Term
| Community acquired pneumonia causative agents? |
|
Definition
Bacteria (most common): Strep pneumonia (most common), H influenza, M catarrhails, Staph aurues, Klebsiella pneumonia
Viral: Influenza, RSV, adenovirus, parainfluenza |
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|
Term
| CAP, clinical presentation? |
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Definition
| 1-10 day hx of increasing cough, purulent sputum, SOB, tachycardia, pleuritic chest pain, fever or hypothermia, sweats, rigors |
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Term
|
Definition
| Altered breath sounds and crackles, dullness to percussion (if effusion is present), note that the physical exam is not enough to confirm or exclude diagnosis |
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Term
|
Definition
| CXR shows lobar or segmental infiltrates, air bronchograms, and pleural effusions. |
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|
Term
| CAP, treatment of a pt who is otherwise healthy, no respiratory distress? |
|
Definition
| Doxycycline, erythromycin, macrolides (clarithromycin, azithromycin), or fluoroquinolones are appropriate |
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Term
| CAP, treatment with neutropenia, involvement of more than 1 lobe, or poor host resistance? |
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Definition
| Hospitalization. Also consider hospitalization for pts older than 50 with comorbidities, altered mental status, or hemodynamic instability |
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Term
| CAP, treatment of pt that is hospitalized? |
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Definition
| Consider coverage of strep pneumonia and Legionnella sp. with ceftriaxone or cefotaxime PLUS azithromycin or a fluoroquinolone |
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|
Term
| Who is the pneumococcal conjugate vaccine (PCV) recommended for? |
|
Definition
| As a series of 4 doses in children aged 6 weeks to 15 months |
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|
Term
| Who is the pneumonococcal polysaccharide vaccine (PPV) recommended for? |
|
Definition
| Children aged 2-5 years who have no been previously immunized, persons over 65, or anyone with chronic illness that increases risk of CAP |
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Term
| Typical manifestations: Low grade fever, cough, bullous myringitis, cold agglutinins. What pathogen causes this? |
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Definition
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|
Term
| Typical manifestation: Slower onset, immunosuppression, increased LDH, more hypoxemic than appears on CXR, interstitial infiltrates. What pathogen causes this? |
|
Definition
| Pneumocystitis Jiroveci (nee carinii) |
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|
Term
| Typical manifestation: Chronic cardiac or respiratory disease, hyponatremia, diarrhea, other systemic symptoms. What pathogen causes this? |
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Definition
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|
Term
| Typical manifestation: Longer prodrome, sore throat, hoarseness. What pathogen causes this? |
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Definition
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|
Term
| Typical manifestation: Single rigor, rust-colored sputum. What pathogen causes this? |
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Definition
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|
Term
| Typical manifestation: Currant jelly sputum, chronic illness, including alcohol abuse. What pathogen causes this? |
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Definition
|
|
Term
| What pathogen is more likely to cause pneumonia in alcohol abusers? |
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Definition
|
|
Term
| What pathogen is more likely to cause pneumonia in COPD patients? |
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Definition
|
|
Term
| What pathogen is more likely to cause pneumonia in cystic fibrosis patients? |
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Definition
|
|
Term
| What pathogen is more likely to cause pneumonia in young adults, college setting? |
|
Definition
Mycoplasma pneumonia
Chlamydia pneumoniae |
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|
Term
| What pathogen is more likely to cause pneumonia in air conditioning/water aerosolized water |
|
Definition
|
|
Term
| What pathogen is more likely to cause pneumonia post splenectomy? |
|
Definition
Encapsulated organism
Streptococcus pneumonia
Haemophilus pneumonia |
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|
Term
| What pathogen is more likely to cause pneumonia in leukemia/lymphoma patients? |
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Definition
|
|
Term
| What pathogen is more likely to cause pneumonia in children <1? |
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Definition
|
|
Term
| What pathogen is more likely to cause pneumonia in children <2 |
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Definition
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|
Term
| What is the most common cause of atypical CAP? |
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Definition
|
|
Term
| What is the clinical presentation of atypical CAP? |
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Definition
| Low grade-fever, mild pulmonary symptoms, non productive cough, myalgia, fatigue, which are self-limited, all occuring in otherwise healthy young adults |
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|
Term
| What are the lab findings in atypical CAP? |
|
Definition
Organisms usually are no detected
WBC normal
CXR shows segmental unilateral lower lung zone infiltrates or diffuse infiltrates |
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Term
| Treatment of atypical CAP, if bacterial is suspected? |
|
Definition
ABX: Erythromyocin (for suspected mycoplasm or legionella)
Tetracycline (for suspected Chlamydia) |
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|
Term
| Treatment of atypical CAP, if viral is suspected? |
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Definition
| Supportive measures, analgesics, fluids, cough suppressants. Tamiflu, if flu A |
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|
Term
| What is hospital-acquired pneumonia? |
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Definition
| Clinical infection more than 48 hours after admission to the hospital, ICU and mechanical ventilator patients are at the highest risk |
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|
Term
| What organism is the most likely cause of nosocomial pneumonia in the ICU? |
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Definition
| Pseudomonas aeruginosa, and they carry the worst prognosis |
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|
Term
| What are the lab findings for nosocomial pneumonia? |
|
Definition
Gram stain and culture of sputum and blood
CXR may help diagnosis |
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|
Term
| What is the treatment of nosocomial pneumonia? |
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Definition
| Empiric ABX: cefepime, ticarcillin/clavlanic acid, piperacillin/tazabactum, meropenem |
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|
Term
| Pneumonia HIV related, what is the most common cause? |
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Definition
| Pneumocystitis jiroveci, typically with CD4 <200 |
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|
Term
| What are the lab findings in pneumonia related to HIV? |
|
Definition
CXR is cornerstone of diagnosis; shows diffuse or perihilar infiltrates; no effusions
Sputum staining will establish diagnosis in 90% of its |
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|
Term
| Tx for pneumonia related to HIV? |
|
Definition
| Bactrim is the tx of choice, also the choice for prophylaxis treatment, which is recommended for those with a CD4 <200 or history of pneumocystis |
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|
Term
| How is mycobacterium tuberculosis acquired? |
|
Definition
| Inhaling organisms with aerosol droplets expelled during coughing by people with active disease |
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|
Term
| Patients who are infected with TB, and who develop the disease are consider to have what? |
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Definition
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Term
| 95% Patients who become infected with TB, but are no symptomatic, this is known as what? |
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Definition
| Latent TB infection, reactivation can occur in the setting of immune compromise |
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|
Term
| What are the clinical features of TB? |
|
Definition
Cough, most important symptom. Begins dry and progresses to productive, with or without hemoptysis, typically over 3 weeks or longer.
Fever, drenching night sweats, anorexia, and wt loss. Posttussive rales are classic |
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|
Term
| What are the lab findings in primary TB? |
|
Definition
| Homogeneous infiltrates, hilar/paratracheal lymph node enlargement, segmental atelaectasis cavitations with progression of disease |
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|
Term
| What are the lab findings for reactivation TB? |
|
Definition
| Fibrocavitary apical disease, nodules, infiltrates, posterior and apical segments of the right and left upper lobe |
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Term
| What represents healed primary infection? |
|
Definition
Ghon complexes (calcified primary focus)
Ranke complexes (calcified primary focus and calcified hilar lymph node) |
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|
Term
| What represents healed primary infection? |
|
Definition
Ghon complexes (calcified primary focus)
Ranke complexes (calcified primary focus and calcified hilar lymph node) |
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Term
|
Definition
| Abnormal permanent dilation of the bronchi |
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|
Term
| If you suspect bronchiectasis, what is the first lab you would like to do, and what would it show? |
|
Definition
| CT, dilated tortuous airways |
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|
Term
| What test could be performed to diagnose bronchiectasis? |
|
Definition
|
|
Term
| How are bronchiectasis exacerbations treated? |
|
Definition
| ABX, amox, augmentin, bactrim, tetracycline |
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|
Term
| What is seen on CXR in a patient with cystic fibrosis? |
|
Definition
| Hyperinfiltration, bronchiectasis |
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|
Term
|
Definition
Control infections, such as pseudomonas.
Lung transplant |
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|
Term
| Acute bronchitis is usually caused by what type of organism? |
|
Definition
|
|
Term
| What symptoms help differentiate from viral and bacterial acute bronchitis? If it bacterial, what antibx? |
|
Definition
| SOB, purulent, sputum. 2/3 tx for bacterial |
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|
Term
| In patients with bronchioloitis, what is the tx? |
|
Definition
| Supportive - fluids, O2, nebulizer albuterol |
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|
Term
| When would you hospitalize a patient with bronchioloitis? |
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Definition
|
|
Term
| What is the sign seen on Xray in a patient with epiglotitis? |
|
Definition
|
|
Term
| What is the treatment of epiglotitis? |
|
Definition
Hospitalization for IV ABX: Cefotaxime/Ceftriaxone + dexamethasone
Intubation if: dyspnea, rapid onset of sore throat, endolaryngeal abscess found on CT |
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|
Term
| What is the sign seen on Xray, in a patient with Croup? |
|
Definition
|
|
Term
| What view on Xray should be used for a patient that you suspect croup? |
|
Definition
PA neck film, may show steeple sign
Lateral neck film will differentiate croup from epiglottitis |
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|
Term
| What are the key signs of croup? |
|
Definition
| Harsh barking seal-like cough, inspiratory stridor, aphonia |
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|
Term
|
Definition
| Steroids, O2/humidifier, nebulizer treatments |
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|
Term
|
Definition
|
|
Term
|
Definition
Fatty liver and encephalitis
2-3 weeks post flu A infections, aspirin ingestion, or varicella |
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|
Term
| What is the tx of Reye syndrome? |
|
Definition
|
|
Term
| What labs would you do if you suspected flu? |
|
Definition
CBC (leukocytosis)
Nasal/throat swab |
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|
Term
|
Definition
Antipretics/cough
Zanamiviri or oseltamivir + ramanditine |
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|
Term
| How do you treat Pertussis? |
|
Definition
| Erythromycin, also tx close contacts of patient |
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|
Term
| What is the clinical presentation that could signify whooping cough (pertussis)? |
|
Definition
| Spasms of rapid coughing fits followed by deep, high pitched inspirations (the whoop) |
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|
Term
| In a PPD test, what is the reaction necessary to be considered a positive test in a individual with no risks? |
|
Definition
|
|
Term
| In a PPD test, what is the reaction necessary to be considered a positive test in a individual that is HIV positive, those who have came in close contact with TB pt, TB seen on CXR, or immunosuppressed by steroids? |
|
Definition
|
|
Term
| What is the histologic hallmark or TB? |
|
Definition
| Caseating granulomas on biopsy |
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|
Term
| What are the prominent side effects of INH? |
|
Definition
|
|
Term
| What can you coadminister with INH to reduce the likilihood of its main SE? |
|
Definition
|
|
Term
| What are the prominent side effects of RIF? |
|
Definition
|
|
Term
| What is the prominent side effect of EMB? |
|
Definition
| Optic neuritis (red-green vision loss) |
|
|
Term
| What is the SE of pyrazinamide? |
|
Definition
|
|
Term
| What are the prominent side effects of INH? |
|
Definition
|
|
Term
| What can you coadminister with INH to reduce the likilihood of its main SE? |
|
Definition
|
|
Term
| What are the prominent side effects of RIF? |
|
Definition
|
|
Term
| What is the prominent side effect of EMB? |
|
Definition
| Optic neuritis (red-green vision loss) |
|
|
Term
| What is the SE of pyrazinamide? |
|
Definition
|
|
Term
| Whats the treatment of pleural effusions? What if they're malignant? |
|
Definition
Thoracocentesis, underlying cause with diuretics
Doxy, if malignant |
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|
Term
| What is the treatment for tension pneumothorax? |
|
Definition
| Emergency needle decompression |
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|
Term
| What would a CXR show in a pneumothorax? |
|
Definition
| Mediastinal shift to the contra side |
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|
Term
| How often should f/u CXR be ordered after the first one, with a patient who has a pneumothorax? |
|
Definition
| Every 24hours until it has resolved |
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|
Term
| What is the treatment of sarcoidosis? |
|
Definition
|
|
Term
| How often should a CT be performed, on a patient with a coin lesion on imaging? |
|
Definition
| Every 3 months for the first year, if clear every 6 months for 2 years. |
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|
Term
| How do you diagnose a carcinoid tumor? |
|
Definition
| Bronchoscopy, well vascularized lesion |
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|
Term
| How do you treat carcinoid tumors? |
|
Definition
|
|
Term
| Where is a pancoast tumor located, and what is the complication typically? |
|
Definition
| Apex (top of the lugs), and it compressed the brachial plexus |
|
|
Term
| What is horners syndrome? |
|
Definition
| Ptosis, anhydrosis, miosis |
|
|
Term
|
Definition
| Oral fungal infection. White patches that DO rub off |
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|
Term
|
Definition
|
|
Term
| How do you treat a vaginal canidiasis infection? |
|
Definition
|
|
Term
| How do you treat candiasis fungemia? |
|
Definition
|
|
Term
| How do you treat endocarditis that is caused by candida? |
|
Definition
| IV Amphotercin B, and lifelong flucaonzole |
|
|
Term
| What is a common cause of histoplasmosis? |
|
Definition
| Bat droppings, transmitted via inhalation |
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|
Term
| How do you treat histoplasmosis? |
|
Definition
| Itraconazole, Amphotercin B if resistent |
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|
Term
| What is a common source of cryptococcosis? |
|
Definition
| Dried pigeon poop via inhilation |
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|
Term
| If cryptococcosis is in the lungs, what is the treatment? |
|
Definition
|
|
Term
| How do you treat pneumocystis? |
|
Definition
|
|
Term
| How does Botulism present? |
|
Definition
Food borne illness, infants (honey)
Diplopia, dry mouth, pupils fixed and dilated |
|
|
Term
| How do you treat botulism? |
|
Definition
| Antitoxin, within 24 hours |
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|
Term
| What is the treatment of chlamydia? |
|
Definition
| Azithromycin or doxycycline |
|
|
Term
| What is the preferred tx of chlamydia in a pregnant woman? |
|
Definition
|
|
Term
| How does Cholera present? |
|
Definition
| "rice water diarrhea", dehydration, electrolyte imbalance |
|
|
Term
| How do you treat cholera? |
|
Definition
Rehydration
Ampicillan, tetracycline |
|
|
Term
| What labs do you do for cholera? |
|
Definition
| Stool culture, serum agglutination |
|
|
Term
| Diphtheria commonly presents how? |
|
Definition
| Greyish membrane in the throat |
|
|
Term
| How do you treat diphtheria? |
|
Definition
Horse serum antitoxin
Penicillin or Erythromycin |
|
|
Term
| How does gonorrhea present? |
|
Definition
| Burning on urination, milking or serous discharge |
|
|
Term
| What labs do you order for suspected gonorrhea? |
|
Definition
|
|
Term
| What is the treatment of gonorrhea? |
|
Definition
Ceftriaxone or oral Cefixime
You also need to treat partners and chlamydia concurrently
Chlamydia - azithromycin or doxy |
|
|
Term
|
Definition
Usually with puncture wounds
Pain at the site, followed by muscle spams, jaw spasms |
|
|
Term
|
Definition
Tetnus immune globulin IM
Full course tetnus toxiod upon recovery
Penicillin |
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|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| What lab do you do for salmonellosis? |
|
Definition
| Diagnosis is made through stool culture |
|
|
Term
| What is the tx for salmonellosis? |
|
Definition
|
|
Term
| How do you treat shigellosis? |
|
Definition
| bactrim, replacement of fluid volume is essential |
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