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Paige: Pulm Module! > Infectious d/o > Flashcards

Infectious d/o Flashcards

(85 cards)

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1
Q

What is the MC cause of CAP?

A

Streptococcus pneumoniae

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2
Q

What is the most common bacteria in pts with CAP and other lung disease?

A

Haemophilus influenzae

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3
Q

What is the MC cause of atypical (walking) pneumonia?

A

Mycoplasma pneumonia

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4
Q

Which pneumonia bacteria is related to outbreaks assocated with water supply?

A

Legionella pneumophila

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5
Q

Which pneumonia is seen post viral illness?

A

Staphylococcus aureus

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6
Q

What 4 other bacterias can cause pneumonia?

A

Chlamydia pneumoniae

Klebsiella pneumoniae

Anaerobes

Pseudomonas aeruginosa

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7
Q

Which viral pneumonia is MC in infants/small children?

A

RSV and parainfluenza

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8
Q

Which viral pneumonia is MC in adults?

A

influenza

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9
Q

In all, which microbes cause CAP?

A

S pneumonia

mycoplasma, chlamydia, viral (in healthy)

H influenzae, M catarrhalis (in COPD)

Legionella

Klebsiella and GNR (in ETOH)

S aureus

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10
Q

In all, which microbes cause hospital acquired pneumonia?

A

Gm neg rods

Pseudomonas

Klebsiella

Enterobacter

Serratia

Acinetobacter

S aureus

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11
Q

so what is community acquired pneumonia (CAP)?

A

patient acquires pneumonia outside of hospital/nursing home OR within 48 hours of admission

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12
Q

What is nosocomial (hosp acquired) pneumonia?

A

pneumonia occurs more than 48 hours after admission

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13
Q

Which organisms are “typical” pneumonia?

A

S pneumo

H influenzae

Klebsiella

S aureus

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14
Q

Which organisms are “atypical” pneumonia?

A

Mycoplasma

Chlamydia

Legionella

Viruses

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15
Q

What are the clinical manifestations of typical pneumonia?

A

sudden fever

prod cough

pleuritic chest pain

tachycardia/pnea

Rigors

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16
Q

What are the clinical manifestations of atypical pneumonia?

A

low grade fever

dry, nonprod cough

myalgias, malaise, sore throat, HA, N/V/D

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17
Q

What will you see on PE with typical pneumonia?

A

signs of consolidation like bronchial breath sounds, dullness to percussion, inc fremitus, crackles

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18
Q

What will you see on PE with atypical pneumonia?

A

Normal!

maybe crackles or rhonchi

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19
Q

How ya gonna diagnose pneumonia?

A

CXR/CT: Exudative pleural effusion may be present. Abcess formation

Sputum culture

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20
Q

What will you see specifically on Klebsiella CXR/CT?

A

RUL with bulging fissure and cavitations

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21
Q

What if you sputum comes back rusty and blood tinged? What organism?

A

Strep pneumonia

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22
Q

Sputum is like currant jelly?

A

Klebsiella

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23
Q

sputum is green?

A

H influenzae

Pseudomonas

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24
Q

sputum is foul?

A

anaerobes

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25
What abx will you give for CAP outpatient?
macrolide or doxycycline
26
What will you give for CAP inpatient?
B lactam + macrolide (or doxy) OR broad spectrum FQ
27
What will you give for CAP in ICU?
B lactam + macrolide OR b lactam + broad FQ
28
What will you give for hosp acquired?
Anti-pseudomonal B lactam + anti-pseudomonal AG or FQ
29
What will you add to hosp acquired pneumo if you suspect legionella? MRSA?
legionella: macrolide MRSA: vancomycin
30
How else can you manage a pt with pneumonia?
02, IV fluids
31
What are the pneumococcal vaccines?
PCV13: in childhood vaccination PPV23: used in adults (2-64y with chronic disease, 65+ otherwise)
32
How common is TB?
Not that common in US, but one of the leading causes of death worldwide
33
How is TB transmitted?
Respiratory droplets of Mycobacterium Must inhale the droplets
34
Who is at a greater risk for getting TB?
those exposed those from high prev areas those immunodeficient (**HIV**) under 4y IVDU
35
What is the pathophysiology of TB?
Inhalation of airborne droplets --\> mycobacterium reaches alveoli, gets ingested by macrophages --\> if bacteria remains viable, active infection occurs
36
There are three outcomes to getting infected. What are they?
Primary TB Chronic (Latent) Tb Secondary (Reactivation) TB
37
What is primary TB?
the outcome of the initial infection - usually self-limited patients are contagious in this stage common in \<4y
38
What is chronic (latent) TB?
A pt gets the infection, but is able to control it patients not contagious (this happens about 90% of the time)
39
What is secondary (reactivation) tb?
a pt who had the latent infection now gets reinfected patients are contagious common in HIV, elderly, malignancy, steroid use
40
When TB is active, what are the clinical manifestations?
1. **Pulmonary sx:** chronic prod cough, chest pain, hemoptysis 2. **Constitutional sx:** night sweats, fever/chills, fatigue, anorexia, wt loss
41
What will you see on PE with TB?
**Signs of consolidation**: rales/ronchi, dullness
42
What is extra-pulmonary TB?
When it affects any organ system e.g. Pott's dz affects vertebrae
43
What do you use to screen for TB?
PPD: Purified Protein Derivative Give and examine in 48-72h
44
What is a + PPD test
\>5mm with a strong suggestion of TB (e.g. HIV, family members w/ it, abn CXR) \>10mm for other high-risk populations \>15mm for everyone else
45
When will you see a false + PPD?
Chronic (latent) inf 2-4 weeks post exposure
46
What is the gold standard for dx of TB?
Acid-fast bacilli culture done on 3 different occasions + all must be negative
47
What diagnostic measure do you use to EXCLUDE TB? What would TB look like on this test?
CXR Reactivation: upper lobe fibrocavitary Primary: middle/lower lobe consolidation
48
How do you treat TB?
Tx duration is 3-6 mos RIPE: Rifampin, INH, Pyrazinamde, Ethambutol
49
When is treated TB no longer infectious?
2 weeks after therapy begins
50
What's broncholitis?
inflammation of the bronchioles (lower resp tract)
51
What is the pathophys of bronchiolitis?
your airways get obstructed because there is necrosis, which causes epithelium to slough off there is also edema, causing narrowing
52
What causes acute broncholitis?
RSV MC also adenovirus, influenza, parainfluenza
53
What are the risks for developing bronchiolitis?
infants 2mos-2y exposure to cigs no breastfeeding premature
54
How is bronchiolitis transmitted?
HIGHLY contagious trans by direct contact w/ secretions usually fall to spring
55
What are clinical manifestations of bronchiolitis?
Fever URI sx days before respiratory distress inc. wheezing, tachypnea, nasal flaring, cyanosis
56
How do you dx bronchiolitis?
Nasal washings: using monoclonal Ab testing CXR shows nonspecific findings
57
What's the best predictor of bronchiolitis?
Pulse oximetry 02 \< 96% admit to hosp
58
How do you tx bronchiolitis?
Supportive w/ 02, fluid, antipyretics Meds (ehhhh): b agonists Severe: ribavirin
59
How do you prevent bronchiolitis?
palivizumab prophylaxis
60
What are sequellae of bronchiolitis?
otitis media w/ strep pneumonia (MC) asthma later in life (MC)
61
What is acute bronchitis?
inflammation of trachea/bronchi
62
What causes acute bronchitis?
MC **Viruses** **Adenovirus**, parainfluenza, coxsackie, rhinovirus, RSV Can also be caused by bacteria (S pneumo, H inf, M cat, Mycoplasma)
63
When does acute bronchitis occur?
After URI
64
Clinical manifestations of acute bronchitis?
similar to pneumonia ## Footnote **Cough - hallmark**
65
What is the gold standard diagnosis for acute bronchitis?
**Clinical!!!!** CXR will be nonspecific or normal
66
How do you manage acute bronchitis?
fluids, rest, antitussive drugs +/- bronchodilators NO abx if healthy adult
67
What is croup?
inflammation of the upper airway (larynx, subglottis, trachea)
68
When does croup occur?
After an acute **viral** infection **MC parainfluenza**, also adenovirus
69
In what age group does croup occur?
6mos - 6y
70
What is the pathophys of croup?
Infection leads to subglottic larynx and trachea swelling (which causes the sx)
71
What are the sx of croup?
stridor, "barking" cough, hoarseness, dyspnea (worse at night) maybe URI sx
72
How do you dx croup?
Usually clinical BUT you'll prob get a cervical XR and see a **steeple sign** (subglottic narrowing of trachea)
73
How do you treat croup?
**cool, humidified air mist** **oral steroids** 02
74
What is acute epiglottitis (supraglottitis)?
inflammation of the epiglottis, causes swelling ## Footnote **emergency**
75
What causes epiglottitis?
**MC H influenzae type B**
76
Who gets epiglottitis?
MC in children 3mos-6y males 2x MC in adults: DM is a risk
77
What are sx of epiglottitis?
**D**ysphagia, **D**rooling, **D**istress Fevers, odynophagia, stridor, dyspnea, hoarseness, **tripoding**
78
How do you diagnose epiglottitis?
**Laryngoscopy is definitive.** Cherry red epiglottis with swelling ## Footnote **Lat Cerv XR: Thumb Sign**
79
How do you treat epiglottitis?
**Maintain airway** Dexamethasone can decrease airway edema Tracheal intubation if severe **Abx:** 2nd and 3rd gen cephalosporins
80
What is pertussis?
whooping cough! highly contagious infection
81
What causes pertussis? Who gets it?
Gm neg coccobaccilus Children \<2y
82
What are the sx of pertussis?
1. **catarrhal phase:** URI sx 1-2 wks 2. **paroxysmal phase:** severe paroxysmal coughing fits with inspiratory whoop; emesis after cough 3. **convalescent phase:** cough and emesis resolve
83
How do you dx pertussis?
Nasopharyngeal swap w/in first 3wks Severe lymphocytosis on CBC
84
How do you treat pertussis?
**Supportive is the mainstay** **Abx** (although they don't help sx, only contagiousness): macrolides 1st line, Bactrim as 2nd line
85
What are complications of pertussis?
**pneumonia**, encephalopathy, otitis media, sinusitis, seizures

Paige: Pulm Module! (7 decks)

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