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CRRAB 2 > 3: Resp ID 2 Handout > Flashcards

3: Resp ID 2 Handout Flashcards

1
Q

What are pneumocytes? What are type 1 pneumocytes?

A

Cells lining alveoli. 1: large thin cell doing gas exchange, cannot replicate, susceptible to toxins.

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2
Q

Type 2 pneumocytes

A

Produces and secretes surfactant. Granular, smaller, found @ alv septal junctions, can replicate and replace damaged type 1s

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3
Q

Alveolar defenses (3 main things)

A

Alveolar macrophages (most important), complement, alveolar lining fluid containing surfactant, phospholipid, IgG, IgE, IgA, sec IgA, Factor B, B&T cells

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4
Q

What helps to facilitate ingestion of microorganisms by alveolar macrophages?

A

IgG opsonization (slower phagocytosis if nothing can opsonize)

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5
Q

What do alveolar macrophages do once they have phagocytosed? (2)

A
  1. Present antigens on its surface activating B and T cells -> further activation of macrophages & prod of antibody 2. Release factors to stim immune response
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6
Q

2 ways microorganisms get around alveolar macrophages (general)

A
  1. kill them 2. survive inside them
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7
Q

Mechanisms to avoid phagocytosis (5)

A

capsule, toxin prod, large size (parasites & fungi), enter cells, mimicry

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8
Q

What toxins might a microorganism produce to avoid phagocytosis?

A

cytotoxins, leukocidins, exotoxin

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9
Q

Mechanisms to survive in a phagocyte (4)

A

Inhibition of lysosome fusion w phagosome, escape phagosome, resistance to digestion, growth in phagocyte

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10
Q

How does Legionella pneumophila handle alveolar macrophages?

A

Grows in the phagocytic ell

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11
Q

How does the influenza virus deal with alveolar macrophages?

A

Escapes the phagosome

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12
Q

Two major bacteria that utilize capsules to avoid phagocytosis?

A

S. pneumo and H. flu

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13
Q

Unilateral vs bilateral pneumonia suggest what?

A

Bilateral: hematogenous spread. Unilateral: transmitted via bronchioles

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14
Q

How might exogenous penetration or contamination of the lung occur?

A

Accident/trauma or surgery

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15
Q

By what microorganism-dependent mechanism might pneumonia result in fever and septic shock?

A

Endotoxin from gram negative

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16
Q

Common causes of bronchitis (8)

A

Influenza viruses A and B, parainfluenza viruses, adenovirus, respiratory syncytial virus (RSV), rhinovirus, coxsackievirus groups A and B

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17
Q

Fever with bronchitis is suggestive of what type of microorganism (general)

A

Bacteria

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18
Q

What level of the respiratory system is affected in bronchiolitis? (What is the cutoff)

A

Airway down to bronchioles but not involving alveoli

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19
Q

How can RSV be diagnosed? Who would this be done for?

A

Antigen tests of nasal washings, done for hospitalized children and those at risk for severe disease

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20
Q

What treatment options for RSV bronchiolitis are available for high risk children?

A

RespiGam (IG vs RSV) or palivizumab (humanized mab vs RSV)

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21
Q

Influenza: mild strain and strains causing most epidemics

A

Mild: C
Epidemics: A & B

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22
Q

Presentation of influenza

A

sudden onset high fever, chills, rigors, HA, congested conjunctiva, extreme prostration, myalgia, non-prod cough

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23
Q

Influenza sx usually only seen in children (2)

A

Diarrhea, vomiting

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24
Q

Clinical course of influenza

A

fever 3-4d, recovery w/in 1 week though cough and tiredness may be 2+ weeks

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25
Q

Influenza -> bact pneumonia 2* infection most common organisms (4)

A

Staph aureus, H flu, Strep pneumo, Strep pyogenes

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26
Q

Timing of being contagious

A

1 day before symptoms til ~5 days after onset.

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27
Q

How can you differentiate influenza from the common cold?

A

Flu: high fever. Common cold: generally afebrile.

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28
Q

Clinical course of pertussis

A

Incubation 7-10d, increasing severity of cough for 1-2w -> 2nd phase: episodic sudden cough 2-4w

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29
Q

Lab dx of pertussis (3 options)

A

narsophary aspirates plated on Bordet-Gengou medium, IF staining, ELISA

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30
Q

Lab abnormality often seen in pertussis in children

A

WBC shows lymphocytosis (weird for bacterial)

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31
Q

Treatment of pertussis

A

Erythromycin if before phase 2, otherwise supportive

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32
Q

Pertussis prophylaxis

A

All close contacts treated wtih antibiotics regardless of immunization status

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33
Q

Most common causes of typical pneumonia (5)

A

Most common: strep pneumo

Others: Klebsiella, H. flu, Moraxella catarrhalis, Staph aureus

34
Q

How does clinical presentation of atypical pneumonia differ from typical?

A

Gradual onset of dyspnea and cough (non-prod). More prominent extrapulm signs e.g. HA, sore throat, diarrhea

35
Q

3 major causes of atypical pneumonia

A

Mycoplasma (walking pneumonia), chlamydia, legionella

36
Q

What types of atypical pneumonia are more common in young adults? Assoc sx (2)

A

Mycoplasma pneumonia and chlamydia pneumonia. Often w pharyngitis and milder whereas Legionella can be quite severe

37
Q

Viral cause of pneumonia in children

A

RSV, influenza

38
Q

Viral cause of pneumonia in immunocomporomised

A

CMV

39
Q

Cause of pneumonia in patients with chronic corticosteroids? Manifestation?

A

Nocardia. Fever, cough, cavities or nodules that can look like TB.

40
Q

Most common causes of pneumonia in neonates

A

Strep agalactiae (GBS) and e.coli

41
Q

Most common causes of pneumonia in children 6 weeks - 18 years

A

Viruses (RSV & influenza), mycoplasma pneumo, Chlamydia pneumo, strep pneumo

42
Q

Most common causes of pneumonia in adults 18-40

A

Mycoplasma pneumo, chlamydia pneumo, strep pneumo

43
Q

Most common causes of pneumonia in adults 40-65

A

Strep pneumo, H flu, anaerobic bacteria, viruses

44
Q

Most common causes of pneumonia in elderly >65

A

Strep pneumo, viruses, anaerobic, H. flu, Gram neg rods

45
Q

Most common causes of nosocomial pneumonia

A

Gram neg rods, staph aureus (MDR)

46
Q

Most common causes of pneumonia in immunocompromised patients

A

Gram neg rods, strep pneumo, fungi, filamentous bacteria, pneumocystis jiroveci, viruses

47
Q

Pneumonia special risks - gross aspiration

A

Anaerobes

48
Q

Pneumonia special risks - alcoholics

A

Strep pneumo, klebsiella pneumo, anaerobes

49
Q

Pneumonia special risks - IV drug use

A

Staph aureus

50
Q

Pneumonia special risks - post viral secondary infection

A

staph aureus

51
Q

Chronic steroids

A

nocardia spp

52
Q

What is the most common cause of meningitis in newborns?

A

Strep agalactiae (GBS)

53
Q

Virulence factor of strep agalactiae (1)

A

capsule

54
Q

Clinical presentation of strep agalactiae

A

Neonatal meningitis, neonatal pneumonia, neonatal sepsis

55
Q

How do neonates get strep agalactiae?

A

Present in maternal genital tract. Causes pneumonia within days or meningitis within weeks.

56
Q

Classification of strep agalactiae (gram, hemolysis, bacitracin)

A

Gram + cocci, beta hemolytic, bacitracin resistant.

57
Q

Treatment for strep agalactiae

A

Penicillin G

58
Q

Mycoplasma pneumonia characteristics (gram, shape, microscopic appearance)

A

Gram staining doesn’t work. Pleomorphic, no cell wall. Resistant to beta lactams. Fried egg appearance.

59
Q

Diagnosis of mycoplasma pneumoniae

A

Presence of cold hemagglutinin, fried egg, serology.

60
Q

Treatment of mycoplasma pneumoniae

A

Erythromycin or tetracycline

61
Q

Mycoplasma pneumoniae pathology

A

Adheres to ersp epithel, inhib ciliary motion, destroys mucosa. B cell response can -> autoreactive ab vs erythrocytes (IgM - cold agglutinins), brain, and heart.

62
Q

Clinical presentation of chlamydia pneumoniae

A

Atypical pneumonia

63
Q

Pathology of chlamydia pneumoniae

A

Obligate intracellular parasite (phagocytosed by macrophages). Lymphocytes respond -> local pulm edema, necrosis, hemorrhage

64
Q

Diagnosis of chlamydia pneumoniae

A

Giemsa stain to see intracytoplasmic inclusions. Serology.

65
Q

Treatment for chlamydia pneumoniae

A

Doxycycline

66
Q

Staph aureus virulence factors

A

Protein A (grabs Fc portion), coagulase, hemolysins, leukocidins. Deeper infec w hyaluronidase, staphylokinase, lipase.

67
Q

Treatment of staph aureus

A

Penicillinase-resistant penicillins or vanco

68
Q

Legionella = common cause of ____ in _(group)__

A

comm-acquired pneumonia in elderly smokers

69
Q

Legionella’s usual route of infection

A

Inhabits water reservoirs -> inhaled aerosols from resp devices and air conditioners

70
Q

Microscopic happenings with Legionella

A

Pili -> adhesion to resp epithel. Alveolar macs phagocytose -> prolif in macs -> secrete PMN chemoattractants -> pontiac fever or Legionnaire’s disease (atypical pneumo, severe)

71
Q

Legionella diagnosis

A

Poor gram stainer - use silver stain. Cultures on charcoal yeast extract with iron and cysteine. Serology.

72
Q

Treatment of Legionella

A

Erythromycin

73
Q

What has decreased the incidence of pneumocystis jirovecii pneumonia (PCP) in AIDS patients?

A

TMP-SMX prophylaxis at CD4+ count of <200

74
Q

Diagnosis of pneumocystis jirovecii

A

Sputum silver stain. Bronchoalveolar lavage or lung bx. Cysts forming dark oval bodies.

75
Q

Treatment of PCP

A

TMP-SMX or pentamidine

76
Q

How do immunocompromised individuals get PCP?

A

jirovecii is inhaled by most during childhood -> latent in lungs -> immunocomp -> infec

77
Q

Clinical presentation of nocardia asteroides

A

Pneumonia, abscesses in kidney and brain

78
Q

Diagnosis of nocardia. What must it be distinguished from?

A

Gram + aerobe, weakly acid-fast. Presentation can resemble TB. Distinguish by beaded, filamentous growth.

79
Q

Pathology of nocardia asteroides

A

Found in soil, inhaled. Phagocytosis -> intracellular prolif -> caseous granulomas -> pneumonia with cavitations. Hematog spread -> abscesses in kidney and brain

80
Q

Treatment of Nocardia asteroides

A

TMP-SMX, surgical drainage of abscesses

81
Q

Nocardia infection is common in

A

Immunocompromised patients, pts on corticosteroids.

CRRAB 2 (12 decks)

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