Pulm

Question 1

COPD CAP association

Answer 1

H. influenzae

Question 2

Recent viral infection CAP association

Answer 2

S. aureus

Question 3

Poor dentition/Aspiration CAP association

Answer 3

Anaerobes

Question 4

Young healthy patient CAP association

Answer 4

Mycoplasma pneumoniae

Question 5

Hoarseness CAP association

Answer 5

Chlamydophila pneumoniae

Question 6

Diarrhea CAP association

Answer 6

Legionella

Question 7

Birds CAP association

Answer 7

Chlamydia psittaci

Question 8

Animals birthing, veterinarians, farmers CAP association

Answer 8

Coxiella burnetii

Question 9

Hemoptysis from necrotizing disease, currant jelly sputum

Answer 9

Klebsiella pneumoniae

Question 10

Foul-smelling sputum like rotten eggs

Answer 10

Anaerobes

Question 11

Dry cough, rarely severe, bullous myringitis

Answer 11

Mycoplasma pneumoniae

Question 12

Abdominal pain, diarrhea or headache and confusion

Answer 12

Legionella

Question 13

Aids with <200 CD4 cells

Answer 13

Pneumoncystis

Question 14

Infections associated with dry non-productive cough

Answer 14

Mycoplasma, viruses, Coxiella, pneumocystis, chlamydia

Involve interstitial space more than air space

Question 15

Mycoplasma pneumoniae diagnostic tests

Answer 15

PCR
Cold agglutins
Serology
Eaton’s agar culture

Question 16

Chlamydophila pneumonia diagnostic test

Answer 16

Rising Ab titers

Question 17

Legionella diagnostic test

Answer 17

Urine antigen, culture on charcoal-yeast agar

Question 18

Chlamydia psittaci diagnostic test

Answer 18

Rising Ab titers

Question 19

Coxiella burnetii diagnostic test

Answer 19

Rising Ab titers

Question 20

PJP diagnostic test

Answer 20

brochoalvelolar lavage with silver stain

Question 21

Outpatient tx of CAP in healthy patient with no abx in last 3 months

Answer 21

Azithromycin/clarithromycin

Doxycycline

Question 22

Outpatient tx of CAP in patient with comorbidities or abx in the last 3 months

Answer 22

Levofloxacin/moxifloxacin

Question 23

Inpatient tx of CAP

Answer 23

levoflaxacin/moxiflaxacin

ceftriaxone and azithromycin

Question 24

When to hospitalize CAP?

Answer 24

C-confusion
U-uremia
R-respiratory distress
B-BP low 
65- Age >65

2+ = hospitalization

Question 25

Hospital acquired pneumonia definition

Answer 25

- Pneumonia developing more than 48 hours after hospitalization - 90 days after hospital admission

Question 26

Hospital acquired pneumonia etiology

Answer 26

E.coli or psuedomonas

Question 27

HAP treatment

Answer 27

cefepime/ceftazidine Piperacillin/tazobactam Carbapenem

Question 28

Treatment of ventilator associated pneumonia

Answer 28

1. Antipseudomonal beta lactam: celphalosporin/zosyn/carbapenem 2. Second antipseudomonal agent: gentamicin(or other amino glycoside)/flouroquinolone 3. MRSA agent: Vancomycin or linezolid

Question 29

When to add steroids to bacterium in PCP?

Answer 29

pO2 35

Question 30

Alternative treatment for mild PCP with mild hypoxia

Answer 30

Atovoquone

Question 31

Alternative treatment for PCP with bactrim toxicity

Answer 31

- Clindamycin and primaquine | - Pentamidine

Question 32

When to prophylax for PCP

Answer 32

CD4>200

Question 33

Alternatives to bactrim for PCP prophylaxis

Answer 33

Atovaquone or dapsone

Question 34

When/what to use for prophylaxis for atypical mycobacterium?

Answer 34

CD4 >50 | Azithromycin

Question 35

Risk factors for TB

Answer 35

``` Immigrant in last 5 years Prisoners HIV positive Healthcare workers Close contact with person with TB Steroid use Hematologic malignancy Alcoholic DM ```

Question 36

Diagnosing TB

Answer 36

Best initial test: CXR Sputum stain and culture for acid x3 Most accurate test: pleural biopsy

Question 37

Active TB treatment

Answer 37

2 months: Rifampin, INH, pyrazinamide, ethambutol 4 additional months: rifampin and INH ``` Treatment continues for 9 months if: Osteomyelitis Miliary TB Meningitis Pregnancy or other contraindication for pyrasinamide ```

Question 38

Rifampin toxicity

Answer 38

Red color to body secretions No need to stop therapy

Question 39

Isoniazid toxicity

Answer 39

Peripherla neuropathy Use pyridoxine to prevent

Question 40

Pyrazinamide toxicity

Answer 40

Hyperuricemia No need to treat unless symptomatic

Question 41

Ethambutol toxicity

Answer 41

Optic neuritis/color vision Management: decrease dose in renal failure

Question 42

Induration >5mm positive

Answer 42

``` HIV Glucocorticoid user Close contact with TB Abnormal calcifications on CXR Organ transplant recipient ```

Question 43

Induration >10mm positive

Answer 43

``` Immigrant in last 5 years Prisoner Healthcare worker Close contact with TB Hematologic malignancy Alcoholic DM ```

Question 44

Treatment of Pulmonary hypertension

Answer 44

Prostacyclin analogues (PA vasodilators): epoprostenol, treprostinil, iloprost, beraprost Endothelin antagonists: bosetan PDE inhibitor: sildenafil