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Family Med EOR > Infectious Pulmonary Disorders > Flashcards

Infectious Pulmonary Disorders Flashcards

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
Q

Who is at increased risk of getting pneumo caused by CMV?

A

Transplant

AIDs

26
Q

How does PCP present?

A

Fatigue, dry cough, dyspnea on exertion

A/w O2 desaturation w/ ambulation

27
Q

Where is histoplasma capsulatum MC?

A

MIssissippi & Ohio river valley

Soil contaminated w/ bird or bat poop

28
Q

Who is at increased risk of contracting TB?

A

Close contacts w/ active TB
Immigrants from high-prevalence areas
Immunodeficient (HIV)

29
Q

When does someone normally become + on PPD test?

A

2-4 weeks after infection

30
Q

Describe the 3 stages of TB

A

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
Q

What are the s/s of TB?

A

Pulmonary sx: chronic, productive cough, CP, hemoptysis

Constitutional sx: night sweats, fever/chills, fatigue, anorexia, weight loss

32
Q

What are s/s of extra-pulmonary TB?

A 
Vertebral (Pott's disease)
Lymph nodes (scrofula)
33
Q

How do you dx TB?

A

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
Q

How do you treat active TB?

A

Total tx duration = 6 months

“RIPE”: rifampin + isoniazid + pyrazinamide + ethambutol

No longer contagious after 2 weeks of tx

35
Q

How do you treat latent TB?

A

isoniazid + pyridoxine x 9mos

If HIV –> isoniazid + pyridoxine x 12mos

36
Q

What causes acute bronchitis?

A

MC viruses (adenovirus)

37
Q

What is the hallmark of acute bronchitis?

A

Cough (lasting 1-3 weeks)

38
Q

How do you treat acute bronchitis?

A

Sx: fluids, rest, bronchodilators, antitussives

Abx have no statistical benefit

39
Q

Describe the 3 phases seen in pertussis

A
  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
Q

How do you dx pertussis?

A

PCR of nasopharyngeal swab = GOLD

Lymphocytosis

41
Q

How do you treat pertussis?

A

Sx: O2, nebulizers, ventilation

Macrolides = DOC (erythromycin)
If macrolide allergic –> TMP-SMX

42
Q

What are characteristics of acute bronchiolitis?

A

MC in children > 2 mos- 2 yo after viral infection (esp. RSV, adenovirus)

Neutrophil infiltration
Bronchial narrowing

43
Q

What are characteristics of bronchiolitis obliterans (constrictive)?

A

Chronic inflammation & fibrosis
Collapse of bronchioles
Granulation tissue –> obstructive lung disease
Mosaic pattern on CT

44
Q

How do you treat bronchiolitis obliterans?

A

High dose corticosteroids & immunosuppression

Lung transplant = definitive

45
Q

What are characteristics of cryptogenic organizing pneumo (COP)?

A

Type of bronchiolitis

Persistent alveolar exudates –> fibrosis of bronchioles & alveoli

Resembles pneumo, but doesn’t respond to abx

46
Q

How do you treat COP?

A

Corticosteroids

47
Q

What are s/s of acute bronchiolitis?

A

Fever, URI sx 1-2 days –> respiratory distress

48
Q

How do you dx acute bronchiolitis?

A

CXR: hyperinflation, peribronchial cuffing

Nasal washings using monoclonal Ab testing

Pulse Ox = single best predictor

49
Q

How do you treat acute bronchiolitis?

A

Humidified O2 = mainstay of tx
IV fluids, APAP/ibuprofen

B-agonists, nebulized epi

Ribavirin (if severe lung or heart disease or immunocompromised)

50
Q

How do you prevent acute bronchiolitis?

A

Palivizumab (used in high risk)

Handwashing

51
Q

What MC causes croup?

A

Parainfluenza virus type 1

52
Q

What are 4 s/s of croup?

A
  1. Barking cough (seal like)
  2. Stridor
  3. Hoarseness
  4. Dyspnea (worse at night) +/- URI sx
53
Q

How do you dx croup?

A

Clinical

Frontal cervical radiograph: Steeple sign (subglottic narrowing of trachea)

54
Q

How do you treat croup?

A

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
Q

Which type of influenza is a/w more severe, extensive outbreaks?

A

A!

56
Q

What are s/s of the flu?

A

Abrupt onset of HA, fever, chills, malaise, URI sx, pharyngitis

Myalgias MC in legs & lumbosacral area

57
Q

How do you dx the flu?

A

Clinical

Rapid influenza test (nasal swab) or viral culture

58
Q

How do you treat the flu?

A

Sx: APAP or salicylates

Antivirals (in those at high risk for complications)

  • initiate within 48hrs
  • Oseltamivir (Tamiflu)*, zanamivir, ribavirin

Amantadine, rimantadine

59
Q

What causes pulmonary nodules?

A

Granulomatous infections: TB MC
Tumors
Inflammation
Mediastinal tumors: thymoma MC

60
Q

How do you dx pulmonary nodules?

A

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%)

Family Med EOR (15 decks)

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