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Step 2 CK Pulmonary > Infections > Flashcards

Infections Flashcards

1
Q

Pneumococcal vaccine is indicated in which age groups?

A

Children and adults > 65 years of age.

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2
Q

Other than specific age groups, what are some indications for the pneumococcal vaccine?

A

in individuals with
-Chronic heart/lung/liver/renal disease
-DM
-smoking

-Asplenia

-IC status (congenital immunodeficiency, malignancy)

-CSF leaks

-Cochlear implants

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3
Q

What are the most common pathogens of concern in post-viral pneumonia?

A

-Staph.
-S. Pneumoniae
-H. Influenzae

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4
Q

___ is the pathogen of concern in a patient p/w pneumonia following or during recent travel?

A

Legionella

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5
Q

___, ____, or ____ are the antimicrobials of choice for t/t of outpatient CAP, or patients age ≤ 65 years, otherwise healthy, or no h/o anti-microbial t/t within the previous 3 months?

A

-Amoxicillin, Doxycycline, or macrolide (if local pneumococcal resistance is < 25%).

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6
Q

How does antimicrobial t/t of CAP patients differ between those requiring hospitalization versus ICU admission?

A

CAP-requiring hospitalization:
Macrolide + Respiratory FQ/beta-lactam

CAP-requiring ICU admission:
Beta-lactam + Respiratory FQ/macrolide

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7
Q

What are the antimicrobials of choice for patients with hospital-acquired pneumonia?

A

Anti-pseudomonal agent

+

2nd Anti-pseudomonal agent if structural lung disease

+

anti-MRSA agent in critically ill (in shock, on ventilation).

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8
Q

Hospital-acquired pneumonia requires coverage for which microbial pathogens?

A

-GNRs: Pseudomonas, Acinetobacter.
-S. aureus
-Legionella
-Mixed flora

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9
Q

The phenomena of small, gradual changes in the surface proteins of viruses through point mutations leading to multiple infections by the same virus is known as ___.

A

antigenic drift.

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10
Q

The phenomena of acute, major change in the surface protein of a virus subtype through genetic reassortment leading to pandemics is known as ___.

A

antigenic shift.

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11
Q

In the US, the influenza season begins in ____ and lasts until ___.

A

Nov until April.

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12
Q

Patients in ___ age groups require 2 doses of the seasonal influenza vaccine under what condition?

A

6 months to 8 years if they are receiving the vaccine for the first time.

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13
Q

Older patients with influenza (flu) may present atypically with the ___ as the only manifestation.

A

confusion.

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14
Q

What is the best initial test in patients suspected of influenza infection?

A

*Rapid influenza NP swab test for viral antigens.

*Low SN

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15
Q

What are the most accurate tests for influenza diagnosis?

A

-DFA (antibody)
-viral culture
-PCR assays

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16
Q

___ finding on CBC is a common finding in influenza.

A

leukopenia.

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17
Q

____ antivirals (list all) are most effective when used within ___ days of symptom onset in influenza.

A

Oseltamivir or Zanamivir if started within 2 days of s/s onset.

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18
Q

True/False? Aspergillosis occurs due to inhalation of the fungal hyphae.

A

false;

inhalation of fungal spores.

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19
Q

Aspergillus is seen on ____ stain as ____ (describe microscopic appearance).

A

silver stain

as

acutely branched (< 45 degrees) septate hyphae.

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20
Q

What is the preferred/effective treatment for aspergilloma?

A

-resection (antifungals do not penetrate well in an aspergilloma),

-embolization (for hemoptysis).

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21
Q

Histoplasmosis is common in the ____ geographical belt.

A

Ohio and Mississippi river valley

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22
Q

Which specific conditions/states or activities are a/w increased r/o histoplasmosis?

A

-IC state: HIV/AIDS
-Spelunking (exploring caves)
-Exposure to bird or bat excrement

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23
Q

CP of histoplasmosis ranges from a primary asymptomatic or flu-like illness to _____ features in fulminant/disseminated disease.

A

Disseminated disease within 14 days of exposure p/w
-fever,
-weight loss,
-HSmegaly
-LNpathy
-non-productive cough
-palatal/tongue ulcers
-Pancytopenia.

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24
Q

Describe the CXR findings in histoplasmosis.

A

-diffuse nodular densities
-focal infiltrate
-cavity (chronic)

and/or

hilar LNpathy

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25
Q

What is the best initial test in suspected cases of histoplasmosis?

A

urine or serum polysaccharide antigen test.

*most SN for making the initial diagnosis, monitoring response to t/t, and diagnosing relapse.

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26
Q

What is the classic microscopic appearance of the Histoplasma yeast form?

A

A histiocyte (macrophage) containing numerous yeast cells.(SEE IMAGE).

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27
Q

A broad-based budding yeast on a sputum smear indicates ___ infection.

A

Blastomycosis (central and SE US; Ohio and Mississippi valley)

28
Q

Broad non-septate hyphae are characteristic of ____.

A

mucormycosis.

29
Q

____ individuals are at increased risk of highly aggressive necrotic infection mucormycosis.

A

-Diabetic (uncontrolled)
-Immunocompromised individuals.

30
Q

Tuberculin Skin test (TST) ANERGY is ___ (describe).

A

Negative TST in immunocompromised individuals with a latent TB infection.

31
Q

____ is the t/t of choice for infection with partially acid-fast branching filamentous soil-inhabiting bacilli ____.

A

TMP-SMX for Nocardia.

32
Q

___ number of sputum specimens obtained ___ hours apart must be tested with acid-fast stain for establishing an initial diagnosis of pulmonary TB.

A

3 sputum specimens obtained 8 hours apart.

33
Q

Active disease t/t regimen for TB includes ___.

A

DOTS with
RIPE x 2 months–> RI x 6 months

Rifampin,
INH,
Pyrazinamide,
Ethambutol

34
Q

Tt/ of LTBI includes __.

A

INH + Rifampin/Rifapentine x 3 mth

OR

Rifampin x 4 months

OR

INH x 6 months

35
Q

Optic neuritis is a side effect of which anti-TB medication?

A

Ethambutol

MN: E for eye and E for Ethambutol!

36
Q

Hepatitis, peripheral neuropathy, and a lupus-like syndrome are s/e of ___ anti-TB drug.

A

INH.

*prevent INH-induced PN by concurrent supplementation with pyridoxine.

37
Q

Hepatitis or Hyperuricemia are SEs of ___ anti-TB drug.

A

Pyrazinamide

38
Q

_____ subtype of atypical mycobacteria can cause disseminated disease in HIV +ve patients with CD4 count less than 50 per cubic mm.

A

MAC (Mycobacterium Avium complex).

39
Q

Chemoprophylaxis for MAC with ____ (agent) is indicated in ___ patients.

A

Azithromycin in HIV +ve patients not on HAART with CD4 count < 50.

40
Q

PCP is a/w with ____ (? productive, non-productive) cough.

A

non-productive cough

+

SOB, fever, fatigue, and impaired oxygenation.

41
Q

Folded cysts containing comma-shaped spores on silver staining of sputum sample pr lung tissue in a HIV +ve patient is indicative of ____.

A

PCP

42
Q

The preferred t/t for PCP includes ____.

A

high-dose TMP-SMX for 21 days.

43
Q

What are alternate regimens of t/t of mild-moderate PCP?

A

-TMP + Dapsone,

or

-Primaquine + Clindamycin,

or

-Atovaquone

44
Q

What are alternate regimens of t/t of severe PCP?

A

-Pentamidine/primaquine + Dapsone

45
Q

Management with _____ is indicated in PCP patients with moderate-severe hypoxemia (PaO2 < 70 mmHg or an Aa gradient ≥ 35).

A

Prednisone taper to decrease lung inflammation and reduce mortality.

46
Q

What is the difference between prednisone vs prednisolone?

A

Prednisone is a pro-drug converted in the liver to prednisolone

Prednisone –> Prednisolone (active)

47
Q

What are the modes of transmission of anthrax?

A

-Cutaneous (most common);

-Inhalation (most deadly)

-GI (consumption)

  • no person-person transmission
48
Q

What is the IP of cutaneous versus inhalational anthrax?

A

Cutaneous: 1-7 days

Inhalational: 1-3 days

49
Q

True/False? CXR in pulmonary anthrax reveals bilateral nodular pulmonary infiltrates.

A

False;

CXR in pulmonary anthrax typically reveals

-Widened mediastinum (most SN)
-Pleural effusion (SN)

-No pulmonary infiltrates (typically)

50
Q

Diagnosis of anthrax is based on which tests?

A

-Culture isolation,

or

2 non-culture tests (PCR, IHC staining, ELISA)

51
Q

The best initial t/t for suspected anthrax includes ____ (list all).

A

Ciprofloxacin/Doxycycline
+
1-2 additional antibiotics

for 14 days for the inhalational or cutaneous disease of *HNF.

7-10 days t/t for the cutaneous disease of regions other than the head, neck, and face.

52
Q

____ is the drug of choice given for ____ days for post-exposure prophylaxis for anthrax.

A

Ciprofloxacin for 60 days.

53
Q

True/False? With early t/t of strep. pharyngitis, the complications of rheumatic fever, and PSGN can be effectively prevented.

A

False;

with early t/t, rheumatic fever can be prevented but not PSGN.

54
Q

What are the modified Centor criteria that guide t/t in strep throat?

A

modified Centor criteria include
-Fever (1 pt)
-Tonsillar exudate (1 pt)
-Tender anterior Cx LNpathy (1 pt)
-Lack of cough (1 pt)
-Age 3-14 years (1 pt)

55
Q

How do modified Centor criteria guide t/t in strep throat?

A

4-5 pts –> empirical antibiotic t/t

2-3 pts –> Rapid Ag test such that
-Rapid Ag test +ve –> antibiotic t/t
-Rapid Ag test -ve –> throat culture

0-1 pts –> no test or antibiotics

56
Q

EMpiric t/t for strep throat (GAS) includes t/t with _____.

A

Penicillin x 10 days

57
Q

Other than penicillin, what alternate agents can be used for empiric t/t of strep throat?

A

-cephalosporins
-Amoxycillin
-Azithromycin

58
Q

What are some non-suppurative complications of pharyngitis especially GAS pharyngitis?

A

-Cervical LNadenitis
-mastoiditis
-sinusitis
-otitis media
-retropharyngeal/peritonsillar abscess
-TE of jugular vein (Lemierre syndrome) c/by Fusobacterium (oral anaerobe).

59
Q

Ludwig angina is ____.

A

Rapid progressive bilateral cellulitis of the submental, sublingual, and/or submandibular space that usually results from an infected tooth –> dysphagia, drooling, fever, red, warm mouth –> airway compromise d/t rapidly expanding edema.

60
Q

Massive hemoptysis is defined as ___.

A

> 100-600 ml blood loss in 24 hrs

61
Q

Extrathoracic causes of right-sided and left-sided exudative pleural effusion include ___ (list all).

A

Right-sided exudative pleural effusion
-Meigs syndrome (benign ovarian fibroma + pleural effusion + ascites)
-Endometriosis

Left-sided exudative pleural effusion
-Pancreatitis
-Esophageal rupture

62
Q

Pleural fluid ph < 7.2 indicates __.

A

-complicated parapneumonic effusion, or
-empyema.

63
Q

Complicated parapneumonic effusion can be differentiated from empyema on the basis of what specific criteria as pleural fluid ph < 7.2 in both cases?

A

The appearance of pleural aspirate

-Complicated parapneumonic effusion–> cloudy aspirate

-Empyema –> purulent aspirate

64
Q

Primary spontaneous pneumothorax caused by rupture of an apical subpleural bleb is commonly seen in ___ individuals.

A

tall, thin young males.

65
Q

The diagnosis of tension pneumothorax is made ___.

A

clinically.

66
Q

Immediate needle decompression in the ___ ICS at ___ line followed by chest tube placement is required as emergency m/m of tension pneumothorax.

A

2nd ICS at MCL.

67
Q

____ pneumothorax can be managed with observation and supplemental O2 therapy.

A

Small pneumothorax ≤ 2 cm in size

Step 2 CK Pulmonary (8 decks)

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