Pneumonia and TB CIS Flashcards
(104 cards)
1
Q
22 year old college student with right middle lobe – streaky infiltrate on chest x-ray. She has a dry cough and temperature of 101 F. She has chills and headache. She has had three weeks of pro-dromal symptoms
Which of the following is a likely possibility in this patient?
A. She will have an IgM autoantibody that is directed against the I antigen of red blood cells.
B. This organism is an obligate intracellular that cause pneumonia.
C. It is usually associated with the inhalation of infected excrement from pigeons
D. It is associated with a relative bradycardia in relation to the patients fever.
E. It is a Gram – rod that can cause both CAP and nosocomial pneumonia
A
a
cold agglutin cells for mycoplasma pneumonia
mycoplasma young in dorms
probably cap
in young people
step pneumo comes no fast and rusty colored sputum
dry cough is atypical
2
Q
obligate intracellular that causes pneumonia
A
atypical
3
Q
. This organism is an obligate intracellular that cause pneumonia
A
psittacosis
4
Q
It is associated with a relative bradycardia in relation to the patients fever.
A
legionella
5
Q
It is a Gram – rod that can cause both CAP and nosocomial pneumonia
A
pseudomonas
6
Q
Mycoplasma Pneumonia overview
A
Most common pneumonia in young adults.
Smallest free living organism
No cell wall – No penicillin
7
Q
mycoplasma pneumonia clinical manifestation
respiratory tract
A
Pharyngitis, laryngitis, acute bronchitis, bronchopneumonia
8
Q
mycoplasma pneumonia clinical manifestation
skin and mucosa
A
Maculopapular and vesicular exanthema, urticarial, purpura, erythema nodosum, erythema multiforme, Stevens-Johnson syndrome
9
Q
mycoplasma pneumonia clinical manifestation
CNS
A
Meningitis, meningoencephalitis, acute psychosis, cerebritis, Guillain-Barre syndrome
10
Q
mycoplasma pneumonia clinical manifestation
parenchymatous organs
A
Pancreatitis, diabetes mellitus, non-specific reactive hepatitis, subacute thyroiditis
11
Q
mycoplasma pneumonia clinical manifestation
misc
A
Hemolytic anemia, pericarditis, thromboembolism
12
Q
Your patient recently purchased an old chicken farm in Ohio where he had spent the previous few weeks cleaning out and moving the former chicken coop left behind by the previous owner. He became ill several days ago. He presents with fever, headache, malaise, and a non productive cough.
His chest x-ray presents with bilateral hilar lymphadenopathy and diffuse reticulonodular infiltrates.
Which of the following organisms is most likely the cause of his illness? A. Actinomyces israellii B. Aspergillus fumigatus C. Chlamydophila psittaci D. Coccidiodes immitis E. Histoplamsa capsulatum
A
E. Histoplamsa capsulatum
13
Q
will you have lymphadenopathy with chlamydia psittaci
A
no it is atypical
14
Q
23 year old male has had a previous splenectomy two years ago as a result of an auto accident. You see him in the ER with chills, fever, cough, and chest pain. Sputum specimens are yellow in nature and yield optochin sensitive organisms with a positive quelling reaction.
Which of the following is the most likely cause? A. Streptococcus pneumonia B. Eschericia coli C. Klebsiella pneumonia D. Yersinia pestis E. Candida albicans
A
A. Streptococcus pneumonia
15
Q
optochin sensitive and quellin think
A
strep pneumo also with splenectomy encapsulated organisms are a problem
have pneuomo vaccine after splenectom
16
Q
19 year old college student has a fever, a dry nonproductive cough and malaise. She “aches” all over. Her physical exam demonstrates mildly decreased breath sounds bilaterally. Her laboratory values demonstrate elevated “cold agglutinins”.
Which of the following is the most likely responsible for her illness? A. Streptococcus pneumonia B. Haemophilus influenza C. Klebsiella pneumoniae D. Legionella pneumophila E. Mycoplasma pneumoniae
A
Mycoplasma pneumoniae
17
Q
h flu
A
gram negative pelomorphic rod
18
Q
klebsiella pneumoniae
A
aquatic environments
19
Q
40 year old female presents with a nonproductive cough and low grade fever. You diagnose an atypical pneumonia based upon her chest x-ray. You correctly treat her with azithromycin. You diagnose psittacosis, based upon the presence of complement fixing antibodies to Chlamydia psittaci in her convalescent serum.
Her most likely occupation is? A. Cat breeder B. Homeless shelter worker C. Poultry farmer D. Cave explorer E. Wool sorter
A
poultry farmer
20
Q
cat breeder
A
toxoplasmosis
21
Q
homeless shelter owrker
A
tb
22
Q
poultry farmer
A
histo
23
Q
cave explorer
A
histo
24
Q
wool sorter
A
anthrax
25
25 year old male with fever, non-productive cough, and hypotension. His chest x-ray demonstrates bilateral interstitial infiltrates. BAL reveals cysts that are spherical in shape and stain with methenamine silver.
Which predisposing condition accounts for this?
A. He is most likely a sickle cell patient
B. He resides in the Southwest United States
C. He has AIDS
D. He is an alcoholic
E. He has problems with chronic aspiration
aids
26
alcoholic pneumonia bugs
aspration anaerobes peptso
klebsiella
27
southwest us
coccidio
28
45 year old female who presents with chills, rigors, and fever. Onset was 2 days ago. Gram stain of her sputum demonstrates gram positive encapsulated, lancet shaped diplococci.
```
Which of the following correctly names this organism?
A. Haemophilus influenza
B. Neisseria gonorrhaeae
C. Pneumocystis carinii ( Jiroveci)
D. Staphylococcus aureus
E. Streptococcus pneumonia
```
strep pneumo
29
neisseriea
gram neg gono diplococci
30
Patient brought to ER by ambulance. He is septic and appears to have pneumonia. His ETOH level is 0.2. Liver is enlarged and he has spider angiomata on his abdomen. He appears to be coming down with “Delirium Tremens” clinically. Physical exam reveals decreased breath sounds on the right side, and chest x-ray is compatible with right sided pneumonia, based upon findings of consolidation. His sputum exam demonstrates “currant jelly” appearing sputum
```
Which of the following is highest on your list of differentials?
A. Legionella spp.
B. Klebsiella pneumoniae
C. Mycoplasma pneumoniae
D. Pneumocystis jirovecii
E. Streptococcus pneumoniae
```
klebsiella
31
alcohol and middle age males are a risk but would have trvel history
legionella
32
alcoholism and currant jelly sputum
klebsiella
33
young people
mycoplasma pneumonia
34
atypical aids
pcp
35
56 year old diabetic with chronic sinusitis. He does not respond to 8 weeks worth of antibiotic therapy. You have tried multiple antibiotics, but without results.
Two weeks later her dies from posterior erosion of this organism into his brain.
```
You should strongly suspect infection with ?
A. Actinomyces
B. Aspergillus
C. Cryptococcus
D. Mucor
E. Pneumocystis
```
mucor
36
sinus tracts to skin usually not to the brain
actinomyces
37
india ink stain test csf
hiv pts cd4 less than 50 and meningitis
cryptococcus
38
silve aids cd4 less than 200 give bactrim for prophylaxis
pcp
39
25 year old male prostitute with a history of IV drug abuse. He presents with fever and marked SOB. He describes his cough as hacking and non-productive. It has been present for weeks.
His ABG demonstrates a PaO2 of 55 with a PaCo2 of 50. His chest x-ray demonstrates bilateral infiltrates in the lower lobes. Physical exam reveals a mild wheeze and decreased breath sounds. He has oral thrush.
Which of the following is most consistent with his diagnosis?
A. Acid fast organisms in his sputum
B. Elevated cold agglutinins
C. Positive methamine-silver stain of lung tissue
D. Decreased serum IgA
E. Positive convalescent precipitins for histoplasmosis
oral thrush is low cd4 so hiv or aids, abs and inhalers can lead to thrush
c for pcp
40
6 month old male who just emigrated from Kenya with his family. One week ago he developed a runny nose and a dry – non productive cough. For the past two days the cough has become “hacking” and progressively more frequent and severe. Between paroxysms of the cough, the child appears well to the parents.
The parent bring him to the ER with a series of intense coughing during expiration, followed by a high-pitched inspiratory sound created by a forceful inspiration through a narrowed glottis. Severe paroxysms are associated with cyanosis, plethoric facies, bulging eyes, protrusion of the tongue, and distention of the neck veins.
```
You correctly believe the organism responsible for this is ?
A. Corona virus
B. B. pertussis
C. Respiratory Syncytial Virus
D. Parainfluenza viruses
E. H. influenza
```
pertussis
41
cold
sars
corona virus
42
croup steeple sign
parainfluenza
43
meningitis epiglottitis
h flu
44
50 year old business man comes into ER with severe pneumonia. He just returned from Howell, Michigan where he is the chief air conditioning and heating engineer at a construction site for a new 500 room hotel complex. He has a history of smoking 40 pack years and drinks 8-10 beers per night. His chest x-ray shows marked consolidation of both lungs, predominantly in the lower fields. Culture on charcoal yeast extract medium grows out a small gram negative bacterium.
```
Which of the following antibiotics is the most appropriate for this patient?
A. Amphotericin B
B. Bactrim DS
C. Clindamycin
D. Erythromycin
E. Methicillin or Nafcillin
```
legionella
airconditioning smmokes drinks middle aged male
erythromycin
45
atypical pneumonia for legionella, corynebacterium
erythromycin
46
amphotericin b
severe fungi
47
pcp
uti skin infections cellulitis mrsa on skin
bactim ds
48
anaerobes
aspiration pneumonia
bowel infections
worried about cdiff when taking
clindamycin
49
staph thats not mrsa
methicillin or nafcillin
50
19 year old, previously healthy, African-American male, navy recruit has been training in San Diego for the past 5 months doing mainly outdoor running and military training. He present with a 5 week history of fever, non-productive cough and SOB. He was treated with Levofloxacin for 10 days with little response. Tests are negative for HIV and PPD. Chest x-ray demonstrates a right upper lobe infiltrate. He exhibits a small, painful rash and red bumps on his lower legs.
Which of the following tests is most likely to yield the correct diagnosis?
A. Serologic test for Legionella antibodies
B. Fungal serologic tests
C. Urine antigen test
D. Test of sputum for AFB
E. Influenza A titers
fungal serologic tests
51
rythromycin or levofloxacind for
atypicals like mycoplasma pneumonia
52
65 year old male patient who was hospitalized for acute respiratory failure. He came in with marked CO2 retention and severe hypoxemia. He was placed on a ventilator. On day five of his hospitalization, he became profoundly ill, with signs of sepsis, Kussmaul’s breathing, and evidence of septic shock.
Chest x-ray on day 5 demonstrated diffuse bilateral, patchy pulmonary infiltrates
On day 6, the chest x-ray demonstrated marked bilateral infiltrates.
The patient’s sputum is copious with “greenish” colored sputum noted on suctioning
Which of the following is the most likely organism?
A. Gram negative bacillus that is one of the most common causes of nosocomial pneumonia will be found.
B. Gram negative facultative intracellular bacterium that is transmitted by flea bites
C. In 1988, the initial homology studies indicated that this organism is a fungus rather than a protozoan
D. This patient’s CD4 count is less that 200 and he should be placed on Septra DS prophylaxis
E. This infection is most likely from a gram negative coccobacillary rod that, if typable is encapsulated.
a
pseudomonas
53
Gram negative bacillus that is one of the most common causes of nosocomial pneumonia will be found
pseudomonas
54
Gram negative facultative intracellular bacterium that is transmitted by flea bites
Yersinia pestis
55
In 1988, the initial homology studies indicated that this organism is a fungus rather than a protozoan
pneumocystis
56
This infection is most likely from a gram negative coccobacillary rod that, if typable is encapsulated
h flu
57
36 year old man with stage IV Sarcoidosis presents with hemoptysis. Chest x-ray shows an infiltrate in the left upper lobe with associated pleural thickening. CT of the chest demonstrates a cavity with a free-floating density. A mycetoma or “fungus ball” is suspected!
```
The most common species of fungus that would cause a “fungus ball” is?
A. Histoplasma capsulatum
B. Candida albicans
C. Aspergillus flavus
D. Candida glabrata
E. Cryptococcus neoformans
```
c
58
45 year old male who presents with fever, malaise, fatigue and a temperature of 102F. His sputum is streaked with blood at times from coughing, but his cough is non productive. His pulse is 60. Lungs demonstrate bilateral rales. Chest x-ray demonstrates a left-lower lobe infiltrate.
```
You are concerned about legionnaire‘s disease (L pneumophila) and correctly order?
A. Cold agglutinins
B. CD4 count
C. AFB culture and stain
D. Gram stain of the sputum
E. Urinary antigens
```
urinary antigens
59
cold agglutinins
mycoplasma
60
afb culture and stain
TB
61
LEGIONELLA is poorly
stained
62
urinary antigens
legionnaries
63
21 year old otherwise healthy female secretary is seen in your office. At work they offered free TB skin tests, and her PPD skin test was positive with 16mm of wheal. She has never had a positive skin test before. A chest x-ray is negative, and there are no signs of the disease.
The most appropriate treatment for her is?
A. Quantiferon Gold Test
B. INH and Rifampin for 6 months
C. INH, only for 9 months
D. INH, Rifampin, and ethambutol for 12 months
E. Streptomycin for 6 months
c
64
INH, only for 9 months
positive ppd with neg cxr
65
quantiferon gold test
done on patient that has been vaccinated with bcg, tb vaccine
or confirmatory test that they have latnet if positive ppd
pcg?
66
In December, a 4 month old infant is brought to the ER. Her parents report that she had a runny nose, fever, cough, and wheezing. She attends a daycare center and other children have the same symptoms. On exam she has bilateral rales, wheezing, and intercostal retractions with grunting.
```
The most likely infecting organism is?
A. S. pneumonia
B. H. influenza
C. Adenovirus
D. Respiratory Syncytial Virus (RSV)
E. Coxsackie virus
```
general term for what child has is bronchiolitis
d is answer
67
adenoirus
common cold
68
coxackie virus
hand foot mouth
69
70 year old man presents with a lobar pneumonia on chest x-ray. Sputum gram stain shows a gram negative diplococci.
What is the most likely pathogen?
```
A. Moraxella catarrhalis
B. Neisseria gonorrhoeae
C. H. influenza
D. Yersinia entercolitica
E. S. pneumoniae
```
a
bc this one fits the match and symptoms
otitis media copd are other things it can cause
70
You are the physician on a cruise liner to Alaska, and in the past 2 days influenza B has developed in a few of the passengers. No influenza A activity has been reported thus far. Which of the following medications can you provide to protect against influenza B for the unvaccinated patients on the ship?
```
A. Amantadine
B. Rimantadine
C. Oseltamivir
D. Acyclovir
E. Septra DS
```
c
ab are not really used anymore
71
76 year old American Indian woman was recently admitted to the hospital for the treatment of community acquired pneumonia. While in the hospital, the cause of her pulmonary symptoms is discovered to be Mycobacterium tuberculosis (TB), confirmed by acid fast bacilli sputum smear. She is originally treated with a four drug regimen, pending culture and sensitivity data. Four weeks later her regimen is changed to a different four drug regimen based on the sensitivity data.
Six weeks into the patient’s treatment course the public health nurse calls to tell you that the patient has developed difficulty with her vision and a complaint of a spinning sensation.
On examination you notice vertical nystagmus. You pull her chart to review her TB regimen.
```
Which of the following drugs is responsible for this patient’s condition?
A. Ethambutol
B. Isoniazid
C. Pyrazinamide
D. Rifampin
E. Streptomycin
```
ethambutol
72
liver toxicity look for and peripheral neuropathy without pyradoxine
isoniazid
73
ethambutol
visual changes dizziness and nystagmus
a color vision and nystagmus
74
44 year old male is evaluated for a chronic pneumonia. Over the past 6 months he has had recurrent episodes of fever, night sweats, weight loss, fatigue, cough, sputum production, hemoptysis, and dyspnea.
Chest x-ray demonstrates a left sub-segmental lower lobe pneumonia that has been poorly responsive to antibiotics.
Additionally, he has small, nodular lesions on the surface of his arms and legs that have appeared over the last few months
He travels extensively for work and is currently on a business trip far from home. He is an avid hunter and enjoys the outdoors. He also makes canoes at home out of polyurethane foam.
Aside from an unexplained anemia, the patient’s preliminary laboratory work is unremarkable.
After an extensive workup, the patient receives a bronchoalveolar lavage, and excisional biopsy of one of the lesions, and a bone marrow biopsy. A wet mount of the bronchoalveolar lavage fluid shows large, multinucleated yeast cells with refractile walls.
Stains of the skin biopsy and bone marrow reveal multiple large yeast cells with reproduction via single, broad based buds. Multiple pyogenic granulomas are seen on bone marrow and lung pathology specimens.
Given this patient’s disease, which of the following is the geographic location where he is most likely ot have acquired this disease?
```
A. Seattle, WA
B. Bangkok, Thailand
C. Bakersfield, California
D. Bogalusa, Louisiana
E. Santa Fe, New Mexico
```
d
75
Santa Fe, New Mexico
coccidiomycosis
76
Bogalusa, Louisiana
blasto
77
Bakersfield, California
crypto or cocco
78
Seattle, WA
crypto
79
39 year old prison inmate with a history of HIV is brought to the emergency department because of fevers, cough, night sweats that drench his sheets, a 7 pound weight loss, and hemoptysis over the last 6 days. His CD4 count is 300. His temperature is 39.0 C (102.2F), blood pressure is 120/70 mm Hg, pulse is 113/min, and respirations are 28/min. His oxygen saturation is 91% on room air. Physical examination reveals marked temporal wasting, tachycardia without murmur, and rhonchi in the right upper lobe bi Chest x-ray is shown. His PPD skin test is 5mm. A sputum examination confirms you diagnosis but cultures are still pending.
Which of the following is the most appropriate next step in this patient’s care?
A. Begin therapy with isoniazid, pyrazinamide, ciprofloxacin, and streptomycin
B. Begin therapy with isoniazid, pyrazinamide, and rifampin
C. Begin therapy with isoniazid, pyrazinamide, rifampin, and ethambutol
D. Begin therapy with trimethoprim-sulfamethoxazole
E. Wait for treatment until you have sputum specimen confirmation
c
80
ppd of 5 mm is abnormal in a patient with
hiv
81
Reading the PPD
5 mm or more is positive in
HIV positive person
Recent close contacts of TB case
Persons with nodular or fibrotic changes on chest x-ray consistent with old healed TB
Patients with organ transplants and other immunosuppressed patients
82
Reading the PPD
10 mm or more is positive in
Recent arrivals (less than 5 years) from endemic countries
Injection drug users
Residents and employees of high risk congregate settings (e.g. prisons, nursing homes, hospitals, homeless shelters, etc.).
Mycobacteriology lab personnel
Persons with clinical conditions that place them at high risk (e.g. diabetics, prolonged steroid therapy, leukemia, end-stage renal dx, chronic malabsorption syndromes, low body weight, etc.)
83
Reading the PPD
15 mm or more is positive in
Persons with no known risk factors for TB
84
24 year old HIV positive male is admitted to the hospital for a cough and weight loss. While he is originally given a provisional diagnosis of PCP pneumonia, given a low CD4 count and his lack of antimicrobial prophylaxis, his condition worsens with intravenous trimethoprim/sulfamethoxazole and prednisone. Further questioning of the patient reveals that his domestic partner recently died of pulmonary tuberculosis
The patient is transferred to a negative pressure room, and sputum samples are collected for acid-fast bacillus smear analysis and culture. The patient is found to have active pulmonary tuberculosis, and is placed on a four drug regimen. After appropriated inpatient treatment, he is discharged, with close follow up planned via the outpatient HIV clinic. The patient returns to the clinic 2 weeks later for a check and to start highly active antiretroviral therapy (HAART). At this time he is complaining of numbness, tingling, or an unusual sensation such as burning or prickling on the skin
```
Which of the following is the most likely cause of the patient’s symptoms?
A. Ethambutol
B. Isoniazid
C. Rifampin
D. Streptomycin
E. Pyrazinamide
```
b a and d can all cause this the burning and prickling
b is the most correct..
85
42 year old male archeologist, specializing in ancient ruins of the Anasazi in the Western US, comes to the clinic complaining of worsening pulmonary symptoms. Over the past few months he has developed a headache, productive cough, dyspnea, fatigue, achy joints, and night sweats.
He recently has developed red-painful lumps on his legs
Lung examination reveals decreased breath sounds and diffuse crackles over both apices.
Chest x-ray reveals bilateral hilar adenopathy and a spherical coin lesion. A CT scan of the thorax reveals a thin walled cavitation and fibrotic stranding of both lung apices. Given the concern for tuberculosis the patient is placed in isolation.
Over the following days, three sputum samples are examined for acid fast bacilli, all of which are unrevealing. Further a PPD skin test is read as negative.
```
Which of the following studies is likely to quickly identify this patient’s primary disease?
A. Coccidiomycosis serologies
B. Fungal blood cultures
C. HIV antibody screening
D. India ink stain of sputum
E. Serology for histoplasmosis
```
a
this is a quick test the fungal cultures can take weeks to come back
86
16 year old Denver teenager who has been “living on the street” for the last 6 months. In order to support her drug habit, she has been forced into prostitution. For the last four weeks she has had a cough, low grade fever, and malaise, diffuse abdominal pain and diarrhea. At times she has had occasional hemoptysis with her cough.
On examination, her lungs are relatively clear. Bilateral cervical supraclavicular and inguinal lymphadenopathy is noted. Her liver and spleen are enlarged to palpation. Her heart exhibits a diastolic rumble at the lower left sternal border, increasing in intensity with inspiration.
Her EKG demonstrates tall right atrial P waves. A diastolic murmur is also heard best along the lower left parasternal border in the 4th intercostal space. Needle tracks are noted on her forearms.
Her CD4 count is 50. Blood and sputum cultures are negative. The remainder of the examination is unremarkable.
Her diagnosis is associated with ?
A. Abundant acid fast bacilli within macrophages characteristic of MAC
B. Abundant acid fast bacilli characteristic of Mycobacterium TB
C. Positive silver stains for cyst or trophozoite forms of this organism.
D. Positive antibodies for Legionella
E. Positive cold agglutinin test.
a
87
74 year old female presents with acute dyspnea, cough, and fever. It is flu season and she was suffering with influenza 7 days ago. This was confirmed by you, her family physician one week ago. She improved, but now had episodes of cough and dyspnea.
Vital signs: T 100.7F, BP 120/99, HR 95, RR 16.
Physical Exam: Suggestion of consolidation in her left lower lung field. Cardiac: no remarkable findings.
```
You correctly suspect which of the following organisms as one of the most common cause of post influenza bacterial pneumonia?
A. Klebsiella
B. Staphylococcus aureus
C. Pseudomonas aeruginosa
D. Haemophilus influenza
E. Pneumocystis carinii
```
b
maybe d
88
3 year old is seen in the ER who has just immigrated to the US from Haiti. The child has a high fever, sore throat, and now has marked difficulty breathing with respiratory stridor. The child is sitting on a stretcher leaning forward with her neck extended. “Drool” is running from her mouth. She cannot swallow. A “thumb” sign is seen on her lateral neck x-ray.
Physical exam demonstrates obvious compromise of her airway.
```
The most likely organism is?
A. B. pertussis
B. H. influenzae
C. Respiratory syncytial virus (RSV)
D. S. pneumoniae
E. Parainfluenza virus
```
b
89
25 year old recluse that live in the back woods of Colorado. He lives in a rat/mouse/mold infested cave. Five days ago he developed a low grade fever and myalgias, gastrointestinal symptoms and headache. He thought he had the flu. You now see him in the emergency room with non-cardiac acute pulmonary edema and shock/hypotension. His WBC’s are 26,000/mm3 with shift to the left. He has
b
90
Hanta Virus
Deer mouse is the primary reservoir
Rodents shed the virus through urine, droppings, and saliva
Transmitted by aerosolized rodent excreta or rodent bites
91
Hanta Virus
phases
Incubation Period: 2-4 weeks
Febrile phase: Symptoms include fever, chills, sweaty palms, explosive diarrhea, malaise, headaches, nausea, abdominal pain, back pain, and SOB. Lasts 3-7 days
Hypotensive phase: Platelet levels drop, tachycardia, hypoxia
Oliguric phase: Lasts 3-7 days. Characterized by proteinuria and renal failure
Diuretic phase: Diuresis of 3-6 liters per day, which can last for a couple of days up to weeks.
Convalescent phase: This is normally when recover occurs and symptoms begin to improve.
92
27 year old heroin addict/prostitute that is seen in the clinic because she doesn’t feel well. She complains of fever, night sweats, weight loss, cough with occasional hemoptysis, diffuse abdominal pain, and diarrhea. Examination reveals diffuse lymphadenopathy, hepato/splenomegaly, abdominal tenderness. Auscultation of the heart reveals a grade II/VI systolic murmur radiating to the R sternal border. Auscultation of the lungs reveals bilateral tussive rales and pleuritic chest pain.
Chest x-ray reveals multiple pulmonary infiltrates bilaterally and a pleural effusion. She has a history of smoking 30 pack years. Numerous RBC’s are noted in her urine. Her CD4 count is 175.
Her PPD intermediate skin test demonstrates 5mm of erythema with 4mm of induration.
```
Based upon this your number one differential is?
A. MAC
B. Active tuberculosis
C. Staph pneumonia
D. PCP pneumonia
E. TWAR
```
heroin addict heart murmu...endocarditis
iv drug abuse so staph pneumonia is the most likely organism
staph emboli are breaking off from tricuspid and going to the lungs
normal ppd cant rule out tb but also cxr rules it out
93
35 year old sheep rancher, who for the last 10 days has had a high fever of 104.5F, headache, chills, myalgias, malaise, and dry, non-productive cough. This came on suddenly, and persisted. There are decreased breath sounds bilaterally. The chest x-ray reveals a patchy infiltrate with multiple round, segmental opacities. There is a large area of left lower lobe consolidation. Hepatomegaly is noted, along with elevated AST and ALT levels.
Is this caused by?
A. An intracellular pathogenic bacteria similar to rickettsia, but with genetic and physiologic differences.
B. An aerobic gram positive bacteria that forms spores.
C. An alpha-hemolytic gram positive organism
D. An organism that stains acid fast
E. An organism without a cell wall
fevers and elevated liver transaminases
sheep rancher pneumonia and liver envolvement
a
coxiella or q fever also seen in sheep
94
abundant acid fast bacilli within macrophages characteristic mac
hiv with cd4 50 or less
diarrhea abdominal pain
with tb it would be apical
95
positive silver stains for cyst or trophozoite forms of this organism
ring enhancing lesion in the brain with hiv patients
toxoplasmosis
96
green sputum
nosocomial
ventilatero associated
pseudomonas
97
h flu
epiglottitis
pt not immunized
hib vaccine
98
rsv
bronchilotiis
99
caving with bats can get this, unlikely unless in midwest
histomplasmosis
100
mice feces
hanta virus
101
endocarditis findings
roth spots
oslers noeds
splinters hemorrhages
janeway lesions
102
an alpha hemolytic gram pos
strep
103
ACID FAST
TB
104
without a cell wall
mycoplasma pneumonia
