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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
What must *Legionella* be cultured on and what is an important component of this agar?
Buffered **charcoal yeast** agar (**L-cysteine** is critical ingredient)
26
What are 3 diagnostic tests which can be done for *Legionella?*
1. **Culture** on **buffered charcoal yeast** extract 2. Serology (IFA and ELISA) 3. **Urinary Ag**
27
What is the gram stain and morphology of *H. influenzae?*
Gram **negative**; **COCCOBACILLI;** encapsulated or non-encapsulated
28
Who is most at risk for *H. influenzae* pneumonia?
**COPD** and **smokers**
29
What is MacConkey agar and what 2 things does it select for?
- Selects for gram **negative** bacteria, especially enteric (has **bile salts** and **crystal violet**) - Also has **lactose**, which selects for **fermenters**
30
What is the gram stain, morphology and unique characteristics of *Klebsiella pneumoniae?*
**Encapsulated**, gram-**negative**, lactose fermenter, grows in **mucoid colonies; currant jelly sputum**
31
Which characteristic finding does *Klebsiella pneumoniae* produce on CXR?
**Bulging fissure** sign
32
Which bacteria forms colonies like the ones seen on the right?
*Klebsiella pneumoniae* ---\> **Mucoid colonies**
33
Which 2 bacterial causes of pneumonia are associated with a **Urinary Ag**?
- *Streptococcus pneumoniae* - *Legionella pneumoniae*
34
Which bacterial cause of pneumonia is associated with bullous myringitis?
*Mycoplasma pneumoniae*
35
Which bacteria can often follow viral pneumonia and produce a necrotizing pneumonia which can be fatal?
*S. aureus*
36
Which fungal cause of pneumonia is also associated with SKIN, BONE, and NEURO changes?
Blastomycosis (*Blastomyces dermatitidis)*
37
Who gets the pneumococcal vaccine?
- Age **≥65** - **Immunocompromised** - **Asplenic** pt's - Pt's **2-64 y/o w/ risk factors**
38
It is recommended that all persons over the age of ________ receive the flu vaccine.
**6 months**
39
What are 3 contraindications to receiving the flu vaccine?
- Previous allergic rxn - Egg allergy - **Guillan-Barre within 6 wks** of previous flu vaccine
40
Why don't you give aspirin to kids with a fever; which virus can cause issues?
**Reye syndrome**! If given aspirin while infected with **influenza** or **varciella**
41
What is the oral and inhaled drugs given to tx the flu caused by influenza (orthomyxoviridae)?
- **Oseltamivir** (oral) - **Zanamivir** (inhaled)
42
What is the morphology of orthomyxovirus (influenza)?
**8 segmented + Negative-sense ssRNA + Helical** virus
43
What is the morphology of adenovirus?
Non-enveloped, **dsDNA**, **icosahedral** virus
44
What is this CXR indicative of?
**Aspiration pneumonia**; notice you cannot see the R heart border
45
What is a common finding on a CXR in pt with Histoplasmosis?
"Coin lesions" = calcified pulmonary nodule
46
Which skin lesions may be seen in a small percentage of patients with *Coccidioides immitis?*
Erythema **NODOSUM**
47
What is the gram stain, morphology, unique characteristics and oxygen dependence of *Burkholderia cepacia?*
- Gram **negative** **bacillus** (rod); **oxidase (+); aerobic** - **Catalase (+)** and **non-lactose fermenter** - **EXTEMELY** antibiotic and disinfectant resistant
48
*Burkholderia cepacia* most often causes infections in whom?
- **Burn** and **ventilated** pt's - Pt's with **cystic fibrosis (CF)**
49
What is the primary vector of Hantavirus (bunyaviridae)?
Rodents
50
What are the signs/sx's and labs/imaging associated with Hantavirus infection?
- **High fevers** + **myalgias** + **cough** + **N/V** - Progresses to **pulmonary edema** + **respiratory failure** - **Thrombocytopenia** + **leukocytosis** + ↑ **LDH**, - **Bilateral pulmonary infiltrates**
51
What are the characteristics of infection caused by *Coxiella burnetii?*
- **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
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?
- **Small**, gram **negative**, intracellular - Has an **endospore** form
53
What is the reservoir for *Chlamydophila psittaci* and how is it transmitted?
- **Reservoir** = birds and poultry - **Trasmitted** via **inhalation** of **bird feather dust** or **dried out bird feces**
54
What is the gram stain and morphology of *Moraxella catarrhalis?*
Gram **negative**; **diplococci**
55
What are the 2 most common disease manifestations of *M. catarrhalis?*
- **Otitis media** in children - **Upper respiratory exacerbations** in pt's with **COPD**
56
Using the mnemonic Some Killer Have Pretty Nice Capsules; what are the encapsulated bacteria?
- **S.** pneumoniae - ***K**lebsilla* - ***H.*** *influenzae* - ***P.** aeruginosa* - ***N**. meningitidis* - ***C****ryptococcus*
57
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?
- Fever - Leukocytosis - Purulent sputum
58
What type of pneumonia is this?
Interstitial pneumonia
59
Acquiring a pneumonia from a family member with a MDR organism is considered to be what classification of pneumonia?
Health care associated PNA
60
What is the standard for diagnosis of respiratory viral infections?
**PCR** of nasopharyngeal swabs

CPR Exam 2 (21 decks)

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