8/11/2019 For Pulmonary Infections TB

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For Pulmonary infections TB

1.

According to the American Thoracic Society Guidelines a patient who has treatment initiated as

an outpatient for community acquired pneumonia with no underlying cardiopulmonary or other

modifiers should be treated with either of the below except:

a.

Advanced generation macrolide

b.

Azithromycin or clarithromycin

c.

Doxycycline

d.

IV. Anti-pseudomonal fluoroquinolone

2.

In community acquired pneumonia one can expect to recover the causative organism in what

percentage of cases?

a.

90%

b.

< 50%

c.

65%

d.

Almost never

3.

The most common mechanism of pulmonary infection in an otherwise healthy individual is by:

a.

Gross aspiration of oral flora in a person with periodontal disease

b.

Microaspiration as might occur while asleep

c.

Direct extension from a nearby foci

d.

From a penetrating wound to the chest cavity

4.

Host protective mechanism which help fortify us against inoculation and subsequent infection

of the lower respiratory tree are all except;

a.

Entrapment in the mucous layer and sweeping up the mucociliary escalator of potentially

infectous material to the oropharynx to be swallowed or expectoratedb.

Small particles in the range of 0.5 -2.0 microns, are deposited in the alveoli, where alveolar

macrophages phagocytize and destroy most pathogens

c.

Use of anti-bacterial rinses to keep down the microorganism in the oral cavity

d.

An intact gag reflex

e.

Specific antibodies which opsonize greatly augment the ability of neutrophils and

macrophages to phagocytize and destroy the bacteria

5.

The nonspecific sign(s) which may be the only prevailing clue to infection in the elderly and the

immunocompromised is/are :

a.

Loss of appetite

b.

Confusionc.

Dehydration

d.

Worsening of chronic disease

e.

All of the above

6.

Clinical features of concern in CAP(community acquired pneumonia) include all except

a.

Reparatory rate of >30

b.

Diastolic B/P of >90mmHg

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c.

Evidence of poor end organ perfusion i.e., confusion or a ^BUN or creatinine level

d.

multilobar disease on chest x-ray

e.

hypoxemia

7.

You go down to see a patient who was brought in smelling of ETOH. You immediately notice him

in a fit of cough that is productive of purulent foul smelling sputum in which streaks of blood are

noted. Examination of the oral cavity reveals significant caries and periodontal disease. He has

had malaise, fever associated with cough and weight loss. He has a Temp. of 102F. His lungs

have course rhonchi throughout all lung fields. Chest x-ray shows diffuse pulmonary process c/w

pneumonia . There is a cavitary lesion in the upper left upper lobe with an air fluid level

measuring >4cm. The hilum appears full.(suggesting adenopathy ) diagnostic concerns in this

patient are all except:

a.

Lung abscess

b.

Post obstructive pneumonia

c.

Bronchogenic carcinoma with both a and b

d.

Empyema

e.

Influenza with a secondary bacterial pneumonia

8.

You are called in as an infectious disease consultant. It has been observed that many patients in

the ICU on ventilators have acquired a strange ventilator acquired/ associated pneumonia.

Routine cultures of respiratory secretions have yielded no organisms on standard medium. Fiber

optic bronchoscopy and BAL were performed and the respiratory tubing fluid was cultured An

aquatic protozoan Harmonella vermiformis with an unidentified intracellular bacteria was

noted. Chest x-ray showed a fibro purulent multifocal pneumonia in all patients developing over

several days becoming confluent and c/w a lobar pneumonia. Silver staining of the bronchial

fluid revealed copious mononuclear phagocytes( high monocyte to neutrophil ratio )many

destroyed in the center of the leukocytoclastic regions. Noted were copious silver staining

bacteria in side large bubbly appearing macrophages. Direct florescent antibody staining was

positive for the organism. AFB pending. The most likely diagnosis is:

a.

Hospital acquired ventilator associated pneumonia

b.

Legionella pneumophilia pneumonia from contaminated ventilator tubing by an aquatic

protozoan which happens to be parasites of the fresh water amoebae Hartmanella and

Acanthamoeba. It grows on specialized media having an absolute requirement for L-

cysteine. Optimal growth is on buffered charcoal yeast medium supplemented with iron, L-

cysteine, and alpha-ketoglutarate

c.

Aspiration pneumonia due to loss of protective gag reflex in a intubated individual

d.

TB

Ans. 1.-d, 2.-d, 3.-b, 4.-c 5.-e, 6.-b, 7.e, 8-b