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ABIM Critical Care > Care of Immunocompromised Patient > Flashcards

Care of Immunocompromised Patient Flashcards

1
Q

2 examples of immunoglobulin or compliment deficiency?

A

CVID, MM

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2
Q

Immunoglobulin / compliment deficiency (e.g., CVID, MM) have what clinical infection pattern?

A

Sinopulmonary, GI, meningitis infections.

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3
Q

Immunoglobulin / compliment deficiency (e.g., CVID, MM) are infected with what organisms?

A

Encapsulated ones. S Pneumo, H Flu, N Meningitis). Giardia, campylobacter.

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4
Q

What are 2 examples of granulocyte defects?

A

Neutopenia. Chronic granulomatous disease.

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5
Q

Granulocyte deficiencies (E.g., neutropenia, chronic granulomatous disease) have what clinical picture?

A

SSTIs, abscess

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6
Q

Granulocyte deficiencies (E.g., neutropenia, chronic granulomatous disease) are infected with what bacteria?

A

S Aureus, GNR, Aspergillus

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7
Q

What are three examples of cell-mediated immunity deficits?

A

HIV, Steroids, Rx

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8
Q

Cell-mediated immunity deficits (e.g., HIV, steroids, Rx) are due to what pathogens?

A

Viruses, mycobacteria, fungi

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9
Q

Invasive fungal disease commonly have what three immunodeficieny-related host factors?

A

Neutropenia >10 days, stem cell transplant, steroids

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10
Q

Immunodeficiency + halo sign on CT equals what type of infection?

A

fungal

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11
Q

Difference between “possible”, “Probable”, and “Proven” invasive fungal disease definitions?

A

-Possible = host factors + clinical disease
-Probable = host factors + clinical disease + test positive
-Proven = host factors + clinical disease + culture positive.

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12
Q

Name of fungi with septate hyphae, 45* branching?

A

Aspergillus

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13
Q

Name of fungi wtih non-septate hyphae, 90* branching?

A

Mucor

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14
Q

Infection timeline in post-transplant patients?

A

<1 mo = hospital acquired.
1-6 mo = reactivation of latent infextion
6+ mo = community acquired

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15
Q

A patient has cryptococcus meningoencephalitis. What else should you test for?

A

HIV. AIDS-defining & classic presentation.

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16
Q

Imaging findings of cryptococcus pulmonary disease?

A

solitary or few nodules, LAD, pleural effusions. +/- cavitation.

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17
Q

Presentation of cryptococcus cutaneous disease?

A

papulonodular lesions with umbilicated center resembling molloscum contagiosum.

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18
Q

Treatment of invasive cryptococcus infection?

A

-Induction: Liposomal amphotericin B + flucytosine x2 weeks.
-Consolidation with high dose fluconazole x8 weeks.
-Maitenance with low-dose fluconazole for 6-12 months.

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19
Q

Infection timeline in post hematopoietic stem cell transplant?

A

Pre-engraftment is 0-30 days. Post-engraftment is 30-100 days. Late is >100 days.

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20
Q

Broad categories of infection in post-hematopoietic stemm cell transplant by timeline?

A

Pre-engraftment (0-30 days) are neutropenic bugs. Late infections (>100 days) are due to cell-mediated immunity.

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21
Q

Infection risk with AIDS & CD4 count <200?

A

Primary TB, PJP, cryptococcus.

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22
Q

Infection risk for AIDS & CD4 count <100?

A

MAC, Nocardia, Aspergillus, Toxo.
-In addition to <200 (Primary TB, PJP, cryptococcus)

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23
Q

Infection risk for AIDS & CD4 count <50?

A

CMV, MAC, disseminated endemic fungi.
-In addition to <100 (MAC, Nocardia, Aspergillus, Toxo).
-In addition to <200 (Primary TB, PJP, cryptococcus).

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24
Q

Best test for PJP?

A

Silver stain, “Crushed ping-pong ball” or “deflated beach ball”.

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25
Q

Difference in presentation of PJP PNA in HIV (+) vs (-) patients?

A

HIV (-) patients are much more acute (1 week) & worse survival. Worse sensitivity for microscopy because lor organism burden.

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26
Q

Do steroids help PJP?

A

Only in HIV (+) patients with A-a >35 or PaO2 <70.

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27
Q

Difference between Nocardia & Actinomyces on histology?

A

-Both are gram positive, beaded, branching, filamentous.
-Nocardia is aerobic & weakly acid-fast. Actinomyces is anaerobic and not acid-fast.

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28
Q

Buzzword: “Owl-eye” inclusion body?

A

CMV

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29
Q

Treatment of disseminated CMV infection? 1st and 2nd line?

A

-1st: Ganciclovir. Causes BM suppression.
-2nd: Foscarnet. Causes renal failure.

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30
Q

Toxicity of ganciclovir?

A

bone marrow suppression.

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31
Q

Toxicity of foscarnet?

A

renal failure

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32
Q

Toxicity of IFN-alpha blockers?

A

Granulomatous infections: TB, MAC, Fungi. IRIS can occur when stopping.

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33
Q

Symptoms of PRES?

A

-Posterior Reversible Encephalopathy Syndrome. Headache, AMS, visual changes, seizures, hypertension.

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34
Q

Main drugs to cause PRES?

A

Immunosuppression (tacrolimus, cyclosporine, sirolimus, cisplatin, interferon).

35
Q

Characteristic imaging findings of PRES?

A

Symmetrical white matter edema in posterior hemispheres; hyper-intensity of T2/Flair. Not a singular vascular territory.

36
Q

How do you treat drug-induced PRES?

A

Change immunosuppression (even within same class).

37
Q

Toxicity of anti-thymocyte globulins?

A

Cytokine storm, leukopenia, thrombocytopenia, serum sickness.

38
Q

Toxicity of Azathioprine?

A

Leukopenia.

39
Q

Toxicity of calcineurin blockers?

A

Nephrotoxicity, neurotoxicity, microangiopathy w/ thrombosis.

40
Q

2 examples of calcineurin blockers?

A

cyclosporine, tacrolimus

41
Q

Toxicity of sirolimus?

A

Bone marrow suppression, pneumonitis

42
Q

Drug that blocks mTOR?

A

Sirolimus.

43
Q

Drug that blocks CTLA-4-R?

A

Ipilimumab

44
Q

Drugs (2) that block PD-1-R?

A

Nivolumab, penbrolizumab. Don’t mix them up with atezolizumab, which blocks PDL-1-R?

45
Q

Drug that blocks PDL-1-R?

A

Atezolizumab. Dont mix it up with nivolumab & pembrolizumab, which block PD-1-R.

46
Q

Immune checkpoint inhibitor with highest toxicity?

A

Ipilimumab (CTLA-4 inhibitor)

47
Q

5 most common side effects from immune checkpoint inhibitor therapy for immunosuppression?

A

-Skin rash.
-Diarrhea / colitis.
-Hepatitis.
-Endocrine (hypothyroid, hypophysitis).
-Pneumonitis.

48
Q

Treatment of any immune checkpoint inhibitor toxicity?

A

-Rule out CA progression & infection.
-Change agent.
-Methylprednisone 1-2mg/kg/d, taper over 4-6 weeks.

49
Q

What does halo sign indicate on CT?

A

Hemorrhagic infection. Tx of adenovirus infection

50
Q

Antiviral for adenovirus infection?

A

Cidofovir

51
Q

Tox of Cidofovir?

A

Fanconi syndrome (Proteinuria, glucosuria, bicarb wasting). Dose dependent.

52
Q

Toxicity of acyclovir & valacyclovir?

A

Crystal nephropathy, neurotoxicity.

53
Q

2 infectious caused by coccidiomycosis?

A

Pneumonia, meningitis.

54
Q

Coccidiomycosis CXR findings?

A

unilateral opacity with hilar LAD

55
Q

Desert rheumatism - Sx and etiology.

A

erythema multiforme or nodosum with arthralgias. Coccidiomycosis.

56
Q

Cryptococcus on CXR findings?

A

peripheral, nodular opacities

57
Q

Infections caused by cryptococcus?

A

PNA, meningoencephilitis, rash

58
Q

Fungus that causes fibrosing mediastinitis?

A

Histoplasmosis

59
Q

Imaging findings of histoplasmosis?

A

Nodular opacities, calcification of spleen, LAD

60
Q

Risk factors for vibrio vlnificus infection?

A

EtOH cirrhosis, hemochromatosis, DMa, RA, thallasemia

61
Q

Route of infection of vibrio vulnificus?

A

wound infection with salt water. Raw seafood ingestion.

62
Q

Symptoms of bivrio vulnificus infection?

A

Fever, GI Sx, shock, skin lesions

63
Q

Sx of cutaneous anthrax?

A

painless necrotic ulcers & black eschar. Associated edema & lymphangitis.

64
Q

Sx of inhalational anthrax?

A

Widened mediastinum, pleural effusions

65
Q

Sx of GI anthrax?

A

N/V, pain, intestinal ulcers & edema.

66
Q

Sx of Meliodisis? Why is it important? Distinguishing factors?

A

Fever & PNA. Resembles TB. Travellers from Australia or Thailand. Burkholderia Pseudomalleri

67
Q

Bacteria causing Meliodisis?

A

Burkholderia Pseudomalleri

68
Q

Bacteria causing Q Fever?

A

Coxiella Burnetti

69
Q

Sx fo Q Fever?

A

PNA, hepatitis, endocarditis, APLS. Farm worker. Coxiella Burnetti.

70
Q

Bacteria causing Tularemia?

A

Francisella Tularensis.

71
Q

Exposures (2) causing Tularemia?

A

Bioterrorism. Rabbits.

72
Q

Bacteria causing Plague?

A

Yersenia Pestis.

73
Q

Sx of strongyloides hyperinfection?

A

fever, hemoptysis, wheezing, infiltrates. Ileus/GIB. SIADH.

74
Q

Tx of strongyloides hyperinfection?

A

ivermectin. Abx to cover GNRs and anaerobes (transolcation from gut). Reduce immunosuppression.

75
Q

Travel location for Ancyclostoma Duodenale?

A

Mediterranean or Far East

76
Q

Sx of Ancyclostoma Duodenale infxn?

A

GI Sx, nutritional impairment, Loeffler syndrome.

77
Q

Sx of Ascaris Lumbricoides?

A

Intestinal obstruction, Loeffler Syndrome

78
Q

Sx of Echinococcus Granulosus?

A

Cyssts in lung & liver. Rupture to cause anaphylaxis. Caution w/ Bx.

79
Q

Sx of Paragonimus Westernami infxn?

A

Eosinophilic pleural effusion & parenchymal cysts

80
Q

Travel destination for Paragonimus Westernami?

A

Far East. Raw crab exposure.

81
Q

Tx Paragonimus Westernami?

A

Praziquantel.

82
Q

Tx Ancylostoma Duodenale?

A

Albendazole. (Same with Ancylostoma duodenale, Ascaris Lumbricoides, Echinococcus Granulosus).

83
Q

Tx Ascaris Lumbricoides?

A

Albendazole. (Same with Ancylostoma duodenale, Ascaris Lumbricoides, Echinococcus Granulosus).

84
Q

Tx Echinococcus Granulosus?

A

Albendazole. (Same with Ancylostoma duodenale, Ascaris Lumbricoides, Echinococcus Granulosus).

ABIM Critical Care (37 decks)

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