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Pulmonary > Final > Flashcards

Final Flashcards

1
Q

Acute Pneumonia - community acquired –> which bugs?

A

S. pneumoniae
H. influenza
Influenza virus

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2
Q

Acute pneumonia - nosocomial –> which bugs?

A

Staph aureus

gram negatives

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3
Q

Acute pneumonia - opportunistic –> which bugs?

A 
pseudomonas
pneumocystis
CMV
adenovirus
herpes
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4
Q

Acute stage of pneumonia

A

polys in alveoli

macrophages later

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5
Q

Resolving stage of pneumonia

A

polys gone
many macrophages
infiltrates are cleared
alveolar walls intact

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6
Q

Organizing stage of pneumonia

A

granulation tissue in terminal bronchioles & alveoli

fibrosis

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7
Q

What are the stages of pneumonia?

A

Acute –> resolving –> organizing

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8
Q

What is the typical causative organism for lobar pneumonia?

A

Strep pneumoniae

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9
Q

Which 2 spots is aspiration pneumonia most likely to settle?

A

Posterior segment of upper lobe

Superior segment of lower lobe

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10
Q

What is used to ID the legionella bacteria?

A

Dieterle silver stain

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11
Q

When would you see prominent basophilic inclusions?

A

Atypical pneumonia caused by adenovirus

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12
Q

When would you see prominent eosinophilic nuclear inclusions?

A

Atypical pneumonia caused by herpes simplex virus

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13
Q

When would you see both nuclear AND cytoplasmic inclusions?

A

Atypical pneumonia caused by CMV virus

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14
Q

When would you see oval-crescentic GMS+ cysts?

A

Pneumocystis jiroveci (carinii) pneumonia

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15
Q

When would you see an abundance of plasma cells in the alveolar walls?

A

Pneumocystic jiroveci (carinii) pneumonia

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16
Q

When would you see a gram stain with lots of WBCs but no organisms?

A

Legionella pneumonia

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17
Q

What would you think if the patient isn’t responding to “conventional” antibiotics?

A

Could be legionella pneumonia, esp if the cultures don’t reveal a pathogen

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18
Q

What is the best way to diagnose legionella? Be specific.

A

Culture!

-use BCYE –> buffered charcoal yeast extract, supplemented & made selective

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19
Q

When would you see a bullous otitis media?

A

Mycoplasma infection

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20
Q

Spherules are pathognomonic of what?

A

Coccidiodes immitis (dimorphic fungi)

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21
Q

Where is Coccidiodes immitis endemic?

A

Southwest US

22
Q

Where is Histoplasma capsulatum endemic?

A

Central US

23
Q

What is the mechanism of action of amphotericin B?

A

Binds to Ergosterol (the primary fungal cell membrane sterol)
Direct toxicity to cell membrane –> punches holes in it, making it more leaky

24
Q

What is the mechanism of action of azoles?

A

Inhibits the cytochrome P450 which converts lanosterol to ergosterol (the primary fungal cell membrane sterol)
Interferes with cell membrane synthesis

25
Q

In general, uses of fluconazole?

A

Active against yeasts, NOT against molds

26
Q

what is the mechanism of action of echinocandins?

A

inhibit the fungal beta(1,3)-glucan synthase

depletes beta-glucan, a ubiquitous fungal cell wall constituent

27
Q

Dirty pneumonia

A

adenovirus

28
Q

Etiology of otitis media

A

Streptococcus pneumoniae - 35-40%
Nontypable H influenzae - 25-30%
Moraxella catarrhalis - 15-20%

29
Q

Spread of Hib v. NTHI

A

Hib spreads through hematogenous means

NTHI spreads locally

30
Q

Hib v. NTHI evolutionary history

A

Hib is clonal

NTHI is genetically diverse

31
Q

Causative pathogens for COPD exacerbations

A

H. influenzae > Moraxella catarrhalis > Strep pneumoniae > Pseunomonas aeruginosa

32
Q

Strep pneumoniae v. other viridans strep

A

Strep pneumoniae is optochin sensitive

Other viridans strep are optochin resistant

33
Q

Mechanism of strep pneumoniae intermediate penicillin resistance

A

transformation with penicillin binding protein genes from closely related species

34
Q

Mechanism of strep pneumoniae high level penicillin resistance

A

trasformation with penicillin binding proteins genes from closely related species
+ spontaneous mutations

35
Q

Rx for penicillin suceptible pneumococcal pneumonia

A

penicillin
cephalosporins
fluoroquinolones

36
Q

Rx for penicillin resistant pneumococcal pneumonia

A 
penicillin (high doses)
cephalosporins
fluoroquinolones
vancomycin
linezolid
37
Q

What bug might you see after the use of a lot of carbapenems?

A

Stenotrophomonas maltophilia

38
Q

First choice drug for Pneumocystis jiroveci (Pneumocystis carinii)

A

Trimethoprim-sulfamethoxazole

39
Q

most common extrapulmonary site for nocardia infection

A

Brain

40
Q

Primary treatment for nocardia infection

A

Sulfonamides

41
Q

Ecthyma gangrenosum is strongly associated with which infection?

A

Pseudomonas aeruginosa

42
Q

What infections do you see with terminal complement deficiencies (C6-C9)?

A

Neisseria, esp Neisseria meningitidis

43
Q

Treatment of lung abscess

A

Clindamycin

44
Q

Lung abscess characterized by what?

A

Foul-smelling sputum

history of poor dentition & loss of consciousness

45
Q

Treatment of allergic bronchopulmonary aspergillosis

A

Itraconazole (antifungal) + steroid

46
Q

What is the mechanism of action of terbinafine (lamisil)

A

inhibits squalene epoxidase, an enzyme involved in ergosterol synthesis

47
Q

What is the major use of flucytosine?

A

in combination with amphotericin B for cryptococcal meningitis

48
Q

What is the mechanism of action of flucytosine

A

inhibits fungal protein synthesis by replacing uracil with 5-flurouracil in fungal RNA (& also interferes with fungal DNA synthesis)

49
Q

Major flucytosine toxicities

A

bone marrow suppression & GI toxicity

50
Q

How to culture mycobacterium

A

Does NOT grow on routine lab media

grow in lowenstein-jensen agar

Pulmonary (6 decks)

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