Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pulm > Lec 7 Pneumonia > Flashcards

Lec 7 Pneumonia Flashcards

1
Q

What is definition of pneumonia?

A

infection of pulmonary parenchyma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What 3 general routes to lower respiratory tract?

A
  • inhalation of particles
  • aspiration
  • blood stream [less common]
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What virulence factor for chlamydophila pneumonia?

A

ciliostatic factor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What virulence factor for mycoplasma pneumoniae?

A

shear off cilia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What virulence factor for influenza virus?

A

reduces tracheal mucus velocity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What virulence factor for strep pneumoniae?

A
  • produces proteases that split secretory IgA

- has capsule that inhibits phagocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which 2 types of bugs are resistance to microbicidal activity of phagocytes?

A

mycobacterium

legionella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What things might cause increase volume of inoculum?

A
  • laryngeal dysfunction

- gastric dysfunction = stomach really full + you vomit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What things can increase concentration of pathogen?

A
  • gingival or sinus disease = source of bacteria in you
  • achlorhydria [less acid in stomach that kills bacteria]
  • prolonged critical illness
  • breathing tube
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is morphology of strep pneumoniae?

A

gram positive cocci in pairs or diplococci

has polysaccharide capsule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Where does strep pneumo come from?

A

normally inhabits oropharynx in adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What kind of pneumonia do you get with S. pneumonia?

step1

A
  • mostly lobar

- also bronchopneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is morphology of staph aureus?

A

gram positive cocci in clusters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What settings do you usually get staph aureus pneumonia?

A
  • secondary complication of resp tract infection with influenza
  • hospitalized immune compromised pt
  • widespread dissemination through blood stream
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What kind of pneumonia do you get from staph aureus?

step1

A

bronchopneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is morphology of hemophilus influenzae?

A

small coccobacillary gram negative organism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What kind of setting do you usally get H influenza pneumonia?

A

often colonizes nasopharynx of normal people and lower airway of pts with COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is morphology of klebsiella pneumoniae?

A

large gram-negative bacillus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is setting of klebsiella pneumonaie pneumonia?

A

often in alcoholics

found in GI tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What bug should you think if you hear “thick blood mucoid sputum” = currant jelly sputum?

A

klebsiella pneumoniae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is morphology of pseudomona aeruginosa?

A

gram negative bacillus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is setting of pseudomonas aeruginosa pneumonia?

A
  • found in environmental sources

- big problem in pts who are debilitated, hospitalized and previously treated with antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is setting of legionella pneumophila infection?

A
  • affects previously healthy and those with prior resp impairments
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is morphology of legionella pneumophila?

A

gram negative bacillus

stains very poorly so can’t use conventional stani methods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are some signs of legionella pneumophila pneumonia?

A

may have lots of nonrespiratory manifestations

– GI, CNS, hepatic, renal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is morphology of chlamydophila pneumoniae?

A

obligate intracellular parasite

note readily cultured

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is morphology of mycoplasma pneumoniae?

A
  • intermediate between virus and bacteria
  • no rigid cell walls
  • do not need host cell to replicate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Who gets mycoplasma pneumoniae? how does it present?

A

happens in young adults

get walking pneumonia = chest radiograph looks much worse than clinical presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is most common predisposing factor for anaerobic pneumonia?

A

aspiration of secretions by:
– impaire consciousness –> coma, alcohol, seizure

– difficulty swallowing [neuromuscular disease]

also at higher risk if poor dentition or gum disease = larger burden of organisms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Who mostly gets viral pneumonia?

A

kids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is pathology of pneumonia?

A

infection and inflammation of distal pulmonary parenchyma

have influx neutrophils, edema, erythrocytes,etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is bronchopneumonia?

step1

A

distal airway inflammation and alveolar disease

spread of infection/inflammation occurs through airways

patchy distribution

involves > 1 lobe

33
Q

What are 4 major causes of bronchopneumonia?

step1

A
  • staph aureus [+ cluster]
  • strep pneumo [+ diploccoci]
  • Klebsiella [- large rod, currant]
  • H influenza [- small coccobacilli]
34
Q

What is lobar pneumonia?

step1

A

infectious process through entire lobe of lung

appears as dense consolidation

spread from alveolus to alveolus through interalveolar pores of Kohn

35
Q

What are 3 major causes of lobar pneumonia?

step1

A

s. pneumoniae = most frequent [+ diplococci]

legionella [- rod poor stain]

klebsiella [- large rod, currant]

36
Q

What is interstitial pneumonia?

A
  • inflammatory process within interstitial walls rather than alveolar spaces
  • diffuse patchy inflammation
  • distribution > 1 lobe
37
Q

What major causes for interstitial pneumonia?

A
  • viruses [influenza, RSV, adenovirus]
  • mycoplasma
  • legionella
  • chlamydia
38
Q

What symptoms of pneumonia?

A
  • generalized system response: fever, cough, SOB, high WBC, chest pain, tachycardia, can get hypotension/shock
  • affects of lung function: decreased ventilation in affected areas, can lead to V/Q mismatch == shunt –> hypoxemia
39
Q

What does pneumonia due to CO2?

A

don’t usually have CO2 retention unless you already have limited reserve [bad COPD]

most pts with pneumonia usually have primary respiratory alkalosis = hyperventilate

40
Q

What does type of cough [productive vs nonproductive] tell you about etiology?

A

productive = probably viral

non-productive = probably viral or mycoplasma

41
Q

What info do you see on physical exam?

A
  • tachycardia
  • tachypnea
  • fever
  • rales
  • egophony
  • tactile fremitus
  • dullness to percussion
42
Q

What findings on lung exam suggest opening/closing of distal air spaces

A
  • rales
43
Q

What findings on lung exam suggest consolidation?

A
  • tactile fremitus
  • egophony
  • dullness to percussion
44
Q

What is typical pneumonia? How does it present?

A
  • acute presentation
  • productive cough
  • lung exam shows consolidation
  • leukocytosis with neutrophils
  • lobar consolidation with air bronchograms
45
Q

What bugs cause typical consolidation?

A
  • strep pneumo
  • H. influenza
  • klebsiella
  • stap aureus
  • anaerobes
46
Q

What is atypical pneumonia? how does it present?

A
  • gradual presentation
  • non-productive cough
  • normal WBC
  • systemic complaints more prominent than respiratory ones
47
Q

What bugs cause atypical pneumonia?

A
  • mycoplasma
  • chalmidophyla pneumoniae
  • legionella
  • viruses
48
Q

What is morphology of histoplasma capsulatum?

A
  • dimorphic fungus = branching hyphae in soil; round or oval yeast in the body
49
Q

What is setting of histoplasmosis?

step1

A
  • Mississipi and Ohio River valleys
  • inhale spores from bird/bat droppings –> organism converts to years –> delayed hypersensitivity and granulomatous inflammation

causes pneumonia

50
Q

What happens with histoplamosis in immune competent vs compromised?

A

competent = self-limited infection

compromised = progressive disseminated histoplasmosis

51
Q

What is chronic pulmonary histoplasmosis?

A

chronic lung disease in pt with preexisting structural lung abnormality [ie COPD]

resembles TB

52
Q

What is setting of coccidiodomyocosis?

step1

A

“san joaquin valley fever” in california, utah, SW US

granulomatous inflammatory response

causes pneumonia and meningitis; can disseminate to bone + skin

increase rate after earthquakes b/c spores in dust thrown into air

53
Q

What is morphology of coccidodes immitis?

A

dimorphic fungus = mycelia in soil; spherules in tissue

54
Q

How does size of histoplama vs coccidioides compare to RBC

step1

A

histoplama = smaller than RBC

coccidioides = much larger than RBC

55
Q

What happens to coccidioidomycosis in immune competent vs compromised?

A 
competent = self limited
compromised = hematogenous spread and disseminated disease

chronic pulm involvement can look like TB

56
Q

What is setting of blastomycosis infection?

A
  • primarily midewester + SE US and central america
  • causes inflammatory lung disease; can disseminate to skin and bone

granulomatous nodules + pyogenic response

combo of macrophages and T lymphocytes and neutrophils

resembles bacterial pneumonia

57
Q

What is morphology of blastomyces?

A

broad based budding yeast

58
Q

What signs/symptoms in blastomycosis?

A

acute infection resembles bacterial pneumonia –> abrupt onset fever, cihlls, cough, purulent sputum

may be self limited

if impaired cellular immunity –> at risk for more severe disease

59
Q

What setting of asperigullus infection?

A
  • widespread = no specific geography

pretty much everyone is exposed; it depends on your immune system

60
Q

What is morphology of aspergillus

A

always appears as mycelia
branching hyphy

not dimorphic

61
Q

What is most pathologic type of aspergillus?

A

aspergillus fumigatus

62
Q

What is allergic bronchopulmonary aspergillosis? who gets it?

step1

A

associated w/ asthma and cystic fibrosis

organism stays in airways and is an antigen rather than invasive

causes bronchiectasis and eosinophilia

63
Q

What is aspergilloma? who gets it?

step1

A

seen in people with preexisting lung cavity from TB or sarcoidosis

orgniasm colonizes cavity wtih little tissue invasion

clinically = hemoptysis or no symptoms

64
Q

What is invasive aspergillosis? who gets it?

step1

A

seen in immunocompromised and neutropenic
–> post transplant, radiation, cancer, etc

invades and spreads through lung tissue

65
Q

What is chronic necrotizing pulmonary aspergillosis? who gets it?

A

seen in pts with underlying lung disease or mild impairment of pulmonary or systemic host defense mech [DM, corticosteroids]

indolent, localized invasion

necrosis of tissue –> cavity formation

66
Q

What kind of aspergillus colonization happens in each time of persion:

  • normal host
  • asthmatic
  • person with previous TB
  • ## person with chronic lung disease
A
  • normal host –> nothing
  • asthmatic or CF –> allergic bronchopulmonary aspergillosis [ABPA]
  • person with previous TB –> aspergilloma
  • person with chronic lung disease –> chronic necrotizing aspergillosis
  • immune compromised –> invasive pulmonary aspergillosis
67
Q

Who gets pneumocystis jiroveci pneumonia?

step1

A

immune compromised particular cellullar immune compromised = AIDS (esp CD4 < 200)

in pt with AIDS, cancer, organ transplant, immunosuppression

68
Q

What happens in pneumocystis pneumonia?

A

inhale it; get diffuse interstitial pneumonia

present with insidious onset fever, dyspnea
hypoxemia due to alveolar filling

69
Q

What is morpholgoy of pneumocytsis jiroveci?

A

disc shaped yeast on methenamine silver stain

70
Q

What is lung abscess?

A
  • localized collection of pus within parenchyma

- abscess contents = primarily neutrophils

71
Q

What are some complications of pneumonia?

A
  • lung abcess
72
Q

What type of bugs cause lung abscess from pneumonia?

A
  • those that cause significant tissue necrosis

== anaerobes, staph aureus, gram negatives

73
Q

What is an empyema?

A

pus in pleural space from pneumonia extending to pleural surface

thick/creamy or yellow fluid within plueral space and lots of leukocytes [neutrophils]

74
Q

What is treatment for empyema?

A

drain b/c antibiotics can’t reach

if dont drain can develop pleural scarring and fibrothorax

75
Q

You have diagnosed an ill-appearing patient with pneumonia based on history, physical exam and chest radiograph.

Do you:

A. perform bronchoscopy with biopsy and wait a few days for culture results and antibiotic sensitivity before administering antibiotics

B. empirically administer antibiotics

A

B!

if you do A this process will continue and pt will get worse

76
Q

What types of bugs usually hospital acquired pneumonia?

A
  • gram negative organisms [pseudomonas, klebsiella], MRSA
77
Q

What are most common community acquired causes of pneumonia?

A
  • strep pneumo
  • staph aureus
  • H influenzae
  • chlamidophyla
  • legionella
  • influenza
78
Q

How do you treat community acquired pneumonia?

A
  • macrolide or doxycycline
    OR
  • fluoroquinolone or B lactam plus macrolide

Pulm (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions