindications to flex bronch – name them

A

Refractory hypoxemia, HD instability, life threatening arrhythmias, lack of informed consent, inexperience operator, inadequate equipment/facility

48
Q

What are relative contraindications to bronchoscopy?

A

Severe hypoxemia (~PO2<70), pulmonary HTN, recent MI ~4-6 wks, coagulopathy, increased intracranial pressure, pregnancy

49
Q

For autologous SCT, what are the common infections PRE-engraftment?

A

HSV, Candida, Bacterial, respiratory virus

50
Q

For autologous SCT, what are the common infections POST-engraftment?

A

Still bacterial and respiratory viruses. Added risk for CMV, VZV, PCP. Less risk HSV or Candida.

51
Q

For allogeneic SCT, what the common infections pre-engraftment

A

Bacterial: gram neg bacilli, gram pos, GI streptococcus
Viral: HSV, respiratory and enteric viruses, HHV in late pre-engraftment
Fungal: Candida, Aspergillus

52
Q

For allogeneic SCT, what the common infections POST-engraftment (day 15-45) thru day 100?

A

Bacterial: Gram pos and GI strep, less risk gram neg
Viral: Added risk CMV, HHV6, EBV
Fungal: Added risk PCP, less risk aspergillus. Same risk Candida

53
Q

For allogeneic SCT, what the common infections POST-engraftment day 100 and beyond?

A

Bacterial: Encapsulated bacteria
Viral: Added risk VZV. Same risk CMV, HHV6, EBV
Fungal: No longer at risk Candida. Same risk aspergillus and PCP

MSKCC Pulmonary APP onboarding (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions