Habal: Pneumonia

Question 1

What makes up the mucociliary escalator?

Answer 1

mucous membrane ciliated epithelial cells alveolar macrophages

Question 2

If your patient has no rales on auscultation and is breathing normally, yet has cough with purulent sputum, what can you exclude and include?

Answer 2

exclude pneumonia, think ACUTE BRONCHITIS

Question 3

What is the normal duration of acute bronchitis?

Answer 3

5d-3w

Question 4

Majority of cases of acute bronchitis are due to?

Answer 4

viral infection: influenza, parainfluenza (nursing homes), RSV (babies) If bacterial: Mycoplasma pneumonia, chlamydia pneumo, bordatella pertussis (a cute clam is on my board).

Question 5

What are dx features of acute bronchitis?

Answer 5

COUGH with NO FEVER. CXR will R/O pneumonia.

Question 6

Management of acute bronchitis?

Answer 6

Antibiotics not req’d. Bed rest, cool vapor, analgesics, antitussive, expectorants

Question 7

What is the most common LRI in infants (1-24m)?

Answer 7

Bronchiolitis. Will have WHEEZING.

Question 8

What two main things is bronchiolitis associated with?

Answer 8

crowded conditions and smoke exposure

Question 9

MCC bronchiolitis?

Answer 9

RSV infection (70%).

Question 10

Complications of bronchiolitis?

Answer 10

ARDS, Bronchiolitis obliterans organizing pneumo (BOOP. mucus plugs in alveoli -> irreversible).

Question 11

What are the virulence factors of RSV?

Answer 11

Fusion Protein F: promotes fusion of infected cells (transfer of genetic material) –> form a giant cell called a “synctia”

Question 12

Identify.

Answer 12

RSV. Note the multi-nucleated giant cell at the top right.

Question 13

This recently identified virus can have sx from common cold to LRI and often has a co-association with RSV. What is it and how can you dx it?

Answer 13

Human Metapneumovirus; rtPCR

Question 14

This infection causes consolidation of the affected part and filling of alveolar space with fluid.

Answer 14

Pneumonia.

Question 15

Key differences of typical and atypical pneumonia?

Answer 15

Typical has a sudden onset with HIGH fever and productive cough. CXR: unilateral infiltrate. MCC Strep pneumo. Atypical has slow onset with low fever and dry cough. CXR: bilateral infiltrate. MCC: Mycoplasma pneumonia, Chlamydia, Legionella, Viruses.

Question 16

What are the main dx tests you want to run if you suspect pneumonia in your patient?

Answer 16

ABG, CXR. Also: CBC, blood culture and gram stain, sputum culture

Question 17

What are the two classes (with their MCC) of HAP?

Answer 17

Early onset (within first 5 days): MSSA, H. influenza, Enterobac, Strep pneumo Late onset (>5d/more opportunistic): P. aeruginosa, Acinetobacter, Enterobac, MRSA

Question 18

What would you most likely suspect is the cause of pneumo in a patient with HIV? In a patient with a transplant? CF?

Answer 18

P. jiroveci; CMV; P. aeruginosa

Question 19

What are common causes of lobar pneumonia? (one lobe)

Answer 19

S. pneumo, Klebsiella, H. influnza

Question 20

What are common causes of patchy pattern in pneumo?

Answer 20

Atypicals; viral

Question 21

What are common causes of interstitial pnuemo?

Answer 21

Viral, PCP/PJP, Legionella

Question 22

What are common causes of Cavitary pneumo?

Answer 22

TB, fungi, klebsilla, anaerobes

Question 23

What are common causes of large effusion on CXR?

Answer 23

S. aureus, klebsiella

Question 24

Hantavirus is caused by inhalation of?

Answer 24

dry urine from rodents.

Question 25

Is person-person transmission possible in Hantavirus Pulmonary Syndrome (HPS)?

Answer 25

Previously thought no, but now suspect yes in Andes Virus: causes a release of vascular epithelial growth factor leading to hyper permeability and increased leakage

Question 26

What are the clinical manifestations of HPS?

Answer 26

No sx from 4-30d fever, HA, malaise Cardiopulm: non-productive cough, pulmonary edema, hypotensive, DIC, GI bleed, oliguria Diuretic: 3-6L/day - recover and rapid clearance of plum edema

Question 27

How can you dx HPS?

Answer 27

CXR, serology

Question 28

What supportive measures can you take for HPS?

Answer 28

O2 Dopamine and Dobutamine for hypotension Fluid Replacement ECMO Ribavarin

Question 29

What is the mechanism of influenza virus pneumonia?

Answer 29

M2 lets H into the cell; M1 lets everything into the cell

Question 30

What is a possible vaccine target for SARS?

Answer 30

Spike protein (causes cell fusion)

Question 31

Which adenovirus subtypes are related to keratoconjunctivitis?

Answer 31

3-8

Question 32

What are the clinical signs and sx of CMV?

Answer 32

similar to mono: fever, malaise, lymphadenopathy, hepatosplenomegaly in AIDS patients: retinitis, esophagitis, gastritis, colitis Congenital: jaundice, growth restriction and mental retardation, hearing loss, intracranial calcifications