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Infectious Pulmonary Disorders Flashcards

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1
Q

What are the 2 MC organisms to cause CAP?

A

1 = S. pneumo

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2
Q

What organism causes atypical pneumo (walking pneumo) ?

A

Mycoplasma pneumo

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3
Q

What organisms cause HAP?

A

Pseudomonas

MRSA

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4
Q

What does the CXR look like in typical vs atypical pneumo?

A

Typical = lobar pneumo

Atypical = Diffuse patchy interstitial or reticulonodular infiltrates

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5
Q

What are s/s of typical pneumo?

A 
Sudden fever 
Productive cough, purulent sputum 
Pleuritic CP
Rigors*
Tachy, tachypnea
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6
Q

What are s/s of atypical pneumo?

A

Low grade fever
Dry, nonproductive cough
*Extrapulmonary sx: myalgia, malaise, sore throat, HA, N/V/D

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7
Q

What does typical pneumo look like on PE?

A

Signs of consolidation:

  • bronchial breath sounds
  • dullness to percussion
  • increased tactile fremitus, egophony
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8
Q

What does atypical pneumo look like on PE?

A

Often normal

+/- crackles, rhonchi

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9
Q

What sx does mycoplasma pneumo cause?

A

ear pain, bullous myringitis

persistent dry cough, pharyngitis

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10
Q

How do you dx mycoplasma pneumo?

A

serum cold agglutinins

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11
Q

What sx does legionella cause?

A

GI sx, N/V/D, anorexia
Increased LFTs
Hyponatremia

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12
Q

How do you dx legionella?

A

Legionella urine antigen +/- PCR

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13
Q

What is the dx workup for pneumo?

A

CXR/CT: silhouette sign

  • pleural effusion may be present
  • abscess formation = s. aureus
  • upper lobe w/ bulging fissure, cavitations = klebsiella

Sputum (gram stain/culture)

  • rusty = strep pneumo
  • currant jelly = klebsiella
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14
Q

How do you treat CAP, outpatient?

A

Macrolide or doxy 1st line

FQ only if comorbid conditions

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15
Q

How do you treat CAP, inpatient?

A

B lactam + macrolide OR

FQ

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16
Q

How do you treat CAP, ICU?

A

B lactam + macrolide OR
B lactam + FQ

If B lactam allergy –> FQ +/- aztreonam

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17
Q

How do you treat HAP, pseudomonas risk?

A

B lactam + AG or FQ

If MRSA suspected, + vanco

If legionella suspected, + levofloxacin or azithromycin

If PCP suspected, + TMP-SMX

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18
Q

How do you treat aspiration pneumo?

A

Clinda or metronidazole or augmentin

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19
Q

What is the MC viral cause of pneumo in children?

A

RSV & parainfluenza

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20
Q

What is the MC viral cause of pneumo in adults?

A

Influenza

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21
Q

Who is at increased risk for mycoplasma pneumo?

A

< 40yo
School-aged children
College students
Military

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22
Q

How does pneumo caused by chlamydophila present?

A

Hoarseness, URI sx

Sinusitis*

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23
Q

Why doesn’t mycoplasma pneumo respond to b-lactams?

A

Bc it lacks a cell wall!

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24
Q

Who is pseudomonas aeruginosa MC in?

A

Immunocompromised (HIV, s/p transplant)

CF, Bronchiectasis

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25
Who is at increased risk of getting pneumo caused by CMV?
Transplant | AIDs
26
How does PCP present?
Fatigue, dry cough, dyspnea on exertion | A/w O2 desaturation w/ ambulation
27
Where is histoplasma capsulatum MC?
MIssissippi & Ohio river valley Soil contaminated w/ bird or bat poop
28
Who is at increased risk of contracting TB?
Close contacts w/ active TB Immigrants from high-prevalence areas Immunodeficient (HIV)
29
When does someone normally become + on PPD test?
2-4 weeks after infection
30
Describe the 3 stages of TB
Primary = active inf, contagious, middle/lower lobe consolidation Chronic (latent) = granuloma formation (may become caseating), NOT contagious Secondary (reactivation): MC in apex/upper lobes w/ cavitary lesions, contagious
31
What are the s/s of TB?
Pulmonary sx: chronic, productive cough, CP, hemoptysis Constitutional sx: night sweats, fever/chills, fatigue, anorexia, weight loss
32
What are s/s of extra-pulmonary TB?
``` Vertebral (Pott's disease) Lymph nodes (scrofula) ```
33
How do you dx TB?
Acid fast smear & sputum culture x 3 days = GOLD CXR: excludes active TB, used as annual screening for those w/ hx of + PPD Interferon gamma release assay
34
How do you treat active TB?
Total tx duration = 6 months "RIPE": rifampin + isoniazid + pyrazinamide + ethambutol No longer contagious after 2 weeks of tx
35
How do you treat latent TB?
isoniazid + pyridoxine x 9mos If HIV --> isoniazid + pyridoxine x 12mos
36
What causes acute bronchitis?
MC viruses (adenovirus)
37
What is the hallmark of acute bronchitis?
Cough (lasting 1-3 weeks)
38
How do you treat acute bronchitis?
Sx: fluids, rest, bronchodilators, antitussives Abx have no statistical benefit
39
Describe the 3 phases seen in pertussis
1. Catarrhal: URI sx 1-2 weeks, most contagious 2. Paroxysmal: paroxysmal coughing fits w/ inspiratory whooping sound +/- emesis 3. Convalescent: Resolution (coughing can last up to 6 weeks)
40
How do you dx pertussis?
PCR of nasopharyngeal swab = GOLD Lymphocytosis
41
How do you treat pertussis?
Sx: O2, nebulizers, ventilation Macrolides = DOC (erythromycin) If macrolide allergic --> TMP-SMX
42
What are characteristics of acute bronchiolitis?
MC in children > 2 mos- 2 yo after viral infection (esp. RSV, adenovirus) Neutrophil infiltration Bronchial narrowing
43
What are characteristics of bronchiolitis obliterans (constrictive)?
Chronic inflammation & fibrosis Collapse of bronchioles Granulation tissue --> obstructive lung disease Mosaic pattern on CT
44
How do you treat bronchiolitis obliterans?
High dose corticosteroids & immunosuppression Lung transplant = definitive
45
What are characteristics of cryptogenic organizing pneumo (COP)?
Type of bronchiolitis Persistent alveolar exudates --> fibrosis of bronchioles & alveoli Resembles pneumo, but doesn't respond to abx
46
How do you treat COP?
Corticosteroids
47
What are s/s of acute bronchiolitis?
Fever, URI sx 1-2 days --> respiratory distress
48
How do you dx acute bronchiolitis?
CXR: hyperinflation, peribronchial cuffing Nasal washings using monoclonal Ab testing Pulse Ox = single best predictor
49
How do you treat acute bronchiolitis?
Humidified O2 = mainstay of tx IV fluids, APAP/ibuprofen B-agonists, nebulized epi Ribavirin (if severe lung or heart disease or immunocompromised)
50
How do you prevent acute bronchiolitis?
Palivizumab (used in high risk) | Handwashing
51
What MC causes croup?
Parainfluenza virus type 1
52
What are 4 s/s of croup?
1. Barking cough (seal like) 2. Stridor 3. Hoarseness 4. Dyspnea (worse at night) +/- URI sx
53
How do you dx croup?
Clinical Frontal cervical radiograph: Steeple sign (subglottic narrowing of trachea)
54
How do you treat croup?
MIld (no stridor, no distress): cool humidified air mist, hydration, dexamethasone, O2 Mod (stridor at rest w/ mild-mod retractions): dexamethasone PO or IM, nebulized epi, obs 3-4 hrs Severe (stridor w/ marked retractions): dexamethasone + nebulized epi & hospitalization
55
Which type of influenza is a/w more severe, extensive outbreaks?
A!
56
What are s/s of the flu?
Abrupt onset of HA, fever, chills, malaise, URI sx, pharyngitis Myalgias MC in legs & lumbosacral area
57
How do you dx the flu?
Clinical Rapid influenza test (nasal swab) or viral culture
58
How do you treat the flu?
Sx: APAP or salicylates Antivirals (in those at high risk for complications) - initiate within 48hrs - Oseltamivir (Tamiflu)*, zanamivir, ribavirin Amantadine, rimantadine
59
What causes pulmonary nodules?
Granulomatous infections: TB MC Tumors Inflammation Mediastinal tumors: thymoma MC
60
How do you dx pulmonary nodules?
Obs: if low malignant probability. CT can assess lesion TNA (for peripheral lesions) or bronchoscopy (for central lesions): if intermediate probability Resection w/ biopsy: if high probability (>60%)

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