diagnosis/treatment/etc Flashcards
(28 cards)
How would you treat this pneumonia? What is the most probable cause of it?
most likely strep pneumo
Treat with almost any beta-lactam
A young patient comes in with a severe shaking chill, sustained high fever, and rusty sputum. What diagnostic measures would you take to diagnose this patients?
chest x-ray, gram stain, LDH (elevated?), urine antigen test
most likely strep pneumo
If pneumolysin is the cause of lyses of RBCs and WBCs, what is the patient most likely infected with?
strep pneumo
What phase of infection is this picture?
phase 2-3 due to the formation of firbin strands in the alveoli and spreading through the pores of Kohn.
Based on the amount of necrosis in this slide, what can you say about the most probable diagnosis?
There is no necrosis, so there will most likely be no scarring leading to complete resolution
What type of symptoms would a younger patient with this bacteria probably present with?
cough with rusty sputum
fever
rigor
What phase is this lung most likely in?
phase 2: red hepatization
What can be expected on gross anatomy from a patient with microscopic acute necrotizing bronchitis, bronchiolitis, fibrin, edema fluid, hemorrhage and evloving abscesses?
heavy plum-colored lungs which exude bloody fluid on sectioning and develop numerous small abscesses
*staph aureus
What is the prognosis of this infection when treated?
*staph aureus
50% mortality even when treated
What are the red arrows pointing to? What has caused these?
abscesses in lungs caused by staph aureus
How would you treat the things the red arrow is pointing to? Why?
pointing to lung abscess caused by staph aureus.
They are difficult and risky to drain, so drainage is generally NOT done.
There is no treatment, unless they rupture and form an empyema. Empyemas are treated with drainage
What do the blue dots show? Red on lower R? pink on upper L? dark blue near center and bottom R? What is the mostly likey pathogen causing this?
blue dots: degenerating neutrophils in the alveoli
red: hemmorhage
pink: necrosis
dark blue: aggregated of bacteria
**staph aureus
A patient is suspected to have acquired a bug after visiting a spa (with lots of warm water). What is the best and most specific diagnostic test to preform?
probably Legionella
best diagnosed with a urine antigen test
A bacteria attaches to respiratory epithelial cells and macrophages by flagella and pili, then inhibits phagosome-lysosome fusion intracellularly. What is the best treatment?
*Lengionella
newer macrolides (azithromycin) or respiratory tract quinolones (levofloxacin)
You suspect a gram +, abscess forming microorganism. What is the best way to treat it?
oxacillin (or beta-lactam) if sensitive
vancomycin if MRSA
What would you expect to see on a CXR in a patient with productive cough of mucoid sputum, diarrhea, pulmonary crackles, and confusion with early infiltration of numerous macrophages? What would be the prognosis if treated correctly?
*Legionella
patchy unilobar bronchopneumonic infiltrates
very good. <5% mortality if treated early in immunocompetent patient
In a patient with Legionella, what would you expect to see on gross pathology?
bulging, firm rubbery areas of consolidation
A patient is intubated and has been neutropenic. The microoragnism infecting him is known to causes biofilms. What would you expect to see on a CXR?
*pseudomonas aeruginosa
diffusely distributed bilateral bronchopneumonic infiltrates with possible nodules, small abscesses and pleural effusion
What does this gross pathology show? How would yo treat the microorganism causing this?
firm red areas of hemorrhagic consolidation caused by pseudomonas aeruginosa
treat with combo of antipseuodomonal beta-lactam and antipseudomonal quinolone
A 5 yo comes in with an URT infection in December. The microorganism is found to attach to respiratory epithelial cells by adherence proteins and cause illness that is largely immune mediated. How will you treat this patient?
*mycoplasma
treat with azithromycin or levofloxacin
What cells would be most likely infected and what will happen to them with lymphoplasmacytic bronchiolitis with mucosal ulceratoin and fibrinopurulent exudate in the lumen?
alveolar type 2 pneumocyte hyperplasia
A 2nd grader comes in with a persistent incessant intractable dry cough. What do you expect to see on CXR?
*mycoplasma pneumonia
patchy areas of airspace consolidation or reticulonodular infiltrate (unilateral or bilateral) usually in lower lobes
A caseating gramuloma is found on gross pathology of an untreated patient. What should the initial treatment have been to possibly save this patient?
*tuberculosis
RIPES
rifampin, isoniazid, pyrazinamide, ethambutol or streptomycin
A patient with anorexia, weight loss, chills, fever, night sweats, mucopurulent sputum and hemoptysis presents. What would you expect to see microscopically?
necrotizing granulomas with epithelioid histiocytes, Langhans types giant cells, with very few organisms.
