MTB Resp Flashcards
Gastrointestinal Involvement of CF
- Meconium ileus in infants with abdominal distention
- Pancreatic insufficiency (in 90%) with steatorrhea and vitamin A, D, E, and K malabsorption
- Recurrent pancreatitis
- Distal intestinal obstruction
- Biliary cirrhosis
Allergic bronchopulmonary aspergillosis
ABPA is hypersensitivity of the lungs to fungal antigens that colonize the bronchial tree. ABPA occurs almost exclusively in patients with asthma and a history of atopic disorders.
Haemophilus influenzae Staphylococcus aureus Klebsiella pneumoniae Anaerobes Mycoplasma pneumoniae Chlamydophila pneumoniae Legionella Chlamydia psittaci Coxiella burnetii
COPD Recent viral infection (influenza) Alcoholism, diabetes Poor dentition, aspiration Young, healthy patients Hoarseness Contaminated water sources, air conditioning, ventilation systems Birds Animals at the time of giving birth, veterinarians, farmers
Klebsiella pneumoniae Anaerobes Mycoplasma pneumoniae Legionella Pneumocystis
Hemoptysis from necrotizing disease, “currant jelly” sputum
Foul-smelling sputum, “rotten eggs”
Dry cough, rarely severe, bullous myringitis
Gastrointestinal symptoms (abdominal pain, diarrhea) or CNS symptoms such as headache and confusion
AIDS with <200 CD4 cells
Infections often with a “dry” or non-productive cough
- Mycoplasma
- Viruses
- Coxiella
- Pneumocystis
- Chlamydia
Atypical pneumonia pathogens
Mycoplasma, Chlamydophila, Legionella, Coxiella, and viruses
Pneumonia admission criteria
CURB65 = admission Confusion Uremia Respiratory distress BP low Age >65
Exudate versus Transudate
Pleural effusion with pH 60% of serum (0.6) or protein >50% of serum (0.5) suggest an exu-date. Exudates are caused by infection and cancer.
Difference in hospital acquired pneumonia
These patients have a much higher incidence of Gram-negative bacilli such as E. coli or Pseudomonas as the cause of their infection. The main difference in management is that macrolides (azithromycin or darithromycin) are not acceptable as empiric therapy. Instead, treatment of HAP is centered around therapy for Gram-negative bacilli such as:
Antipseudomonal cephalosporins: cefepime or ceftazidime
or
Antipseudomonal penicillin: piperacillin/tazobactam
or
Carbapenems: imipenem, meropenem, or doripenem
Pneumocystis pneumonia
AIDS
P.g
Trimethoprim/sulfamethoxazole (TMP/SMX)
TB diagnosis
X-ray
Acid-base bacilli 3x
PDD skin is never good for active TB
Biopsy, most accurate
TB treatment
Rifampin, Isoniazid, Pyrazinamide, and Ethambutol (RIPE). You do not need the ethambutol if it is known at the beginning of therapy that the organism is sensitive to all TB medications. Ethambutol is given as part of 4-drug empiric therapy prior to knowing the sensitivity of the organism.
After using RIPE for the first 2 months, stop ethambutol and pyrazinamide and continue rifampin and iso-niazid for the next 4 months. The standard of care is 6 months total of therapy.
RIPE side effects
R. Red color to body secretions - None, benign finding
I. Peripheral neuropathy - Use pyridoxine to prevent
P. Hyperuricemia - No treatment unless symptomatic
E. Optic neuritis/color vision - Decrease dose in renal failure
Decrease dose in renal failure
PPD positive non active TB treatment
9 month isoniazid with pyridoxine
Malignant feature of pulmonary nodule
Age > 40 Enlarging Smoker Spiculated (spikes) Large, >2 em Atelectasis Yes adenopathy Sparse, eccentric calcification Abnormal PET scan
