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BBS- 2nd bimonthly > IM- CAP > Flashcards

IM- CAP Flashcards

1
Q

Results from the proliferation of microbial pathogens at the alveolar level and the host’s response to those pathogen

A

Pathophysiology of community acquired pneumonia

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2
Q

What are the Most common mode of transmission?

A

o Aspiration from the oropharynx (Sleep, decreased sensorium)
o Inhaled as contaminated droplets
o Via hematogenous spread or contagious extension from an infected pleural or mediastinal space

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3
Q

What are the mechsnical factors in regards to host defense from CAP?

A
  • Hair and turbinates of the nares
  • Branching architecture of the tracheobronchial tree
  • Gag reflex and the cough mechanism
  • Normal flora adhering to mucosal cell of the oropharynx (prevents pathogenic bacteria from binding)
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4
Q

have intrinsic opsonizing properties or antibacterial or antiviral activity

A

Surfactant proteins A and D

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5
Q

Initiate host inflammatory response

A 
o Fever (TNF IL 1) 
o Pheripheral leukocytosis and increased purulent secretions (chemokines: IL8, GCSF)
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6
Q
  • Hemoptysis
  • Rales
  • Radiologic infiltrates
  • Hypoxemia
A

Alveolar capillary leak

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7
Q
  • decrease compliance due to capillary leak
  • hypoxemia
  • increased respiratory drive
  • increase secretions
  • occasionally infection-related bronchospasm
A

Dyspnea

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8
Q

Rarely evident in clinical or autopsy specimens bc of the rapid transition to 2nd phase

A

Edema

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9
Q
  • Presence of proteinaceous

- Exudate- and often of bacteria- in the alveoli

A

Edema

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10
Q

Erythrocytes in the cellular intraalveolar exudate (red)

A

Red hepatization

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11
Q

more important from the standpoint of host defense in the stage of red hepatization

A

Neutrophil influx

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12
Q

occasionally seen in pathologic specimens collected during the phase of red hepatization

A

Bacteria

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13
Q

No new erythrocytes are extravasating and those already present have been lysed and degraded, turning Gray

A

Gray Hepatization

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14
Q

predominant cell in the phase of gray hepatization

A

Neutrophil

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15
Q

Abundant in the gray hepatization

A

Fibrin deposition

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16
Q

corresponds with successful containment of the infection → improve gas exchange

A

Gray hepatization

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17
Q

Debris of neutrophils, bacteria and fibrin has been cleared, as has the inflammatory response

A

Resolution phase

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18
Q

dominant cell type in alveolar space during resolution phase

A

Macrophage reappearance

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19
Q

2 pathogens that causes the typical penumonia

A

o Streptococcus pneumonia

o H. Influenzae

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20
Q

3 pathiogens that causes the atypical pneumonia?

A

o Mycoplasma pneumoniae
o Chlamydia pneumoniae
o Legionella pneumoniae

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21
Q

What are the clinical manifestestation of Pneumonia?

A
  • frequently febrile with tachycardia or may have a history of chills and or/sweats
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22
Q

What is the quality of cough in Pneumonia?

A

productive/non-productive

23
Q

In Atypical Pneumonia, Up to _____ of patients may have gastrointestinal symptoms such as nausea, vomiting, and or/diarrhea

A

20%

24
Q

Its other symptoms may include fatigue, headache, mylagias and athralgias

A

Atypical pneumonia

25
Q

Crackles, bronchial breath sounds, and possibly a pleural ____ may be heard on auscultation

A

Friction rub

26
Q

In Pneumonia, severly ill pt may have ___ and evidence of ______

A

Septic shock and organ failure

27
Q

Can CAP be diagnostically accurately with history and PE alone?

A

No

28
Q

Accuracy of predicting CAP by physicians’ clinical judgment is between ________ (Grade B)

A

60-70%

29
Q

essential in the diagnosis of CAP

A

Chest x ray

30
Q
  • Assess severity
  • Differentiate pneumoniae from other condition
  • For prognostication
A

Chest radiograph

31
Q

remains the reference dx standard for pneumonia

A

new parenchymal infiltrate in the chest radiograph

32
Q

should be done in patient suspected with CAP to confirm dx

A

Chest x ray

33
Q

Can we do not do CXR?

A

Yes

34
Q

What specific views of CXR should be requested?

A

Standing (1) posteroanterior and (2) lateral views of the chest in full inspiration (Grade A)

35
Q

Can CXR be “normal” in a patient with suspected pneumonia?

A

YES! Consider as “radiologic lag”

36
Q
  • Not routinely done
  • Minimal role
  • Non-resolving or progressive pneumonia
A

CT Scan

37
Q

In Gram- staining and culture of sputum of CAP, Sputum should be

A

▪ >25 Neutrophils

▪ <10 Squamous Epithelial Cells

38
Q

What does the blood culture in CAP yields?

A

disappointingly low

39
Q

Only approximately _____ of cultures of blood from pt hospitalized w/ CAP are positive

A

5-14%

40
Q

Most frequently isolated pathogens in CAP

A

S. pneumoniae

41
Q

allow narrowing of antibiotic therapy in appropriate cases.

A

Susceptibility data

42
Q

no longer considered de rigueur for all hospitalized CAP patient

A

Blood culture

43
Q

Disadvantages of Antigen test, PCR, Serology

A

o Not cost effective
▪ Low yield pf blood cultures (5 to 15%)
▪ Poor quality of samples in respiratory specimens o Availability of the tests

44
Q

Antibiotic should be initiated _____ when diagnosis is made

A

ASAP

45
Q

The choice of oral antibiotics ff initial parenteral therapy is based on:

A 
o Available culture results 
o Antimicrobial spectrum 
o Efficacy 
o Safety 
o Cost
46
Q

Dosage of Amoxicillin-clavulznic acid

A

625 mg TID or 1gm BID

47
Q

Dosage of Azithromycin

A

500 mg OD

48
Q

Cefixime

A

200 mg BID

49
Q

Cefuroxime Axetil

A

500 mg BID

50
Q

Cefpodoxime Proxetil

A

200 mg BID

51
Q

Levofloxacin

A

500-750 mg OD

52
Q

Moxifloxacin

A

400 mg OD

53
Q

Sultamicilin

A

750 mg BID

BBS- 2nd bimonthly (3 decks)

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