Im Resp Pneumonia Usmle 2

Front 1

(3) Typical Sx of Pneumonia

Back 1

Fever;

Cough w/ sputum;

Pleurtic Chest pain

Front 2

(4) Physical Exam findings w/ Pneumonia

Back 2

Dullness to Percussion;
Rales (Crackles);
Egophany;
Tactile Fremitus in consolidated segment

Front 3

Bug Dx:
27-yo patient has pneumonia, bullous myringitis and a chest film that looks worse then expected

Back 3

Mycoplasma Pneumonia

Front 4

If a patient comes to the ER w/ consolidation and pleural effusion on CXR, what is the most important test to determine admission / Tx?

Back 4

Thoracentesis

Front 5

Bug Dx:
patient w/ HIV who has a CD-4 count of 52 does not take antiretroviral meds or TMP-SMX, is hypoxic on room air, and has a diffuse bilateral infiltrate on chest film

Back 5

PCP
(Pneumocystis Carinii Pneumonia)

Front 6

Bug Dx:
Elderly man presents w/ pneumonia, GI Sx, bradycardia, and hypoN

Back 6

Legionella

Front 7

Pneumonia Bug Dx:

Currant Jelly sputum

Back 7

Klebsiella

Front 8

Pneumonia Bug Dx:

Rusty sputum

Back 8

Pneumococcus

Front 9

Pneumonia Bug Dx:

patient develops a post-influenza pneumonia

Back 9

Pneumococcus

Front 10

Pneumonia Bug Dx:

Buldging fissure on CXR

Back 10

Klebsiella

Front 11

Pneumonia Bug Dx:

No bacteria on sputum gram stain culture
(2)

Back 11

Legionella


Mycoplasma

Front 12

Pneumonia Bug Dx:

signs of pneumonia and Serum LDH is high

Back 12

PCP

Front 13

MC Community Acquired, typical pneumonia
(2)

Back 13

S. pneumoniae


H. Influenzae

Front 14

MC Community Acquired, atypical pneumonia
(3)*

Back 14

Community Lung Mess:

Chlamydia pneumoniae;

Legionella;

Mycoplasma

Hint 14

Community Lung Mess

Front 15

MC Hospital Acquired pneumonia
(3)

Back 15

Pseudomonas aeruginosa;

S. aureus;

Enteric organisms (E. coli)

Front 16

What is the MCC of pneumonia (bugs) in the HIV patients as the CD-4 count decreases to the following numbers
(in order of occurrence)*:
1. < 500
2. < 200
3. < 200
4. < 200
5. < 50
6. < 50

Back 16

The Pneumonia HIV Causes Are Count-based:
1. TB (500)
2. PCP (200)
3. Histoplasma (200)
4. Cryptococcus (200)
5. Avium (mycoplasma) (50)
6. CMV (50)

Hint 16

The Pneumonia HIV Causes Are Count-based

Front 17

MCC of pneumonia in the immunocompromised host w/ Neutropenia
(4)*

Back 17

Pseudomonas;

Enterobacteriaceae;

S. Aureus;

Aspergillus

Hint 17

PESA

Front 18

MCC of pneumonia in the immunocompromised host w/ sickle cell or a splenectomy

Back 18

Encapsulated organisms

Front 19

MCC of pneumonia in the immunocompromised host w/ chronic Steroid use
(2)

Back 19

TB;

Nocardia

Front 20

MCC of pneumonia in Alcoholics
(4)

Back 20

S. pneumoniae;

H. Influenzae;

Klebsiella;

TB

Front 21

Pneumonia Bug Dx:

Small gram negative rod w/ a halo on gram stain

Back 21

H. Influenzae

Front 22

CXR pneumonia findings:

Upper lobe
(2)

Back 22

TB;

Klebsiella

Front 23

CXR pneumonia findings:

small cavities w/o air-fluid levels

Back 23

TB

(Mycobacterium)

Front 24

CXR pneumonia findings:

Large cavities w/ air-fluid levels that do not culture
(2)

Back 24

Coccidioidomycosis;

Nocardia

Front 25

CXR pneumonia findings:

Diffuse Bilateral Infiltrates
(2)

Back 25

PCP;

Mycoplasma

Front 26

Definition:
Idiopathic Eosinophilic Pneumonia

Back 26

Loeffler's pneumonia

Front 27

Pneumonia bugs causing "Relative Bradycardia"
(slower then expected HR for Temp, but above 60bpm)
(3)

Back 27

Legionella;

Salmonella;

Chlamydia Psittaci

Front 28

What drug prevents respiratory failure and improves survival in PCP pneumonia patients?

Criteria for when it is given?
(2)

Back 28

Steroids

give:
A-a gradient > 35
PaO2 < 75

Front 29

Drug of choice for:

Any Community Acquired Pneumonia w/ no risk factors

Back 29

Macrolide

(Erythromycin, Azithromycin)

Front 30

Drug of choice for:

Any Community Acquired Pneumonia w/ risk factors
(CHF, DM, etc)
(2)

Back 30

1. Macrolide + 2nd generation Cephalosporin

2. FQ (Extended-spectum)

Front 31

Drug of choice for:

Any Hospital Acquired Pneumonia
(2)

Back 31

1. Cefixime

2. Piperacillin-tazobactam

[both for Pseudomonas coverage]

Front 32

Drug of choice for:

Any Immunocompromised patient w/ Pneumonia

Back 32

TMP-SMX

[for PCP coverage]

Front 33

Dx:
Productive cough, night sweats, hemoptysis, anorexia, weight loss, chest pain, fever, chills

Back 33

TB

Front 34

(3) Dx tests for TB

Back 34

Positive PPD;

Granuloma in upper lobes of lung;

Acid-fast bacilli on sputum

Front 35

How is latent TB treated?

Back 35

INH daily for 9 months

(or Rifampin for 4 if in contact w/ INH-resistant TB)

Front 36

How is Active TB treated?

Back 36

RIPE for 2 months:
Rifampin; INH, Pyrazinamide; Ethambutol

followed w/ 4 months of:
INH and Rifampin

Front 37

How is tx of TB different w/ pregnant pt?

Back 37

No pyrazamide

(other med ok)

Front 38

Toxicity of INH
(2)*

Back 38

INH: Infects Neuro and Hepatic:

Neruopathy;
Seizures;

Hepatitis

Front 39

Dx:
patient brought by ambulance in status epilepticus. Patient says only medical history is TB

How is it treated?

Back 39

INH toxicity


Tx: Pyridoxine

Front 40

Toxicity of Rifampin
(2)

Back 40

Induces P450

Gives Red-orange secretions
(tears, urine, sweat, etc)

Front 41

Toxicity of Ethambutol

Back 41

Optic neuritis and impaired color vision