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CPR Exam 2 > Lecture 2: Pneumonias and Respiratory Infections > Flashcards

Lecture 2: Pneumonias and Respiratory Infections Flashcards

1
Q

What are the 2 major bacteria that will grow on chocolate agar (factors V and X)?

A
  • Haemophilus influenza
  • Neisseria
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2
Q

Mycoplasma pneumoniae requires growth on a media containing what?

A

Cholesterol and Nucleic acids (purines and pyrimidines)

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3
Q

What is the number one cause of bronchitis and atypical pneumonia in teenagers and young adults?

A

Mycoplasma pneumoniae

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4
Q

What is the appearance of Mycoplasma pneumonia when grow on cultured media?

A

Dome-shaped colonies with “fried egg” appearance or “mullberry” appearance

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5
Q

Why is microcytic anemia associated with Mycoplasma pneumoniae?

A
  • Cold agglutinins
  • Pts develop monoclonal IgM ab’s directed at a common RBC Ag called the “I” Ag, which appears to be modified w/ infection
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6
Q

Labs drawn from person with pneumonia showing hyponatremia and hypophosphatemia is consistent with what organism?

A

Legionella

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7
Q

Which 2 bacterial causes of pneumonia are associated with positive urinary antigens?

A
  • S. pneumoniae
  • Legionella
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8
Q

What are 3 Abx options for Mycoplasma pneumoniae?

A
  1. Macrolides
  2. Tetracyclines
  3. Fluoroquinolones
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9
Q

Emperic abx for community acquired pneumonia requires minimum of how many days of tx?

A

5 days

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10
Q

For the emperic tx of commuity acquired pneumonia what is first drug you should consider using in an ambulatory patient; what if they can’t tolerate this first lin drug?

A
  • Macrolide = 1st
  • Can’t tolerate –> go with Doxycycline
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11
Q

For the emperic tx of commuity acquired pneumonia what are 2 options for pt at increased risk for drug resistance (Abx in past 90 days, immunosuppression, exposure to kids)?

A
  • Fluoroquinolone
  • Macrolide + beta-lactam
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12
Q

For the emperic tx of commuity acquired pneumonia what should you give to hospitalized pt?

A

Fluoroquinolone

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13
Q

For the emperic tx of commuity acquired pneumonia what should you give to pt in ICU?

A

Fluoroquinolone + antipneumococcal beta lactam (3rd gen. Ceph or ampicillin sulbactam)

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14
Q

What Abx should be added to regimen for pneumonia if coverage for pseudomonas is desired?

A

Piperacillin-tazobactam, cefipime, or a “penem”

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15
Q

What are the 3 etiologic agents most often causing atypical pneumonia?

A
  • Mycoplasma pneumoniae
  • Chlamydia pneumoniae
  • Legionella pneumophilia
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16
Q

Chlamydia pneumoniae presents similar to M. pneumoniae, but what is one part of the presentation that may be a clue?

A

Pt may have hoarse voice w/ Chlamydia pneumoniae

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17
Q

Who is most often affected by atypical pneumonia and how does it present?

A
  • Younger adults
  • Generally “milder” sx’s –> fever + chills + cough (may be dry) + dyspnea
  • Typically follows URI like sx’s: rhinitis, laryngitis, pharyngitis, sinusitis
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18
Q

What lab can be ordered to aid in differentiating between viral and bacterial pneumonia?

A

Procalcitonin –> will be elevated in bacterial pneumonia

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19
Q

What is CURB-65 severity score for whether you should admit someone or discharge pt with pneumonia; what scores are necessary?

A
  • Confusion
  • BUN >20 mg/dL;

- RR >30;

- BP (systolic <90 or diastolic <60)

  • Age ≥65 y/o

*Each worth 1 point –> 0-1 = outpatient; 2 = moderate/severe - short hospitalization; 3-5 = severe pneumonia/ICU

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20
Q

Which bacterial cause of pneumonia has a life cycle consisting of an elementary body and a initital body (aka reticulate body)?

A

Chlamydia pneumoniae

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21
Q

What is the gram stain, morphology, and oxygen dependence of Legionella?

A

Gram negative rod (pleomorphic), aerobic, flagellate, water lover

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22
Q

Legionella is a facultative intracellular parasite for what?

A

Amoebas

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23
Q

Which bacterial cause of pneumonia is associated with a fever with pulse-temperature dissociation (high fever, low HR), severe HA, confusion, myalgia and cough?

A

Legionella

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24
Q

Which 3 abx can be used for tx of Legionella?

A
  1. Azithromycin
  2. Levofloxacin
  3. Doxycycline
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25
Q

What must Legionella be cultured on and what is an important component of this agar?

A

Buffered charcoal yeast agar (L-cysteine is critical ingredient)

26
Q

What are 3 diagnostic tests which can be done for Legionella?

A
  1. Culture on buffered charcoal yeast extract
  2. Serology (IFA and ELISA)
  3. Urinary Ag
27
Q

What is the gram stain and morphology of H. influenzae?

A

Gram negative; COCCOBACILLI; encapsulated or non-encapsulated

28
Q

Who is most at risk for H. influenzae pneumonia?

A

COPD and smokers

29
Q

What is MacConkey agar and what 2 things does it select for?

A
  • Selects for gram negative bacteria, especially enteric (has bile salts and crystal violet)
  • Also has lactose, which selects for fermenters
30
Q

What is the gram stain, morphology and unique characteristics of Klebsiella pneumoniae?

A

Encapsulated, gram-negative, lactose fermenter, grows in mucoid colonies; currant jelly sputum

31
Q

Which characteristic finding does Klebsiella pneumoniae produce on CXR?

A

Bulging fissure sign

32
Q

Which bacteria forms colonies like the ones seen on the right?

A

Klebsiella pneumoniae —> Mucoid colonies

33
Q

Which 2 bacterial causes of pneumonia are associated with a Urinary Ag?

A
  • Streptococcus pneumoniae
  • Legionella pneumoniae
34
Q

Which bacterial cause of pneumonia is associated with bullous myringitis?

A

Mycoplasma pneumoniae

35
Q

Which bacteria can often follow viral pneumonia and produce a necrotizing pneumonia which can be fatal?

36
Q

Which fungal cause of pneumonia is also associated with SKIN, BONE, and NEURO changes?

A

Blastomycosis (Blastomyces dermatitidis)

37
Q

Who gets the pneumococcal vaccine?

A
  • Age ≥65
  • Immunocompromised
  • Asplenic pt’s
  • Pt’s 2-64 y/o w/ risk factors
38
Q

It is recommended that all persons over the age of ________ receive the flu vaccine.

39
Q

What are 3 contraindications to receiving the flu vaccine?

A
  • Previous allergic rxn
  • Egg allergy
  • Guillan-Barre within 6 wks of previous flu vaccine
40
Q

Why don’t you give aspirin to kids with a fever; which virus can cause issues?

A

Reye syndrome! If given aspirin while infected with influenza or varciella

41
Q

What is the oral and inhaled drugs given to tx the flu caused by influenza (orthomyxoviridae)?

A
  • Oseltamivir (oral)
  • Zanamivir (inhaled)
42
Q

What is the morphology of orthomyxovirus (influenza)?

A

8 segmented + Negative-sense ssRNA + Helical virus

43
Q

What is the morphology of adenovirus?

A

Non-enveloped, dsDNA, icosahedral virus

44
Q

What is this CXR indicative of?

A

Aspiration pneumonia; notice you cannot see the R heart border

45
Q

What is a common finding on a CXR in pt with Histoplasmosis?

A

“Coin lesions” = calcified pulmonary nodule

46
Q

Which skin lesions may be seen in a small percentage of patients with Coccidioides immitis?

A

Erythema NODOSUM

47
Q

What is the gram stain, morphology, unique characteristics and oxygen dependence of Burkholderia cepacia?

A
  • Gram negative bacillus (rod); oxidase (+); aerobic
  • Catalase (+) and non-lactose fermenter
  • EXTEMELY antibiotic and disinfectant resistant
48
Q

Burkholderia cepacia most often causes infections in whom?

A
  • Burn and ventilated pt’s
  • Pt’s with cystic fibrosis (CF)
49
Q

What is the primary vector of Hantavirus (bunyaviridae)?

50
Q

What are the signs/sx’s and labs/imaging associated with Hantavirus infection?

A
  • High fevers + myalgias + cough + N/V
  • Progresses to pulmonary edema + respiratory failure
  • Thrombocytopenia + leukocytosis + ↑ LDH,
  • Bilateral pulmonary infiltrates
51
Q

What are the characteristics of infection caused by Coxiella burnetii?

A
  • Abrupt high fever (Q fever) + HA + myalgias
  • May be mild PNA or progress to respiratory distress
  • Hepatitis w/ NO jaundice and culture-negative endocarditis
52
Q

What is the gram stain and morphology of Coxiella Burnetti and what makes it a unique Rickettsia species and allows it to resist heat and drying?

A
  • Small, gram negative, intracellular
  • Has an endospore form
53
Q

What is the reservoir for Chlamydophila psittaci and how is it transmitted?

A
  • Reservoir = birds and poultry
  • Trasmitted via inhalation of bird feather dust or dried out bird feces
54
Q

What is the gram stain and morphology of Moraxella catarrhalis?

A

Gram negative; diplococci

55
Q

What are the 2 most common disease manifestations of M. catarrhalis?

A
  • Otitis media in children
  • Upper respiratory exacerbations in pt’s with COPD
56
Q

Using the mnemonic Some Killer Have Pretty Nice Capsules; what are the encapsulated bacteria?

A
  • S. pneumoniae
  • Klebsilla
  • H. influenzae
  • P. aeruginosa
  • N. meningitidis
  • Cryptococcus
57
Q

To be nosocomial pneumonia the patient will have to have at least 2 out of what 3 sign/sx’s in the presence of a new or progressing pulmonary opacity on CXR?

A
  • Fever
  • Leukocytosis
  • Purulent sputum
58
Q

What type of pneumonia is this?

A

Interstitial pneumonia

59
Q

Acquiring a pneumonia from a family member with a MDR organism is considered to be what classification of pneumonia?

A

Health care associated PNA

60
Q

What is the standard for diagnosis of respiratory viral infections?

A

PCR of nasopharyngeal swabs

CPR Exam 2 (21 decks)

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