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PULMONARY BOARDS > Infectious Disease > Flashcards

Infectious Disease Flashcards

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1
Q

Tx of echinococcus

A

albendazole

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2
Q

Tx of strongyloides

A

ivermectin

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3
Q

___ is associated with increased risk of invasive pneumococcal PNA

A

opioid use

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4
Q

___ (behavior) is associated with increased CAP

A

high alcohol consumption

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5
Q

risk factors for pseudomonas pna

A
  1. prior pseudomonas infection
  2. bronchiectasis
  3. tracheostomy
  4. COPD
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6
Q

WHich imaging has highest sensitivity of PNA

A

POCUS
CT Chest

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7
Q

Most common pathogens in lower respiratory infection

A

VIRUSES - more common than bacterial
#1 rhinovirus
Influenza A & B
HMP
RSV
Parainfluenza
Coronavirus
Adenovirus

and #1 strep pneumoniae

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8
Q

MRSA nares has what components of the following (high or low)

Sensitivity
Specificity
PPV
NPV

A

85% sensitivity
92% specificity
POOR PPV (57%)
great NPV (98%)

If the test is negative, very unlikely that MRSA is present in the lungs

Parente, Clin ID 2018

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9
Q

Does having MRSA in the past 12 mo show colonization?

A

no

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10
Q

In non-severe outpatient CAP, what testing is indicated

A

Influenza
Covid

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11
Q

In severe and non-severe admitted patients with CAP, what testing is indicated

What about immunocompromised patients

(Based on ATS/IDSA 2019 guidelines)

A

Influenza
Blood & resp culture (only if risk of MRSA or pseudomonas in non-severe)
Legionella U Ag only if local outbreak
MRSA PCR

In severe CAP and immunocompromised, additionally should include legionella UAg no matter what, Strep urinary Ag
PNA PCR (NAAT)
RVP

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12
Q

What is the effect of using procalcitonin in treatment of CAP

A

reduce the # of days the patient will be on Abx

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13
Q

CURB 65

A

Confusion
Urea
Resp
Blood pressure <90/60

> 65 yo

3 or more requires hospitalization

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14
Q

Severe CAP criteria (whether or not to admit to ICU)

A

Either 1 major or 3+ minor

Major criteria:
1. Septic Shock with need of vasopressors
2. Respiratory failure requiring mechanical ventilation

Minor:
- RR >30bpm
- P:F ratio <250
- Multilobar infiltrates
- Confusion
- Uremia BUN >20
- Leukopenia <4000
- Thombocytopenia <100
- Hypothermia core <36C
- Hypotension requiring aggressive fluid resus

Minor: RPM CULTHH

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15
Q

CAP outpatient tx

A

No comorbidities:
the usuals (amox, doxy, or macrolides)

+ comorbidities:
Augmentin
Cefuroxime
PLUS macrolide or doxy
or resp fluoroquinolone

ATS/IDSA 2019

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16
Q

CAP inpatient tx

A

Non-severe:
beta-lactam + macrolide
OR
resp fluoroquinolone
+ antipseudomonal if prior pseudomonas in 12 mo

Severe:
betalactam + macrolide
OR
betalactam + resp fluoroquinolone

for either above:
+ Anti-MRSA to be added if prior MRSA infection in 12 mo

+ anti-pseudomonal if prior pseudomonas in 12 mo

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17
Q

Covid tx outpatient

A

paxlovid
can get remdesivir

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18
Q

Indication for starting remdesivir for covid 19

A

hospitalization
O2 requirement (but not if its so severe you need HFNC, can consider in those who are at high risk of dz progression)

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19
Q

Indication for starting dexamethasone in covid 19

A

requiring O2 supplement

If with HFNC, should be given with remdesivir

If still very hypoxic, add baricitinib or IV tocilizumab

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20
Q

Indication for giving IV tocilizumab in covid-19 infection

(or IV sarilumab)

A

Hospitalized, requiring mechanical ventilation or ECMO

within 24h of MICU admission

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21
Q

When is remdesivir NOT indicated for covid-19 infection

A

hospitalized without O2 requirement OR mechanically ventilated OR ECMO

(so the mild-moderate people can get it, not the severe)

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22
Q

Duration of abx for CAP coverage in the hospital

A

3-5-7days if clinically stable

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23
Q

When should you cover for anaerobes in PNA

A

severe CAP (even this is controversial)
Parapneumonic effusion

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24
Q

WHen is corticosteroids indicated in CAP

A

severe CAP with high CRP
Covid-19 with O2 requirement

Contraindicated in influenza

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25
Vaccinations indicated for respiratory protection (6)
Influenza Covid-19 RSV PCV20 Herpes Zoster TdaPertussis
26
Definition of HAP
>48h in the hospital
27
Ventilator associated pneumonia definition
ventilated for >48h AND 2 or more of: fever abnormal WBC sputum purulence New infiltrate
28
VAP after vomiting in a patient who had abd surgery, patient likely has which pathogen
pseudomonas aeruginosa! Gram negative bacteria
29
Rate of anaerobes in VAP and aspiration pneumonia
pretty much none
30
Superinfections in the ICU associated with covid-19 include which pathogens? (4 bacteria, 2 fungi)
acinetobacter e. coli kleb pseudomonas candida aspergillus
31
MDR risk factors (3)
1. IV abx in the past 90 days 2. Unit rate >20% of MRSA 3. positive screening or prior infection or colonization with MDR
32
Most relevant risk factor for suspecting MDR pathogens in patients with HAP
prior IV Abx use within 90 days
33
HAP tx (no MDR risk factors with low risk of death)
zosyn cefepime levoflox imipenem or meropenem *consider coverage for MSSA* If CF or NonCF bronchiectasis, consider pseudomonal coverage
34
VAP tx
MRSA coverage Pseudomonal coverage (consider double)
35
Risk factor for MRSA
Prior 90d abx therapy Unit rate 10-20% prevalence or unknown Need for vent support or septic shock
36
When to add double pseudomonal coverage in HAP
High mortality risk VAP prior risk of pseudomonas
37
What abx should you not use alone for HAP
aminoglycoside
38
Duration of tx for HAP or VAP
7d unless non-lactose fermenting GNR (pseudomonas, acinetobacter, steno) and not getting better, consider longer duration
39
Tx for acinetobacter HAP/VAP sensitive only to polymyxins
IV polymyxin (colistin or polymyxin B) AND adjunctive inhaled colistin No effect on mortality or nephrotoxicity but with clinical improvement
40
For GNR/acinetobacter VAP/HAP with sensitivity to aminoglycosides or polymyxins OR carbapenem resistant, must use ____
both inhaled and systemic abx
41
Should you treat ventilator associated tracheitis?
NO
42
Tx of acinetobacter and pseudomonas (at the same time)
cefiderecol
43
Treatment of acinetobacter
unasyn (beta lactams) or carbapenems and fluoroquinolones aminoglycoside or bactrim for UTI Resistant disease: polymyxin B, colistin
44
Carbapenemase producing genes (Enterobacterales)
KPC OXA-48 MBL
45
Most common resistance mechanism in pseudomonas (intrinsic)
DNA gyrase and topoisomerase IV (fluoroquinolone resistance) AmpC (b-lactams)
46
Most common resistance mechanism in pseudomonas (imported)
class A, B, D .... b-lactam (ESBL) and carbapenem resistance and abx inactivation
47
Important VAP prevention
Oral care- toothbrushing WITHOUT chlorhexedine Minimize sedation Maintain and improve physical conditioning Avoid intubation/prevent reintubation
48
What ICU interventions have no impact on VAP rates
stress ulcer ppx monitoring residual gastric volumes closed endotracheal suctioning systems
49
percent of household contact that will become infected with TB
~35%
50
Percent of LTBI that progresses to TB disease how about if you're on HIV or TNF alpha-blockers?
~10% per lifetime HIV and TNF alpha blocker = 10% PER YEAR
51
MDR TB definition
Resistant to INH AND Rifampin
52
XDR TB definition
MDR TB (INH, Rif) + Fluoroquinolone AND at least one of the injectables or bedaquiline/linezolid
53
infecting dose of MTB = __#___ organisms
10
54
smear negative TB but culture positive, how infectious is the patient?
15-17%
55
Most common location of pulmonary TB in immunocompetent patient
RUL posterior segment
56
Sensitivity of 3x AFB and 2x MTB PCR for TB disease
85%
57
Pregnant patients and TB tx
IRE (no PZA - in US lack of safety data, though WHO recommends it) for 2 mo, then 7 mo of IR (total 9 mo)
58
MDR TB tx
BPaL Bedaquiline, Pretomanid Linezolid
59
Timing of highest risk of TB reactivation after exposure
within 1-2 years
60
You can have + TST or IGRA with what other diseases other than MTB
M. bovis, NTM
61
IGRA and TST PPV and NPV (in non-immunocompromised patients)
both >90% NPV Better specificity of IGRA
62
Dose of prednisone that increases TB reactivation risk
>15 mg prednisone
63
"Dimorphic" definition
can live in either shape as a yeast or mold depending on temp
64
septated acute branching hyphae at 45 degree angle
aspergillus
65
Biggest risk factor for invasive pulmonary aspergillosis
prolonged neutropenia CGD
66
Pauci-septated 90degree angle branching hyphae, ribbon like
mucor
67
What can give you false positive galactomannan
histoplasma high rice/pasta diet (What?) plasma-lyte some beta-lactams (older ones)
68
Does TBBx increase sensitivity for diagnosing invasive pulmonary aspergillosis?
not much
69
WHich are more likely to have pleural effusion, mucor or invasive aspergillosis?
mucor
70
Other than vori, what other meds can you use for invasive aspergillosis
isavuconazonium posaconazole (for ppx) can be paired with echinocandin
71
which type of aspergillus would aspergillus IgG ab be present?
chronic necrotizing pulmonary aspergillosis AND ABPA
72
Tx of ABPA
steroids +/- itraconazole +/- omalizumab
73
BDG and Galactomannan for mucor
would be negative
74
Mucor tx
1. surgical resection 2. antifungals (ampho, posaconazole, isovuconazole) 3. immune reconstitution stop iron chelating agent if they are on it
75
candida in urinary or respiratory tract, do you treat?
more likely colonization
76
spaghetti and meatballs, yeast and pseudohyphae on path
candida
77
Treatment of toxoplasmosis
pyrimethamine and sulfadiazine
78
Treatment of paragonimiasis
praziquantel (two long Ps!)
79
fungal infection most likely to have peripheral eosinophilia
coccidiodomycosis
80
treatment of mpox
tecovirimat 2nd line cidofovir
81
Someone works with animal skinning, pleural effusion with lymphocytic predominance
Tuleremia
82
Treatment for tuleremia
mild: doxy or cipro mod to severe: aminoglycoside (classically genta)
83
Pt with nocardiosis, aspergillosis and noncaseating granulomas on path, what does this patient likely have
chronic granulomatous disease CGD
84
How do you test for CGD
test for dihydrorhodamine with indirect flow cytometry
85
path showing "pseudohyphae, budding yeasts"
candida
86
branching, beaded, anaerobe on path
actino
87
branching beaded, will grow on agar (aerobe). weakly acid fast. Gram positive
nocardia
88
which can you use with carbapenem-resistant enterobacterales? ceftaz/avibactam or ceftolozane/tasobactam
ceftaz/avibactam
89
Treatment of candidemia (antifungal and duration)
echinocandins --> later can transition to azoles if susceptible Candidemia only: Continue two weeks after neg blood cultures Endophthalmitis 4-6 weeks Consider prophylaxis for 1 week with fluconazole if colonization of 2 or more sites (inconsistent literature)
90
broad based dimorphic fungus like a bowling pin + skin lesion
blasto
91
Mississippi/Arkansas/Michigan, dog is also sick, bony erosion, ulcerative, verrucous derm findings, pneumonia (or even ARDS) think ___
blasto
92
Dx of blasto
serum and urine Ag, BAL Ab to anti-BAD-1 Ag
93
fruiting heads on path
aspergillosis
94
Infection that is an absolute contraindication for lung transplant
Bukholderia cenocepacia, M. abscessus
95
Owl's eyes on path
CMV
96
Blasto tx
no tx if sx are mild (like mild cough) Mild-moderate: itraconazole 6-12 mo Severe ampho B 1-2wk then itraconazole CNS: ampho Pregnancy: ampho (avoid azoles)
97
Skin manifestation of coccidioidomycosis
erythema nodosum
98
Dx of coccidio
Ab testing Urine and serum Ag
99
Spherules on culture or path
coccidiomycosis
100
Treatment of coccidio
immunocompetent: observation If sx persist >6 weeks: fluconazole or itra or amphotericin in severe cases
101
Narrow based fungus
histo
102
spelunking and bats, chicken coops pneumonia with pulm nodules
histo
103
infection related to broncholithiasis and fibrosing mediastinitis
histo
104
Dx of histo
serum Ag (sens 81%, spec 98%) Urine Ag, BAL, CSF culture may take 6 weeks to grow
105
Tx of histo
mild or chronic - observation moderate disease: itraconazole severe: ampho
106
Round, oval, helmet, crushed ping-pong ball or crescent shaped, dot-like foci with enhanced staining
PJP
107
Tx for influenza that is contraindicated in asthma
zanamivir
108
halo, narrow based budding, mucicarnine stain +
crypto
109
Alternative to TMP-SMX for PJP
Add steroids if a-a gradient >35mmHg Severe disease clinda + primaquine IV pentamidine Mild disease: TMP + dapsone Atovaquone
110
Difference between malaria and lepto (serum lab findings) (2)
1. lepto has isolated elevated bilirubin 2. hypoglycemia is more typical in malaria
111
Tx for c. neoformans
Fluconazole (lung) Ampho + flucytosine (CNS) - induction (minimal 2 weeks, or more if severe and cryp Ag still high), consolidation with fluconazole for 2 mo, then 1 year of maintenance therapy with fluc or other azoles (except itra) if not tolerating fluc
112
Where is Cryptococcus gattii endemic
tropical and subtropical regions plus pacific coast of N america
113
Azoles that need monitoring (levels)
itraconazole posaconazole voriconazole (IPV)
114
MOA of azoles
inhibit cell wall function/growth
115
What is echinocandins fungicidal to
CANDIDA echinoCANDins
116
Which test should we use for influenza that is recommended by the CDC
RT-PCR (4-6h turn around time) Rapid influenza Ag detection (neuroaminidase assay) has low/mod sensitivity but high specificity
117
What viruses (aside from Sars-cov-2) can cause really bad ARDS
adenovirus Human metapneumo
118
who should be treated for influenza
pregnant ppl immunocompromised *within 48h of sx If hospitalized, lab confirmed, can prob treat >48h of sx* Start early, don't wait for viral test to come back if influenza is suspected
119
CMV timing post LT
1-6 mo (not in the acute post-transplant time)
120
Which is more typical for actinomyces rather than nocardia
can extend fascial planes
121
Tx of nocardia
bactrim CNS involvement: bactrim, meropenem, amikacin (6 weeks IV), then ORAL bactrim, minocycline, augmentin 6-12 mo therapy
122
Definition of "refractory MAC"
ongoing positive sputum after 6 mo add amikacin (for pan-sensitive)
123
Tx for patients exposed to MDR-TB
levofloxacin for 6-12 mo
124
difference between crypto neoformans and c. gattii
c. neoformans: immunocompromised c. gatti: immunocompetent ppl (eucalyptus tree)
125
risk for actinomycosis
ETOH Poor dentition
126
actino on path
sulphur granules
127
actino treatment
PENICILLINS or ceftriaxone avoid aminoglycoside
128
How is nocardia spread throughout the body
hematogenously
129
How is actinomycosis spread throughout the body
direct invasion
130
SE Asia, raw crab & crayfish ingestion, consolidation, eosinophilic pleural effusion, chocolate-colored sputum. Dx/Tx?
Paragonimus westermani eggs in BAL + Elisa Tx: praziquantel, triclabendazole
131
SE asia, nocturnal cough, migratory GGOs, refractory asthma, peripheral eos, mosquito bite, elevated IgE. Dx?
Wuchereria bancrofti Tx diethylcarbamzine
132
Tx histoplasmosis
Mild: itraconazole Severe: ampho
133
Blasto tx
Mild: itraconazole Severe ampho
134
Cocci tx
Mild fluconazole or itraconazole Severe ampho
135
Sporothricosis tx
Mild itra Severe ampho
136
Paracoccidiomycosis tx
Mild itra +/- bactrim Severe ampho
137
Bipolar gram negative stain, safety pin looking; pathogen and tx
Yersinia Tx aminoglycoside
138
What disease look like malaria but can be transmitted through blood transfucion
Babesia
139
What disease can cause mulch pneumonitis and cause eosinophilia
CGD
140
Maltese cross
babesia though can be in in the trophozite circular form too
141
Difference between baloxavir and oseltamivir in influenza tx
Baloxavir has greater reduction in viral load by day 1 of treatment
142
Procal lvl to discontinue abx
<0.5 OR decrease by 80% from peak
143
How do you get M. Bovis and what is it usually resistant to
unpasteurized cheese PZA resistant

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