Respiratory ID

Question 1

First step if sx of pneumonia?

Answer 1

CXR

Question 2

Most common bug of pneumonia (all comers?) Treatment?

Answer 2

Strep pneumo. Treat: M, FQ, 3rd gen ceph

Question 3

Most common bug of pneumonia - healthy young people? Treatment?

Answer 3

Mycoplasmia. Treat: macrolide 1st priority.

Question 4

Association of mycoplasmia pneumonia?

Answer 4

cold agluttins.

Question 5

Pneumonia with recent hospitalization (3months, or in hospiital longer than 5 days)? Treatment?

Answer 5

Pseudomonas, Klebsiella, E. coli, MRSA. Tx: pip-tazo or imipenem + vanc

Question 6

Alcoholics w/ Pneumonia w/ current jelly sputum? Tx?

Answer 6

Klebsiella. Tx w/ 3rd gen ceph.

Question 7

Pneumonia in old men w/ HA, confusion, diarrhea and abdominal pain? Dx? Tx?

Answer 7

Legionella. Urine antigen. Tx: M, FQ, doxy.

Question 8

Pneumonia post influenza? TX?

Answer 8

MRSA. Vanc.

Question 9

Pneumonia + baby cow + GI sx? Tx?

Answer 9

Q fever. Coxiella burnetti. Tx: doxy

Question 10

Pneumonia + rabbit contact? TX?

Answer 10

Franciella Tularenesis. TX w/ streptamycin, gentamycin

Question 11

Most common cause of pneumonia in neonates?

Answer 11

Group B STrep, E coli

Question 12

Most common cause of peumonia in children?

Answer 12

RSV, Mycoplasma, C. trachomatis (infants - 3 yrs), C. pneumonia (school aged children), S. pneumo. (Runts May Cough Chunky Sputum).

Question 13

Aspiration pneumonia?

Answer 13

Anaerobes - peptostreptococcus, fusobacterium, prevotella, bacteroides

Question 14

Atypical pneumonia

Answer 14

Mycoplasma, legionella, chlamydia

Question 15

Cystic fibrosis + pneumonia?

Answer 15

pseudomonas, s. aureus, s. pneumo

Question 16

pneumonia in the immunocompromised?

Answer 16

S. Aureus, enteric gram negative rods, fungi, viruses, p. jirovecci (HIV).

Question 17

Nosocomial pneumonia

Answer 17

s. aureus, pseudomonas, other enteric gram negs.

Question 18

post-viral pneumonia?

Answer 18

s. aureus, h. influenza, s. pneumo.

Question 19

If suspicion for TB, best first test?

Answer 19

CXR

Question 20

Where are TB lesions seen?

Answer 20

primary TB: hilar nodes + ghon focus in mid/lower lung: Ghon complex
Secondary TB/reactivation: fibrocaseous cavitary lesion in upper lobes.

Question 21

TB screening guidelines? What’s a + PPD?

Answer 21

> 15 mm for normal patient
10 mm for prison, healthcare worker, nursing home, chronically ill, DM, EtoH
5mm for AIDS/immunosuppressed.

Question 22

If +PPD then what?

Answer 22

CXR

Question 23

If + CXR for TB then what?

Answer 23

acid fast stain of sputum. If neg, repeat x2.

Question 24

If CXR neg or +CXR + three neg sputums, for TB then what?

Answer 24

negative.

Question 25

If acid fast sputum +, treat with?

Answer 25

Rifampin, INH, pyrazinamide, ethambutol

Question 26

Who needs chemoprophylaxis for TB exposure? What is the treatment?

Answer 26

INH for 9 months, kids under 4.

Question 27

Side effects of Rifampin?

Answer 27

body fluids turn red/orange, induces cyp450

Question 28

Side effects of INH?

Answer 28

Peripheral neuropathy, hepatitis w/ mild bump in LFTs, sideroblastic anemia (prevent w/ B6)

Question 29

Side effects of pyrazinamide?

Answer 29

benign hyperuricemia

Question 30

Side effects of ethambutol?

Answer 30

Optic neuritis, color vision abnormalities

Question 31

False negative PPDs?

Answer 31

severely immunocompromised, sarcoidosis

Question 32

False positive PPDs?

Answer 32

BCG vax.

Question 33

Sx of extrapulmonary TB?

Answer 33

CNS (parenchymal tuberculoma, meningitis) Pott's disease - vertebral body. Lymphadenitis, Renal, Adrenal, GI.