Infectious Pulm
Patient presents with drenching night sweats & a cough with hemoptysis, along with fever, anorexia, weight loss and progressive cough. Describe the bacterium.
What is: Aerobic, acid-fast & nonencapsulated bacteria
Mycobacterium tuberculosis
It is not severe. She is being Tx with medication?
Itraconazole for weeks or months
If severe: Amphotericin B
Kaleigh, Beth, & Jenny went on a cruise for continued-medical-education training (for free!). However, they all developed a nonproductive cough, SOB, HA, diarrhea, and nausea :(.
What did they contract + Tx?
Legionella Pneumophilia
Tx: Erythromycin or doxycycline
What hallmark finding in a patient with acute glomerulonephritis in urine?
RBC casts!
What is the Renal Protocol & when do you do it?
CT scan abdomen pelvis WITHOUT contrast
done to evaluate acute flank pain + renal colic --> stone disease (Nephrolithiasis)
(renal cell carcinoma, Wilms tumor, CKD uses contrast)
Patient with drenching night sweats & hemoptysis is receiving Tx. Patient is experiencing red-green vision loss. What medication within the Tx regime is causing the problem?
Ethambutol, is causing the optic neuritis
Other meds include Rifampin (orange bodily fluids), Isoniazid (given w/ B6 b/c peripheral neuropathy), and Pyrazinamide.
Farmer Beth Kulp was petting her pigs in the compost piles, also dead leaves, stored grains, and decaying vegetation. (She has a lot of pigs) What are the major presenting symptoms with this condition?
Aspergillosis
S+S: Fever, pleuritic chest pain, hemoptysis, SOB
Patient is presenting with low grade fever, nonproductive cough and bullous myringitis. My CXR demonstrates patchy interstitial pattern. Who am I + Tx?
Mycoplasma Pneumonia
Tx: Azithromycin, erythromycin, or doxycycline.
Elderly man (above age 65) presents with significant back pain, nocturia, urinary frequency & hesitancy. What is top differential & what do you feel on prostate exam?
Prostate cancer ----> induration, nodules on prostate.
(BPH (incorrect) is enlarged, firm, smooth)
(Prostatitis (incorrect) = boggy)
What are 1st line Tx of patient presenting w/ urinary fq., urgency, dysuria?
Cystitis.
Nitrofurantoin (Macrobid) 100mg Bidx5d
Bactrim Bidx3d
Fosfomycin powder packet
Antispasmodic --> Pyridium as needed to relieve pain
Recent stroke patient with esophageal motility d/o presents with weight loss, anemia, chest pain, chills, hemoptysis, fever and a productive, putrid, sour-tasting cough, all developing over the past month. What is the likely Dx?
Lung Abscess (secondary to aspiration pneumonia)
Tx: Ampicillin-Sulbactam (unasyn) or Imipenem
Jenny was digging in the soils of NYC (?) and have contracted pneumonia :(. Her CD4 count is less than 50. What special symptoms is she experiencing?
C. neoformans
CD4 < 50 = CNS symptoms: HA, mental status change, visual abnormalities, Meningeal signs
Tx w/ Amphotericin B x 2weeks then switch to oral fluconazole.
What are the reasons of CRUB-65 to admit a patient for Pneumonia?
Confusion, Bun<19, Respiratory Rate>30, Age>65,
Systolic<90 or diastolic<60
(only need 1 to admit)
Male patient with unilateral hydronephrosis of L kidney due to proximal renal calculus causes partial obstruction. What is next step if stone is <5 mm?
Give Tamsulosin & urology referral.
An 18 month old is presenting w/ 5th UTI in the year + a fever. What diagnostic is needed for this condition to confirm?
Vesicoureteral Reflux (VUR) - when valve btwn ureter &bladder neck has poor closure
Need a Voiding Cystourethrogram (VCUG)
Patient presents with smelly sputum, Hx of periodontal disease, does not have rigors, and was given amoxicillin and has not responded. What is the likely Dx & Tx?
Chemical aspiration Pneumonia
Tx with steroids & keep O2 above 90 (+ Augmentin or doxy if immunocomp. as prophylaxis)
A patient Dx with typical Community Acquired Pneumonia has fever, productive cough, and SOB. What are the physical exam findings?
SHaKeM (Strep pneumonia, hemophilis, Klebseilla, Moxella)
PE: Crackles, Dullness to percussion, increases tactile fremitus, bronchial breath sounds, egophony, bronchophony.
What is the Tx for CAP typical?
Tx: Amoxicillin 1g PO TiD x10-14 days or Doxy 100mg Bid
Comorbid conditions = Azithromycin or Doxycycline.
What lab value indicates immunity from Hepatitis B?
Anti-HBs
HBs-AG = active infx
Anti-HBc = active infx (3-6mo persistance)
HBeAG = active infectivity
A patient presents with dyspnea and hemoptysis followed by an URI. When doing a CXR, you see shifting infiltrates in lung. This condition is autoimmune with Tx including plasma exchange therapy & immunosuppressants & steroids. What is this condition? (HINT: it is composed of a 1 urinary condition & 1 general pulmonary symptom/syndrome)
Good Pasture Syndrome
Glomerulonephritis & Pulmonary hemorrhage, caused by Antibodies to the glomerular basement membrane.
What is the Pneumonia associated with CD4 count BELOW 200 cell/uL &&&& What about ABOVE 200 cells uL?
Bonus Q: What is the Tx?
<200 cells/uL = Pneuomcystis jirovecii
>200 cells/uL = Streptococcus Pneumonia
Tx (& prophylaxis if CD4 is under 200) = Bactrim (trimethoprim-sulfamethoxazole.
(old review, if CD4 <50, prophylaxis Tx is azithromycin!)
A patient with Cystic Fibrosis, 72 hours into her hospital stay, has developed fever, leukocytosis and purulent secretions, consistent with Pneumonia. What specific pathogen caused her illness & name the Tx options.
Hospital Acquired Pneumonia - Pseudomonas, S. aureus, MRSA
- Ceftriaxone, Fluoroquinolone, Vancomycin
- Carbapenem, Fluoroquinolone, Vancomycin
- Piperacillin/tazobactam (zosyn), Fluoroquinolone, Vancomycin
Patient with CD4 @ 150 cells/uL is presenting with what symptoms & what is the gram stain + morphology ? (hint, what are Buzz terms assoc. w/ this condition)
Streptococcus Pneumonia
Typical presentation (productive cough, fever, sob), rust-colored sputum, high WBC, Gram-positive encapsulated diplococci
What lab indicates there is an adrenal issue, not a pituitary, when wanting to do a CT scan for Cushing's Disease?
LOW plasma ACTH = adrenal tumor
High plasma ACTH = pituitary tumor
In a patient with flank pain, shaking chills, + CVA tenderness, as well as cystitis symptoms, What is Inpatient v Outpatient meds?
Pyelonephritis
Outpatient - Quinolone 7-10days
Inpatient - Rocephin (cephatriaxone) 1gm IV daily until stable --> fluroquinolone (7-10 days total incl IV Tx)