E1- Baterial Pneumonia I

Question 1

What type of pneumonia is an acute infection of the pulmonary parenchyma in a patient who is not immunocompromised and has acquired the infection outside of the hospital?

Answer 1

CAP (community acquired pneumonia)

Question 2

What type of pneumonia occurs 48 hrs or more after admission and did not appear to be incubating at the time of admission or 7-10 days after discharge?

Answer 2

HAP (hospital acquired pneumonia)

Question 3

What type of pneumonia develops more than 48 to 72 hours after an endotracheal intubation?

Answer 3

VAP (ventilator associated pneumonia)

Question 4

What are the common causes of CAP?

Answer 4

S. pneumoniae
H. Influenza
K. pneumonia
S. aureus

Question 5

What is the gold standard for dx of CAP?

Answer 5

Presence of an infiltrate on CXR with supportive clinical and microbiology findings

Question 6

What can be useful for rapid dx of pneumonia?

Answer 6

Gram stain of sputum

Question 7

What two main factors are considered with CAP outpatient treatment?

Answer 7

No major comorbidities

No abx in last 3 months

Question 8

What is pneumonia caused by streptococcus pneumoniae also called?

Answer 8

Pneumococcus

Question 9

What type of media must streptococcus pneumoniae be grown on? Why?

Answer 9

Blood because it supplies catalase for organism to survive aerobically

Question 10

Streptococcus pneumoniae grows poorly with what in the media? Why?

Answer 10

Glucose because lactic acidosis builds up

Question 11

In the growth of streptococcus pneumoniae on blood agar, the breakdown of ____ gives colonies a ____ appearance.

Answer 11

Heme

Green

Question 12

What are the three virulence factors associated with streptococcus pneumoniae?

Answer 12

Capsule*
Secretory IgA protease
Pneumolysin

Question 13

How does the thick polysaccharide capsule increase virulence in streptococcus pneumoniae?

Answer 13

Resists opsonization by complement

Question 14

How does the secretory IgA protease increase virulence in streptococcus pneumoniae?

Answer 14

Prevents organism from getting stuck in mucus of upper respiratory tract

Question 15

How does the pneumolysin increase virulence in streptococcus pneumoniae?

Answer 15

Produces cytotoxin

Question 16

A pt presents with sick appearance, high fever, productive cough, and well-defined consolidation on CXR. What do you suspect?

Answer 16

Typical pneumonia

Question 17

A pt presents with well appearance, low fever, non-productive cough, and non-defined patchy infiltrates on CXR. What do you suspect?

Answer 17

Atypical pneumonia

Question 18

What is clinically the most important a-hemolytic strep?

Answer 18

Streptococcus pneumoniae

Question 19

What is used for stereotyping Streptococcus pneumoniae?

Answer 19

Capsule

Question 20

What is responsible for releasing heme on blood agar in Streptococcus pneumoniae?

Answer 20

Pneumolysin

Question 21

What virulence factor did Griffith’s experiment show was most important in Streptococcus pneumoniae?

Answer 21

Capsule

Question 22

Griffith’s experiment discovered what bacterial capability?

Answer 22

Natural competence

Question 23

What is natural competence?

Answer 23

The ability of bacterial to uptake DNA from the environment

Strep pneumo can do this intra and interspecies

Question 24

What process is known to cause penicillin resistant Streptococcus pneumoniae?

Answer 24

Natural competence

Question 25

What induces the alternative pathway of complement in Streptococcus pneumoniae, leading to tissue damage?

Answer 25

Techoic acid and peptidoglycan

Question 26

What induces the classical complement pathway in Streptococcus pneumoniae, leading to tissue damage?

Answer 26

Pneumolysin

Question 27

What two vaccines are available for pneumoniae prevention?

Answer 27

Pneumovax 23 and Prevnar 13

Question 28

What is a possible complication of pneumococcal pneumonia?

Answer 28

Bacteremia

Question 29

Meningitis caused by what organism is more likely to lead to neurologic effects and mortality?

Answer 29

Streptococcus pneumoniae

Question 30

How is Streptococcus pneumoniae dx?

Answer 30

Gram stain and CXR +/- culture

Question 31

Is Streptococcus pneumoniae gram positive or negative?

Answer 31

Gram positive

Question 32

What test is used to dx bacteremia and meningitis?

Answer 32

Antigen detection

Question 33

What identifying factors would be noted from a culture with Streptococcus pneumoniae?

Answer 33

Green on blood agar (a-hemolytic) | Lysis by bile

Question 34

What is the DOC for Streptococcus pneumoniae?

Answer 34

Penicillins (beta-lactam)

Question 35

Is H. flu gram positive or negative? What shape?

Answer 35

Gram negative rodes

Question 36

Hib was at one time responsible for 95% of H. flu infections, but that number is now reduced to 2-4%. How did this happen?

Answer 36

Hib Vaccine

Question 37

What is a major difference between Streptococcus pneumoniae and H. flu?

Answer 37

Streptococcus pneumoniae w/o a capsule are avirulent, but H. flu w/o a capsule are virulent

Question 38

What are the virulence factors of H. flu?

Answer 38

``` Capsule LOS Fimbriae Neuraminidase IgA protease ```

Question 39

How is H. flu dx?

Answer 39

Gram stain, CXR, +/- culture, +/- LAT

Question 40

Is Klebsiella pneumoniae gram positive or negative? What shape?

Answer 40

Gram negative bacillus

Question 41

What is the # cause of pneumoniae in alcoholics? What is a close second?

Answer 41

Streptococcus pneumoniae | Klebsiella pneumoniae

Question 42

What organism is a major source of abx resistance world wide?

Answer 42

Klebsiella pneumoniae

Question 43

What are the virulence factors of Klebsiella pneumoniae ?

Answer 43

Slime capsule LPS Adhesins

Question 44

What organism causes necrotizing CAP that is often fatal even with abx treatment?

Answer 44

Klebsiella pneumoniae

Question 45

How is Klebsiella pneumoniae dx?

Answer 45

Gram stain, CXR (cavities), culture, currant jelly sputum | Susceptibility

Question 46

What is required for treatment of Klebsiella pneumoniae?

Answer 46

Susceptibility testing

Question 47

What type of agar should you use to culture Klebsiella pneumoniae? Why?

Answer 47

MacConkey Agar Selects for gram - Differentiates b/w lactose +/-