Pnuemonias and TB Part I, D KInder, CIS

Question 1

22 y.o bullous myringitis, right middle lobe infiltrate, non-productive cough, fever

Answer 1

mycoplasma pnuemonia

Question 2

bullous myringitis

Answer 2

blood filled TM

Question 3

how to test for mycoplasma pneumonia

Answer 3

cold agglutinins test. autoAb to RBC

Question 4

obligate intracell organism to cause pneumonia

Answer 4

chlamydia spp

Question 5

pneumonia from infected excrement from pigeons

Answer 5

histoplasmosis

Question 6

bradycardia in relation to patient’s fever
pneumonia
what causes this

Answer 6

legionella

Question 7

why does penicillin not work on mycoplasma

Answer 7

has no cell wall

Question 8

fever, chills, yellow sputum
previous splenectomy
optochin sensitive
\+ quelling reaction
microbe?

Answer 8

streptococcus pneumonia

Question 9

splenectomy patients are unable to protect against what organisms

Answer 9

encapsulated because B cell immunity is down

Question 10

19 y.o college student
fever, dry cough, malaise, aches all over
mildly dec breath sounds b/l
cold agglutinins

Answer 10

mycoplasma pneumonia

Question 11

40 y.o female
nonproductive cough, low grade fever
atypical pneumonia based on CXR
complement Ab to Chlamydia psittaci
most likely occupation?
- cat breeder
-homeless shelter worker
-poultry farmer
-cave explorer
-wool sorter

Answer 11

poultry farmer

Question 12

wool sorter disease pathogen

Answer 12

Bacillus anthracis

Question 13

poultry farmer in central US, microbe?

Answer 13

histoplasmosis or psittaci

Question 14

25 y.o M
fever nonproductive cough
hypotension
CXR b/l infiltrates
silver stain with foamy alveolar exudates
predisposing condition?

Answer 14

AIDS
pneumocystis jirovecii
CD4<200

Question 15

what organism causing pneumonia do you expect in sickle cell patient?

Answer 15

asplenic

encapsulated pathogens like strep pneuomnia

Question 16

southwest US organisms

Answer 16

coccidiodes

Question 17

drug used for chronic aspiration

Answer 17

clindamycin

Question 18

45y.o F
chills rigors, fever
onset 2 days
gram + encapsulated lancet shaped diplococci
microbe?

Answer 18

strep pneumoniae

Question 19

type microbe H influenza

Answer 19

gram - rod

Question 20

vital signs legionella

Answer 20

high fever and bradycardia

Question 21

alcoholism is assoc with what pneumonia-causing organism

Answer 21

klebsiella

Question 22

56 y.o DM M with chronic sinusitis
Tx 8 weeks antibiotics does not get better
2 wks later dies from posterior erosion of organism into his brain
strongly suspect infection with what?

Answer 22

mucormycosis
fungus
common in DM

Question 23

25 y.o M prostitute, IV drug abuse
fever marked SOB
hacking and non-productive, present for weeks
PaO2 55 PaCO2 50
b/l infiltrates lower lobes
wheeze and dec breath sounds. oral thrush
what is most consistent with Dx?
Acid fast organisms in sputum
elevated cold agglutinins
\+ methamine silver stain lung tissue
decreased serium IgA
\+ convalescent precipitans for histpolasmosis

Answer 23

pneumocystis jiroveci

+ silver stain of lung tissue

Question 24

6 mo from kenya
runny nose, dry non-productive cough
hacking and progressively more frequent and severe
severe paroxysms assoc with cyanosis, plethoric facies, bulging eyes, protrusion of the tongue, and distention of the neck veins

Answer 24

bordetella pertussis

Question 25

decreased IgA means what in patients

Answer 25

more prone to respiratory infections

Question 26

croup microbe

Answer 26

parainfluenza

Question 27

50 y.o M ER with severe pneumonia just returned from Howell MI air conditioning and heat engineer 40 pack yr and drinks 8-10 beers/night culture on charcoal yeast extract has small gram - bacteria best antibiotic?

Answer 27

legionella | erythromycin-- macrolide

Question 28

clindamycin is used to Tx what

Answer 28

anaerobic

Question 29

Staph non resistant is Tx with what

Answer 29

methicillin or nafcillin

Question 30

``` 19 y.o african american M San Diego 5 week fever, nonproductive cough and SOB Tx for levofloxacin little response - HIV and PPD CXR R upper lobe infiltrate small painful rash and red bumps on lower extremities Dx test? ```

Answer 30

fungal serologic tests- coccidiodes mycosis

Question 31

65 y.o M with acute respiratory failure marked CO2 retention and hypoxemia ventialor became ill with signs sepsis, kussmaul breathing and signs of septic shock CXR show diffuse b/l infiltrates that turned to marked in one day greenish colored sputum noticed on suction most likely organism?

Answer 31

Pseudomonas aeruginosa

Question 32

gram negative faculative intracell bacterium transmitted by flea bites

Answer 32

yersinia pestis

Question 33

36 y.o M with stage IV sarcoidosis with hemoptysis CXR L upper lobe pleural thickening CT shows free floating density- fungus ball most likely fungus to cause fungus ball?

Answer 33

aspergillus flavus

Question 34

``` 45 y.o M fever malaise, fatigue sputum streaked with blood nonproductive pulse 60 b/l rales L lower lobe infiltrate concerned about legionnaires and order what test? ```

Answer 34

Urinary antigens

Question 35

21 y/o F + PPD asymptomatic Tx?

Answer 35

INH 6 mo

Question 36

``` 4 mo infant, winter runny nose, fever, cough, wheezing daycare with children same Sx b/l rales wheezing and intercostal retractions with grunting most likley infecting oganism ```

Answer 36

RSV

Question 37

70 t.o M lobar pneumoniae kidney shaped gram - diplococci most likely organism?

Answer 37

Moraxella catarrhalis

Question 38

Influenza B on cruis liner no influenza A so far medications for unvaccinated patients on ship?

Answer 38

oseltamivir

Question 39

76 y.o american indian F admitted for Tx CAP in hospital Dx mycobacterium tb confirmed by AFB began on 4 drug regimen then changed to different regimen 4 wks later from sensitivity data eye complaint now from meds most likely due to what medication?

Answer 39

ethambutol

Question 40

44 y.o M with chronic pneumonia night sweats, fever, weight loss, fatigue, cough, sputum hemoptysis and dyspnea CXR left sub segmental lower lobe pneumonia poorly responsive antibiotics small nodular lesions on surface of arms and legs travels and makes canoes from polyurethane foam single broad based buds off yeast cells most likely region where obtained this disease

Answer 40

louisiana

Question 41

large yeast cells with single broad based buds

Answer 41

blastomyces dermatitidis

Question 42

39 y.o Hx HIV fever, cough, night sweats, 7 lb weight loss hemoptysis CD4

Answer 42

Tx | INH, pyranizamide, rifampin, ethambutol

Question 43

+PPD in healthy med student

Answer 43

10mm or larger

Question 44

10mm + PPD fits what criteria

Answer 44

``` recent arrivals from endemic countries injection drug users residents at high risk settings mycobacterial lab personnel persons with clinical conditions that place them at high risk ```

Question 45

15 mm +PPD test used for what

Answer 45

live in an area no knonw risk factors TB

Question 46

21 y.o HIV+ M cough and weight loss given provisional Dx PCP pnuemonia given low CD4 count worsens partner previously died from pulm TB he has active pulm TB and put on 4 drug regimen 2 weeks later but on HAART and now complaining of unusual sensations

Answer 46

isoniazid but also streptomycin and ethambutol

Question 47

``` 21 y.o F SOB previously admitted for "flu" getting worse put on 15 lb, nonproductive cough rabbit hutches normal heart dec DLCO CXR normal CT diffuse hazy opacities without focal infiltrates Dx? ```

Answer 47

interstitial pulmonary fibrosis

Question 48

cause of Q fever?

Answer 48

coxiella burnetti

Question 49

42 y.o M archeologist, ancient ruin Western US HA, productive cough, dyspnea, fatigue, achy joints night sweats red painful lumps on legs dec breath sounds and diffuse crackles b/l hilar adenopathy with spherical coin lesion - AFB and -PPD Dx?

Answer 49

coccidiomycosis

Question 50

16 y.o homeless for 6 mo, prostitution cough low grade fever, malaise, diffuse abdominal pain and diarrhea occasional hemoptysis b/l cervical supraclavicular and inguinal lymphadenopathy liver and spleen enlarged to palpation diastolic rumble and Left lower sternal borader (increases intensity with inspiration) R atrial P waves needle tracks, CD4 50, blood and sputum cultures negative Dx is associated with? -abundant AFB with macrophages characteristic MAC -abundant AFB characteristic mycobacterium TB - + silver stains for cyst or trophozoite - + Ab legionella - + cold agglutinin test

Answer 50

abundant AFB within macrophages characteristic of MAC

Question 51

71 y.o F acute dyspnea, cough, fever flu season, consolidation left lower lung field most common cause post influenza pneumonia?

Answer 51

staph aureus

Question 52

``` 3 y.o from haiti high fever, sore throat and dsypnea with respiratory stridor drool from mouth, neck extended cannot swallow thumb sign on lateral neck view causative organism? ```

Answer 52

epiglottitis | H influenzae