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Pulmonology Board Review > CF, Non CF bronchiectasis, and atypical infections > Flashcards

CF, Non CF bronchiectasis, and atypical infections Flashcards

1
Q

Two most common filamentous bacteria to pulmonology

A

Actinomyces and nocardia

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2
Q

Bacteria ubiquitous in soil and is a endogenous in mucus membranes. Causes infection with damaged epithelial barriers.

A

Nocardia

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3
Q

Aytpical bacteria that favors immunocompetent hosts

A

Actinomyces

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4
Q

Atypical bacteria that favors immunocompromised hosts

A

Nocardia

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5
Q

Atypical bacteria that appear like fungal organisms but are thinner and lack septations

A

Actinomyces and nocardia

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6
Q

Difference in appearance between nocardia and actinomyces on staining

A

Nocardia more delicate and has right angle branching compared to actinomyces

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7
Q

Staining preferred in nocardia

A

Romanowsky

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8
Q

Most common species of nocardia in humans

A

Asteroides

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9
Q

Stain preferred in actinomyces

A

Papanicolaou

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10
Q

Classic feature of actinomyces slide presentation

A

macroscopically visible sulfur granule comprised of bacteria and proteinaceous material. IF NOT PRESENT, SUSPECT CONTAMINATION

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11
Q

CD4 count in HIV associated with nocardia

A

< 100

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12
Q

Finding highly suggestive of actinomyces infection

A

Bronchocutaneous fistula

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13
Q

Classification of actinomyces and nocardia

A

acid fast bacilli that are gram negative

NOCARDIA CAN ALSO BE GRAM POSITIVE

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14
Q

Radiographic findings of adenopathy, bronchiectasis, and pleural disease suggest what infection

A

Actinomyces

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15
Q

Bacteria suggested by rib osteomyelitis and/or empyema or chest wall sinus tract

A

Actinomyces

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16
Q

Preferred agent in nocardia infection

A

Sulfonamides, 2 drug regimen until resistance pattern is known

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17
Q

Treatment of nocardia infection in sulfa allergic patient

A

Minocycline

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18
Q

Treatment of refractory nocardia infection

A

Zyvox

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19
Q

Duration of treatment for nocardia infection

A

6-12 months

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20
Q

Drug of choice in actinomyces infection

A

PCN

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21
Q

Drug of choice in actinomyces infection if PCN allergic

A

Tetracyclines, erythromcyin, clinda

22
Q

Clinical presentation of bronchiectasis

A

cough
sputum production
recurrent respiratory infections
Permanent dilation of the bronchi

23
Q

3 etiologies of focal bronchiectasis

A

Mechanical obstruction
Congenital bronchial atresia
Necrotizing pneumonia

24
Q

Causes of diffuse central bronchiectasis

A

ABPA

Cartilage syndromes

25
Q

Inheritance pattern of cystic fibrosis

A

autosomal recessive with variable penetrance

26
Q

Gene associated with cystic bronchiectasis

A

CF gene on the long arm of chromosome 7

27
Q

Protein malfunction in cystic fibrosis

A

CF transmembrane regulator protein (CFTR)

28
Q

Ion channel that regulates liquid volume on epithelial surfaces by secreting chloride and inhibiting sodium absorption

A

CF transmembrane regulator

29
Q

Most common CFTR mutation that accounts for 90% of cases of European descent

A

F508

deletion of single phenylalanine at position 508

30
Q

Diagnostic criteria for cystic fibrosis

A

Elevated sweat chloride on 2 occasions OR
ID of mutation known to cause CF on BOTH genes OR
In vivo ion transport abnormalities in nasal epithelium AND
At least one phenotypical feature of CF, sinopulmonary disease, characteristic GI disorders, obstructive azoospermia, salt loss syndrome, OR
Sibling with CF OR
Positive newborn screening

31
Q

Level of sweat chloride considered normal

A

< 30

32
Q

Disease with only 1 CFTR mutation and symptoms of CF

A

CFTR related disorder

33
Q

3 most common bacteria in bronchiectasis

A

H. Influenza
P. Aeruginosa
S. Pneumniae

**S. Aureus atypical

34
Q

Simplified diagnostic criteria for CF in adult

A
  • Classic symptoms with 1 of the following
  • Sweat chloride > 60
  • 2 CF mutations
  • Sweat chloride 40-60 with strong family history or 1 mutation
35
Q

Therapy for all CF patients > 6 years old

A

rhDNase (dornase alpha)

36
Q

3 drugs that are CFTR modulators for select patients with CF

A

Ivacaftor
Tezacaftor-ivacaftor
Lumacaftor-ivacaftor

37
Q

Airway clearance agent in CF indicated for those refractory to dornase alpha or hypertonic saline

A

Inhaled mannitol

38
Q

Treatment of CF with antibiotic guidelines

A
  • Don’t cover for staph aureus
  • Attempt to eradicate pseudomonas on 1st detection
  • Chronic suppression of gram negatives once colonized
39
Q

Antibiotics used in CF

A

Inhaled tobramycine or aztreonam

Azithromycin 3x per week

40
Q

2 drug classes NOT recommended in CF

A 
Leukotriene modifiers
Systemic steroids (unless asthma or ABPA)
41
Q

5 indications for referral for lung transplant regardless of FEV1

A
  • 6MWT < 400 meters
  • Hypoxemia at rest or exertion < 88% or Po2 < 55
  • Hypercarbia PCO2 > 50
  • PA systolic pressure > 50 on echo or evidence of RV dysfunction without tricuspid regurg
  • Any exacerbation requiring PPV (CF patients)
42
Q

Mucolytic agent NOT recommend in Non-CF bronchiectasis

A

dornase alpha

43
Q

Only chronic bacteria to be treated with abx in non-CF bronchiectasis

A

Pseudomonas

44
Q

Length of time required for symptoms of cough and sputum increase to be considered exacerbation in CF

A

48 hours

45
Q

Drug used in the G551-D mutation of CF

A

Ivacaftor

46
Q

Drug used in the F508 mutation of CF

A

Lumacavtor-ivacaftor

47
Q

Condition with situs inversus, recurrent sinus infections, and pneumonias

A

Primary ciliary dyskinesia (kartagener’s syndrome)

48
Q

Genetic abnormality in kartagener’s syndrome

A

DNAH5 or DNAI1

49
Q

Diagnostic testing for kartagener’s syndrome

A

nasal nitric oxide levels

Confirm with microscopy of nasal ciliary brushings

50
Q

Drug injected into mild tracheal stenosis areas to treat without dilation

A

Mytomycin C

Pulmonology Board Review (32 decks)

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