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Pulmonology > 08.19 - Pneumonia, CAP Part 1&2 (Cross) - Questions > Flashcards

08.19 - Pneumonia, CAP Part 1&2 (Cross) - Questions Flashcards

1
Q

Most of the time, the etiologic agent for CAP is

A

never identified

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2
Q

Definition of HAP

A

Appears >48 hours after hospital admission - Was not incubating at time of admission

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3
Q

Leading cause of death among hospital-acquired infections

A

Pneumonia

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4
Q

Highest risk for HAP is in patients ____

A

on mechanical ventilation

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5
Q

Gram stain of H Influenze

A

Gram Positive Diplo

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6
Q

Gram stain of Mycoplasma pneumoniae

A

Gram stain negative

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7
Q

Gram stain of Strep pneumoniae

A

Gram positive Diplo

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8
Q

Gram stain of Staph Aureus

A

Gram positive cocci in clusters

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9
Q

3 Main Categories of Risk Factors for Strep Pneumo

A

Alcohol/Drugs; Respiratory Tract abnormalities; Abnormal circulatory dynamics

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10
Q

How does alcohol/drug intoxication predispose to Strep Pneumo

A

Cerebral impairment –> Depressed cough reflex and increased aspiration of secretions

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11
Q

What abnormal circulatory dynamics predispose to Strep Pneumo

A

Pulmonary Congestion; Heart Failure

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12
Q

Why is sickle cell a risk factor for Strep Pneumoniae

A

Auto-splenectomy –> Encapsulated pathogens normally cleared from circulation by spleen

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13
Q

3 Main Virulence Factors of Strep Pneumo

A

Capsule; Lipoteichoic Acid; IgA Protease

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14
Q

Lipoteichoic Acid (Strep Pneumo)

A

Activates complement, induces cytokine production

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15
Q

IgA Protease (Strep Pneumo)

A

Enhances ability to colonize mucosa of URT

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16
Q

How is Strep Pneumo dx?

A

Urinary antigen and Gram Stain/Culture

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17
Q

4 features of Gram Stain/Culture of Strep Pneumo, other than Gram positive diplot lancet

A

A-Hemolytic; Catalase negative; Optochin Sensitive, Quellung Reaction

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18
Q

Hemolysis, Catalase status of Strep Pneumo

A

Alpha Hemolytic, Catalase negative

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19
Q

Quellung Reaction

A

Antibodies bind to capsule and it swells

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20
Q

Which can be used for Strep Pneumo: Ceftriaxone, Amoxicillin, Levofloxacin, Azithromycin

A

Any

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21
Q

If you have penicillin allergy and bad strep pneumo pneumonia, use what Ab?

A

Vancomycin

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22
Q

For strains of Strep Pneumo with reduced penicillin susceptibility, use

A

3rd gen Cephalosporin (Ceftriaxone) or Fluoroqinolones

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23
Q

For whom is Pneumovax recommended

A

All >65; 19-64 who are at increased risk

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24
Q

For whom is Prevnar recommended

A

Children and infants

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25
Q

Classic beta hemolytic bug

A

Strep pyogenes

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26
Q

Optochin test is used to distinguish

A

S Pneumoniae (sensitive) from Strep Viridans (resistant)

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27
Q

OVR,PS

A

Optochin Viridans Resistant, Pneumoniae Sensitive

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28
Q

S Pneumoniae pneumonia is usually of the ___ type

A

Lobar (as opposed to bronchial)

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29
Q

Leading cause of invasive bacterial disease in children, the elderly, and immunocompromised

A

S. pneumoniae

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30
Q

Most important virulence factor of Strep Pneumo

A

Capsule

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31
Q

Initial event in invasive pneumococcal disease

A

Attachment to epithelial cells, enhanced by pili

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32
Q

Cell wall componentes of strep pneumo contribute to

A

Inflammatory processes

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33
Q

Which strep pneumo component causes much of inflammatory processes

A

Cell Wall components

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34
Q

Walking pneumonia in 16 y/o

A

Mycoplasma Pneumoniae

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35
Q

Who gets Mycoplasma pneumonia most commonly

A

School-age children and military recruits

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36
Q

Most common cause of pneumonia in school-age children

A

Mycoplasma Pneumoniae

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37
Q

CXR in Mycoplasma pneumonia

A

usually looks worse than disease

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38
Q

Capsule that protects against phago is a property of

A

Strep Pneumo

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39
Q

Adhesin

A

Mycoplasma: Binds to ciliated epithelial cells and causes reduced ciliary clearance

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40
Q

How does Mycoplasma pneumoniae cause disease

A

Adhesin binds to ciliated epithelial cells and causes reduced ciliary clearance

41
Q

What bugs produce endotoxins that stimulate release of cytokines

A

Gram negatives in general

42
Q

4 dx tests used in workup of Mycoplasma infection

A

Serology, Eaton agar culture, PCR on respiratory secretions, Cold Agglutinins

43
Q

Why no gram stain with Mycoplasma

A

No cell wall

44
Q

What are Cold Agglutinins

A

IgM auto-Ab’s against Type O RBCs that agglutinate the cells at 4deg C, but not higher

45
Q

__ % of patients with Mycoplasma with have cold agglutinins

A

50%

46
Q

Cold Agglutinins =

A

Mycoplasma

47
Q

What is Bactrim

A

Sulfamethoxazole + Trimethoprim

48
Q

Sulfamethoxazole + Trimethoprim

A

What is Bactrim

49
Q

Vancomycin covers

A

Gram positive infections

50
Q

Why no penicillin for Mycoplasma

A

No cell wall

51
Q

Most common cause of Walking Pneumonia in 40 y/o

A

Chlamydia Pneumoniae

52
Q

Chlamydia pneumonia is very similar to __ in clinical presentation

A

Mycoplasma Pneumonia

53
Q

Tx of Chlamydia pneumonia

A

Doxycycline

54
Q

Dx test for Chlamydia pneumonia

A

No good test

55
Q

Principal Human Mycoplasma Disease

A

Mycoplasma Pneumoniae

56
Q

Mycoplasma pneumonia symptoms

A

Mild respiratory infection - sore throat and pharyngitis

57
Q

Primary Atypical Pneumonia

A

Mycoplasma Pneumonia

58
Q

Structure of Mycoplasma Pneumoniae

A

Pleomorphic, but polar (no cell wall)

59
Q

Relationship of Mycoplasma Pneumoniae to host cells

A

Attaches to surface of respiratory epithelia

60
Q

Inflammatory response in Mycoplasma Pneumonia is both __ and __

A

Protective and Pathogenic

61
Q

Chlamydia is often called the ___ epidemic

A

Silent

62
Q

Transmission of Chlamyidia Pneumoniae

A

Person to person by respiratory droplets or secretions

63
Q

Onset and symptoms of Chlamydia pneumonia

A

Most commonly asymptomatic; but can appear as gradual onset of cough –> Pneumonia or Bronchitis

64
Q

Chlamydia Pneumonia is most common in

A

School age children, but all ages at risk

65
Q

2 most common causes of Walking Pneumonia in school age children and adults

A

Mycoplasma and Chlamydia

66
Q

Why can’t you see Chlamydia Pneumo on Gram Stain?

A

Intracellular

67
Q

2 organisms that live in gut but cause HAP

A

Klebsiella and Enterobacter

68
Q

Fruity odor and Bluish-Green Pus

A

Pseudomonas

69
Q

Biggest risk factor for HAP

A

Mechanical Ventilation

70
Q

Where is Pseudomonas found

A

Wet environments

71
Q

Small, pleomorphic; Facultatively anaerobic; Nonmotile

A

H influenzae

72
Q

Non-fermentive, motile, oxidase positive, green pigment

A

Pseudomonas

73
Q

Lactose fermenting, indole-neg, incabable of growth at 10degC

A

Klebsiella

74
Q

Gram neg coccobacilli, non-motile, strictly aerobic, catalase positive, oxidase neg

A

A baumanii

75
Q

Mycoplasma pneumo: Capsule, Enterotoxin, Endotoxin and Exotoxin A, Adhesin

A

Adhesin

76
Q

Pseudomonas: Capsule, Enterotoxin, Endotoxin and Exotoxin A, Adhesin

A

Endotoxin and Exotoxin A

77
Q

Staph Aureus: Capsule, Enterotoxin, Endotoxin and Exotoxin A, Adhesin

A

Enterotoxin

78
Q

Strep pneumo: Capsule, Enterotoxin, Endotoxin and Exotoxin A, Adhesin

A

Capsule

79
Q

Exotoxin A

A

Blocks protein synthesis by inactivating EF-2 via ADP-ribosylation

80
Q

Blocks protein synthesis by inactivating EF-2 via ADP-ribosylation

A

Exotoxin A

81
Q

Action of virulence factors in Pseudomonas results in extensive

A

Vasculitis w/ thrombosis; Hemorrhage with necrosis

82
Q

Cefepine vs Ceftriaxone

A

4th gen cephalosporin vs 3rd: Pseudomonas coverage with 4th

83
Q

Good drug combo before susceptibility results in Pseudomonas

A

Cefepine + Cipro

84
Q

Zosyn

A

Piperacillin + Tazobactam

85
Q

Piperacillin + Tazobactam

A

Zosyn

86
Q

For cephalosporins, as you move up in generations:

A

Gram neg activity increases; Pseudomonas coverage increasese; CSF penetration increases

87
Q

Pneumonia in large group, think –>

A

Legionella

88
Q

Altered mental status, diarrhea, fever, dry cough

A

Legionella

89
Q

Legionella is a ___ pneumonia

A

Atypical

90
Q

CXR in Legionella pneumonia

A

Variable

91
Q

Gram stain in Legionella pneumonia

A

Macrophages

92
Q

Why no gram stain in Legionella

A

Intracellular

93
Q

Major virulence factor in Legionella

A

Cell Wall Endotoxin

94
Q

What causes host inflammatory response in Legionella

A

Cell Wall Endotoxin

95
Q

2 drugs for Legionella

A

Levofloxacin, Azithromycin

96
Q

Transmission of Legionella pneumo

A

Fomites and vehicles (esp water)

97
Q

Where does Legionella pneumo replicate

A

Alveolar macrophages (amoebas in resorvoir)

98
Q

Dot/Icm-

A

Type 4 secretion system in Legionella that prevents phagosome/lysosome fusion

Pulmonology (31 decks)

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