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Block 5 > Lower respiratory tract infections > Flashcards

Lower respiratory tract infections Flashcards

1
Q

cause of CAP

A

strep pneumo

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2
Q

types of acute pneumonia

A

CAP

nosicomial

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3
Q

types of subacute/chronic pneumonia

A

tuberculosis
fungal
lung abscesses

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4
Q

major diseases caused by strep pneumo

A 
pneumonia
meningitis
sinusitis
otitis media
bacteremia
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5
Q

less frequent diseases caused by strep pneumo

A

endocardiits
spetic arthritis
peritonitis

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6
Q

strep pneumo identifier

A 
gram positive
cocci in pairs or chains
alpha hemolytic
catalase negative
optochin sensitive
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7
Q

main mech of strep pneuma pathogenicity

A

immune evasion

doesn’t release toxins

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8
Q

mechanisms of immune evasion for strep pneumo

A

capsule prevents phagocytosis

induces inflammation which activates complement and attracts neutrophils

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9
Q

what stimulates strep pneumo cytokine production

A

peptidoglycan

teichoic acid

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10
Q

virulence factors of strep pneumo

A 
adhesive cell surface components
neuramidase and hyaluronidase
capsule
autolysin
pneumolysin
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11
Q

adhesive cell surface components of strep pneumo

A

teichoic acid
choline binding proteins
protein A

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12
Q

neuramidase and hyluronidase do what

A

change ECM

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13
Q

capsule

A

prevents phagocytosis

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14
Q

autolysin

A

lyses cells which releases peptidoglycan and pneumolysin

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15
Q

pneumolysin

A

inhibits cillia and neutrophils
promotes inflammation
activates complement system

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16
Q

how is a capsule stained

A

antibody in Quelling rxn

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17
Q

anti capsule antibodies

A

appear 5-8 days post infection- marker of immunity

1/3 of adults make them, rest do not

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18
Q

capsular based strep pen vaccine

A

stimulates IgM and IgG production via capsular polysaccharides from 23 strains

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19
Q

protein conjugated strep pneumo vaccine

A

capsular polysaccharide conjugated to a protein (tetanus or diphtheria)
induces T cell memory

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20
Q

what vaccine do you give to

A

protein conjugated

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21
Q

what vaccine do you give to >4

A

capsular based

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22
Q

pathogenesis of strep pneumo

A

bacteria grow into alveolar spaces which activates complement and vasoactive factors
bacteria accumulate
exudate and WBC migrate into alveolar spaces

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23
Q

CXR of pneumococcal pneumonia

A

fluid accumulation in a lobe with no abscess

24
Q

stage 1 pneumococcal pneumonia

A

alveoli fill with clear serous fluid and bacteria cells which proliferate

25
Q

early consolidation phase of pneumococcal pneumonia

A

neutrophils and bugs infiltrate
antibodies produced OR innate immunity kicks in
CRP increases which activates complement system

26
Q

late consolidation in pneumococcal pneumonia

A

alveoli fill with cellular infiltrate and bacteria–looks like liver

27
Q

resolution in pneumococcal pneumonia

A

macrophages replace neutrophils and clear exudate

lung architecture restored

28
Q

complications to pneumococcal pneumonia

A

pleural effusion

empyema

29
Q

symptoms of pneumococcal pneumonia

A 
sudden onset chills and sweats
high fever
chest pain
cough, fatigue
tachy, 
gray, anxious appearance
30
Q

labs associated with pneomoccal pneumonia

A

low Hg
leukocytosis
capular detection in urine
PCR

31
Q

common carriers of strep pneumo

A

preschool kids

32
Q

transmisison of strep pneumo

A

person to person in close contact

NOT school or work

33
Q

predisposing factors to strep pneumo

A 
defective antibody production
defective complement
neutrophil deficiency
defective bacteria clearance
previous viral infection
34
Q

treatment of strep pneumo

A

penicillin
macrolides
quinolones
vancomcin

35
Q

ermB

A

high level of resistance to ALL macrolides

36
Q

mefA

A

low level resistance to some macrocodes

37
Q

causes of atypical pneumonia

A

mycoplasma pneumoniae

leginella pneumonae

38
Q

mycoplasma pneumonaia features

A

no cell wall
small
slow growing
special media

39
Q

myocplasma pneumoniae causes

A

bronchopneumonia

40
Q

transmission of mycoplasma pneumoniae

A

spread via respiratory droplets

41
Q

symptoms of mycoplasma pneumoniae

A

sore throat
cough
fever

42
Q

diagnosis of mycoplasma pneumoniae

A

clinical presentation- no sputum production

43
Q

CXR of mycoplasma pneumoniae

A

uni/bilateral patchy infiltrate in lower lobes

44
Q

treatment of mycoplasma pneumoniae

A

macrolides
tetracyclines
fluoroquinolones

45
Q

features of leginella pneunominphilia

A

gram neg bacillus
thermophilic
grows on special media
found in ponds

46
Q

transmission of legionella

A

inhalation of infected aerosoles

47
Q

symptoms of legionella pneumonia

A 
flu
watery diarrea
vomitting
diarrhea
low O2--> lethargy, confusion
48
Q

life cycle of legionella

A

infects the macrophage
type 4 secretion system inserts proteins that block formation of phagolysosomes
bacteria replicate in the vesicle
ppGpp increases as nutrients decrease which triggers transcription of genes for release

49
Q

diagnosis of legionella

A

antibody staining or ELISA on urine- misses cases
culture- slow
CXR- patchy dsitribution

50
Q

treatment of legionella

A

macrolides
tetracyclines
quinolones

51
Q

nosocomial early onset

52
Q

nosicomial late onset

A

> 4 days
gram neg bacilli
staph aureus

53
Q

VAP risk factors

A 
prolonged hospitalization
repeated intubations
endotracheal or NG tube
prior antibiotic therapy
stress, ulcer prophylaxis
supine position
54
Q

microaspiration

A

most common
colonized secretions from upper airways get into lower lung areas
gram neg bacilli
staph aureus

55
Q

macroaspiration

A

infection with esophageal or gastric material
bacteria condenses in tube and forms biofilm
pieces break off and get into lung

56
Q

symptoms of VAP

A

fever
leukocytosis
purulent sputum
new lobar filtrate

Block 5 (27 decks)

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