Lecture 7: Pneumonia Flashcards

1
Q

Routes to lower respiratory tract (3)

A

Inhalation, aspiration, bloodstream

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2
Q

Host defenses in lungs include…(4)

A

Removal of inhaled material, antimicrobial peptides, phagocytic and inflammatory cells, adaptive immune responses (humoral and cellular)

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3
Q

Removal of inhaled material by these three mechanism

A

Progressively branching airways, cough, mucociliary tract

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4
Q

First cellular line of defense

A

Pulmonary alveolar macrophages

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5
Q

Can viruses/bacteria affect our natural defenses?

A

Yes: some pathogens can damage our ciliary system, inhibit phagocytosis, damage IgA

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6
Q

Why would we be exposed to a large inocolum of pathogen?

A

Large volume due to laryngeal/gastric dysfunction or large concentration of pathogen due to gum/sinus disease, low stomach acid, prolonged illness, or being on a ventilator

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7
Q

Most common pneumonia bug

A

Streptococcus pneumoniae (50% of cases); gram positive diplococci

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8
Q

Virulence factor of Streptococcus pneumoniae

A

Polysaccharide capsule protects from phagocytosis

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9
Q

Another gram positive, seen in clusters. Associated with what settings?

A

Staphylcoccus aureus –> secondary complication of resp tract infections due to influenza and hospitalized patients

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10
Q

What’s a small coccbacillary gram-neg organism that can cause pneumonia. Associated with what patients?

A

Hemophilus influenzae; patients with COPD

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11
Q

Klebsiella pneumoniae associated with what two things?

A

Currant jelly sputum, often seen in alcoholics

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12
Q

Pseudomonas aeruginosa is primarily seen in patients who are…

A

Hospitalized, previously treated with antibiotics

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13
Q

Pseudomonas aeruginosa and Klebsiella pneumoniae are both (type of bacteria)

A

Gram-negative bacillus

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14
Q

Where do we find Legionella pneumophila. Can this affect healthy people? What kind of bacteria?

A

Cooling towers; yes; poorly staining gram-negative

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15
Q

What kind of bacteria is Chlamydophila pneumoniae

A

Obligate intracellular parasite

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16
Q

What is special about Mycoplasma pneumoniae and what does it cause?

A

Smallest living free organism; “walking pneumonia” (chest looks worse than clinical presentation)

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17
Q

How would we get an anerobic organism infection?

A

Aspiration of secretions due to impaired consciousness or difficulty swallowing

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18
Q

Association between viruses and pneumonia

A

Do not cause pneumonia very often, but influenza can cause it

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19
Q

Definition of pneumonia

A

Infection and inflammation of pulmonary parenchyma

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20
Q

Define bronchopneumonia

A

Distal airway inflammation prominent + alveolar disease with patchy distribution (S. aureus and gram negatives)

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21
Q

Define lobal pneumonia

A

Infectious process throughout entire lobe with dense consolidation; infection spreads from alveolus –> alveolus

22
Q

Define interstitial pneumonia

A

Inflammatory process w/in interstitial walls rather than alveolar spaces; diffuse and bilateral markings; mycoplasma and viruses

23
Q

Lung pathophysiology in pneumonia

A

Inflammation and infection –> decreased ventilation (V/Q mismatch) which can become shunt if bad enough –> hypoxemia

24
Q

When might a patient have CO2 retention?

A

If they already have an extremely limited reserve (healthy patients hyperventilate to get rid of excess CO2)

25
Q

Symptoms of pneumonia (4)

A

Fever, cough (productive if bacterial but dry if viral/mycoplasm in interstitium), SOB, pleuritic chest pain

26
Q

Lung exam of pneumonia

A

Rales and consolidation (high pitched bronchial breath sounds, tactile fremitus, egophony, whispered pectorliquoy, dullness to percussion)

27
Q

Typical pneumonia description

A

Acute, productive cough, consolidation, increased WBC, X-ray demonstrates lobar consildation

28
Q

Typical pneumonia bugs

A

Strep pneumoniae, hemophilus influenza, klebsiella pneumoniae, staph aureus, anaerobes

29
Q

Atypical pneumonia description

A

Gradual presentation, non-productive cough, normal WBC, more systemic complaints

30
Q

Atypical pneumonia bugs

A

Mycoplasma, chlamidophyla, legionella, viruses

31
Q

Fungus that can cause pneumonia

A

Histoplasmosis, coccidiomycosis, blastomycosis, cryptococcosis, aspergillus, pneumocystis jiroveci

32
Q

Histoplasmosis

A

Ohio River valley, dimorphic (yeast in body), can lead to granulomas, should be self-limited in healthy people

33
Q

If someone has chronic lung disease, what an they get with Histoplasmosis?

A

Chronic pulminary histoplasmosis, which looks like tuberculosis

34
Q

Coccidiomycosis

A

San Joaquin Valley, can cause granulomas, self-limited in healthy but disseminated in immunocompromised, can look like TB if someone has chronic pulmonary disease

35
Q

Blastomycosis

A

Soil-dwelling, midwestern US, primary response is neutrophilic + granulomas

36
Q

Acute infection of Blastomycosis?

A

Looks like typical pneumonia, generally self-limited unless immunocompromised

37
Q

Cryptococcosis

A

Soil contaminated with bird droppings, cleared in healthy but pneumonia or dissemination in immunocompromised

38
Q

Scary complication of cryptococcosis

A

Meningoencephalitis

39
Q

Aspergillus

A

Acute angle branching, it’s everywhere so only immunocompromised patients get it

40
Q

What are the complications of aspergillus

A

Allergic bronchopulmonary aspergillosis, aspergilloma, invasive aspergillosis, chronic necrotizing pulmonary aspergillosis

41
Q

Allergic bronchopulmonary aspergillosis (ABPA)

A

Happens to asthmatis, organism acts as antigen causing inflammation (doesn’t invade)

42
Q

Aspergilloma

A

Happens to people with pre-existing cavity in lungs which is colonized (ball of fungus), little tissue invasion, may be asymptomatic or with hemoptysis if it bursts

43
Q

Invasive aspergillosis

A

Happens to people who are immunocompromised (neutropenic), invades into lung tissue

44
Q

Chronic necrotizing pulmonary aspergillosis

A

Happens to people with underlying lung disease/mild immuncompromised, necrosis often leads to cavity formation

45
Q

Pneumocystis jiroveci

A

Seen in immunocompromised, alveolar filling leads to hypoxemia

46
Q

Compliations of pneumonia

A

Lung abscess (generally by bugs that cause necrosis), empyema (pneumonia extends to pleural surface causing pus in pleural space)

47
Q

Why do we drain empyema?

A

Without you can get scarring (fibrothorax) cause antibiotics won’t go to this poorly perfused space

48
Q

If community-acquired pneumonia…

A

Common bugs, treatment should cover these bugs: macrolide or doxycyclne OR fluroquinolone OR beta-lactam plus macrolide

49
Q

If hospital-acquired pneumonia…

A

Could be gram-negatives or MRSA

50
Q

If health-care associated pneumonia…

A

Could be resistant strains

51
Q

What’s a type of pneumonia related to a medical device?

A

Ventilated-associated pneumonia