Pneumonias and TB II CIS Flashcards Preview

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1

Echocardiogram demonstrates tricuspid and mitral valve vegetations. The patient has severe dental carries. You strongly suspect some fastidious gram negative bacilli that are commonly found in the oropharynx.

What are we thinking are the critters here?

HACEK

2

Most likely cause of bronchiolitis in infants?

RSV

3

organism most commonly associated with COPD exacerbation

moraxella
H. flu
sometimes klebsiella in alcoholics

4

who typically gets mycoplasma?

college students, etc.

5

pseudomonas-- who gets it?

nosocomial
and Cystic Fibrosis

6

some symptoms that go along with coccidio

erythema nodosum

violaceous nodules in the lung

7

a disorder that begins with flu like symptoms and then goes to liver, lungs and kidneys leading to renal failure

leptospirosis

(Wheel's Disease)

agglutination antibodies

8

rickettsial organism, exposure to animal placentas

coxiella brunetti

9

tachyzoites that stain with H and E

toxoplasmosis

10

what stains positive to methenamine silver?

pneumocystis

11

which comes first, IgG or IgM?

IgM is followed by IgG

12

what kind of case would we expect cellular immunity with?

viral

HIV, for example

13

primary immune response to strep pneumo, e.g.?

humoral immunity

B cells develop an antibody

14

influenza-- we get it every year because why?

minor changes associated with antigenic drift.

major reassortment of genome RNA would --> pandemic

15

at what CD4 count do we worry about pneumocystis?

200 or less

16

at what CD4 count do we worry about MAC?

50 or less

17

at what CD4 count to we worry about toxo?

less than 100

18

rickettsia prowazecki is spread by

lice and flying squirrel

19

TB drug that causes orange urine

Rifampin

20

drug for anaerobes in suspected aspiration pneumonia

clindamycin

21

previously negative TB test now has been exposed and has a 3 mm induration. What to do?

Retest in 6 months to a year.

5 mm would be abnormal here.

22

what should we do with a stable patient who has a PE?

initiate anticoagulation therapy

23

DIC is demonstrated by what?

anemia, low platelets, fibrin degradation products, prolonged PT, PTT, decreased fibrinogen

24

most common EKG with pulmonary emoblism

sinus tachycardia

25

Virchow's triad

Hypercoagulability
Stasis
Endothelial damage

leads to DVT/ PE/ clots

26

Well's Clinical Likelihood of Pulmonary Embolism

Predisposing factors:
Previous VTE 1.5
Recent Surgery of immobilization 1.5
Cancer 1

Symptoms:
Hemoptysis 1

Signs:
Heart Rate > 100 bpm 1.5
Cliical signs of DVT 3

Clinical Judgement:
Alternative diagnosis less likely than PE 1.5

Clinical probability total points

Less than 2 is low
Moderate: 2-6
High: over 6

27

testing when high vs low probability of PE

low probability: d dimer

moderate or high probability: V/Q perfusion scan

28

heparin / warfarin and preganancy

no warfarin in pregnancy! teratogenic

29

How does warfarin work?

vitamin K dependent coagulation factors-2, 7, 9, 10

Warfarin blocks them as well as protein C and protein S

30

why don't we start warfarin alone

it takes some time to kick in

starts with protein C, which makes patients hypercoagulable

thus we overlap with heparin for a few days

31

Hypercoagulation workup

lupus anticoagulant
factor 5 leiden
prothrombin G20210A mutation
antithrombin III deficiency
protein C and S deficiencies

32

INH side effects

peripheral neuropathies

give B6

hepatotoxicity, check liver function tests

33

pyramidazine side effects

hepatotoxicity, (hyperuricemia)

34

rifampin side effects

CYP inducer
orange urine
hepatotoxicity

35

ethambutol side effects

optic neuritis, red/green color blindness

36

CURB-65

confusion
uremia over 20
respiratory rate over 30
Blood pressure under 90 / 60

age over 65

3 or more? hospitalization

37

when do we use azithromycin

outpatient

38

what should we use for inpatient pneumonia?

floroquinolone, e.g.

39

when do we use oseltamivir?

influenza

40

when do we use amphotericin B?

severe fungal infections

41

when do we use itroconazole

oral agent for less severe fungal infections