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CPR Exam 4 > Bacterial Pneumonias > Flashcards

Bacterial Pneumonias Flashcards

1
Q

What are the 4 most important signs of “typical” pnemonia?

A
  1. Acute onset
  2. Productive cough
  3. Lung consolidation (with chest x-ray)
  4. No extra-pulmonary symptoms
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2
Q

What are the 3 most important signs of “atypical” pneumonia?

A
  1. Slow onset
  2. Non-productive cough
  3. Frequent extra-pulmonary symptoms
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3
Q

What are the 3 most common causes of “typical” pneumonia if it is community aquired?

A
  1. Streptococcus pneumoniae
  2. Haemophilus influenzae
  3. Moraxella catarrhalis
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4
Q

What are the 3 most common causes of “atypical” pneumonia if it is community aquired?

A
  1. Legionella sp.
  2. Mycoplasma pneumoniae
  3. Chlamydophila pneumoniae
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5
Q

What is the definition of hospital aquired pnemonia?

A

Pneumonia occuring in a patient 7 days after hospitalization.

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6
Q

What cause of pneumonia will can you especially see in alcoholics and COPD patients?

A

Klebsiella (these patients are immune compromised)

(Furthermore… Although it’s rarely seen in Community Aquired Pneumonia, it is a cause of healthcare associated, hospital aquired pneumonias, and ventilator associated pneumonias.)

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7
Q

What sources of pneumonia will you especially see in cystic fibrosis patients?

A
  1. Pseudomonas aeruginosa (they love wet environments)
  2. Berkholderia
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8
Q

What the hell is this?

A
  • Gram positive
  • Diplococci
  • Streptoccocus pneumoniae
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9
Q

What is the empiric therapy for an in-patient with CAP?

A
  • Advanced macrolide (clarithromycin, azithromycin, etc… (anything except erythromycin)) + b-lactam (penicillin, ampicillin, carbapenem, etc.)
    or. ..
  • Repiratory floroquinolone (moxifloxacin, gemifloxacin, levofloxacin)
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10
Q

What is the empiric therapy for an outpatient with CAP?

A
  • Macrolide (clarithromycin, azithromycin, erythromycin, etc.)

or

  • doxycycline (unless you are pregnant)
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11
Q

What is the emperic therapy for a patient with CAP who already had recent antibiotic treatment?

A
  • Advanced macrolide (clarithromycin, azithromycin, etc… (anything except erythromycin)) + amoxicillin +/- clavulanate
    or. ..
  • Repiratory floroquinolone (moxifloxacin, gemifloxacin, levofloxacin)
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12
Q

What are 4 culture results for Steptococcus pneumoniae?

A
  • Growth on blood agar
  • Alpha hemolytic (brown, muddy)
  • Optocin disc sensitive
  • Positive bile solubility test (bile turns clear becayse it has lysed the Step. pneumo
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13
Q

What are the 2 mechanisms for Steptoccocus pneumoniae resistance and how is Pneumococci treated?

A
  1. Altered Penicillin Binding Protein (aka transpeptidase) = penicillin resistance
  2. Efflux pumps = resistance to macrolides, TMP/SMX, and fluroquinolones
  3. Penicillin, amoxicillin, ampicillin treatment for sensitive Pneumococci
  4. Respiratory floroquinolone treatment for restsitant strains
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14
Q

Describe the histologic features of Haemophilus influenzae and it’s 2 main virulence factor.

A
  1. Gram negative
  2. pleomorphic rod (it can change its shape)
  3. H. influenzae serotype b produces an anti-phagocytic capsule
  4. Both typable and non-typable strains produce beta-lactamase… so this means you need to treat it with Amoxicillin-clavulanate
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15
Q

Discribe the histological features of Moraxella catarrhalis.

A
  1. Gram neagtive
  2. Diplococci
  3. Aerobic
  4. Oxidase-positive
  5. Non-hemolytic on blood agar
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16
Q

What are the 2 most common causes of post-influenza pnuemonia?

A
  1. Steptococcus pneumoniae
  2. Staphylococcus aureus
17
Q

What bacteria is associated with necrotizing pneumonia?

A

Staphylococcus aureus (especially MRSA)

18
Q

What are some histological features of Staphylococcus aureus?

A
  1. Gram positive
  2. Cocci
  3. Beta-hemolytic (yellow color on blood agar)
  4. Catalase positive
  5. Coagulase positive
  6. Oxacillin resistant (MRSA)
19
Q

What does Legionella grow on, what symptoms does it cause, and how is it treated?

A
  1. BCYE agar (charcol = black)
  2. It does not gram stain (facultative intracellular pathogen)
  3. Fever, chills, non-productive cough, headache; affects the GI tract, liver, kidneys, etc.
  4. Affects immunocompromised patients
  5. Azithromycin or Levofloxacin
20
Q

What are the 2 causes of “walking pneumonia”?

A
  1. Mycoplasma pneumoniae
  2. Chlamydophila/chlamydia
21
Q

What is the pathogenesis of Mycoplasma pneumonia, does it show up on gram stain, and how is it treated?

A
  1. P1 adhesion protein mediates attachment to cilia. Cilia stop moving and epithelial cells die.
  2. It does not gram stain. (Fried-egg appearence in culture)
  3. Macrolides or respiratory fluoroquinolone
22
Q

What makes Chlamydophila so weird and how is it treated?

A
  1. It’s an obligate intracellular pathogen
  2. It exists as elementary (infective form) and reticulate bodies
  3. It does not gram stain
  4. Doxycycline (except for pregnant women and children) or macrolide
23
Q

What are the 3 most common causes of Hospital Aquired Pneumonia?

A
  1. Pseudomonas aeruginosa
  2. Klebsiella pneumoniae
  3. MSSA/MRSA
24
Q

What is the emperic therapy for Hospital Aquired Pneumonia?

A
  1. 4th generation cephalosporin or carbapenem or extended spectrum penicilin + beta-lactamase inhibitor
    • fluroquinolone or aminoglycoside
  3. If MRSA is suspected, add vancoymcin or linezolid
25
Q

What histological evidence would you see with Pseudomonas aerginosa?

A
  1. Gram negative
  2. Rod
  3. Aerobic
  4. Growth on blood agar and MacConkey agar
  5. Fruity odor
  6. Blue-green color
26
Q

What is the treatment for Psudomonas pneumonia?

A

Ticarcillin-clavulanate

or

Piperacillin-tazobactam with tobramycin

27
Q

What is distinguishing for Klebsiella pneumoniae and how is it treated?

A
  1. Gram negative
  2. Rod
  3. Catalase positive
  4. Oxidase negative
  5. Growth on blood agar and MacConkey agar
  6. Third gen. cephalosporin +/- aminoglycosides
28
Q

What are the distinguishing characteristics of Myocobacterium tuberculosis?

A
  1. Acid-fast (does not gram stain)
  2. Aerobic rod
  3. Night sweats
  4. Weight loss
  5. Cavitary lesions on x-ray
  6. Has recently been out of the US
29
Q

Who will develop primary vs. secondary (latent) tuberculosis?

A
  1. Primary - you develop miliary TB in immune-compromised or young children
  2. Secondary (latent) - devops in immune competent patients who had granulomas
30
Q

For a positive diagnosis, how large must the flare from a TB test be in various patients?

A
  • 15 mm - no risk factors
  • 10 mm - recent arrival from high-prevalent country
  • 5 mm - immunosuppressed patients
31
Q

What is the treatment for Mycobacterium tuberculosis?

A

RIPE - Isoniazid, Rifampin, Ethambutol, Pyrazinamide

32
Q

What the hell is this?

A

Mycoplasma pneumoniae (fried eggs)

33
Q

What the hell is this?

A

Klebsiella (slimey white mess on blood agar)

CPR Exam 4 (6 decks)

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