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CRRAB II Part 2 Respiratory > Lower Respiratory Tract Infections (Zimmer) - W2 > Flashcards

Lower Respiratory Tract Infections (Zimmer) - W2 Flashcards

1
Q

What presents with cough, fever & chest pain. May have signs of common cold prior, but chest radiograph is negative.

A

Bronchitis

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2
Q

How is bronchitis diagnosed and how is it treated?

A
  • diagnosed by distinguishing it from pneumonia on chest xray.
  • self limiting
  • if longer than 14 days, along with sputum and fever, need bacterial treatment.
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3
Q

what is the bacterial treatment for bronchitis

A

erythromycin

azithromycin

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4
Q

what are some common viral causes of the common cold?

A
  1. Rhinovirus
  2. Parainfluenza virus
  3. Adenovirus
  4. Influenza C
  5. Coxsackie A and B
  6. RSV
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5
Q

What are 2 bacterial causes of bronchitis?

A
  • Mycoplasma pneumoniae
  • Chlamydia pneumoniae
  • S. pneumoniae
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6
Q

What patient population is bronchiolitis common in?

A

children under 1 year typically.

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7
Q

What are the common causes of bronchiolitis?

A
  • RSV = most common
  • Parainfluenza virus
  • Adenovirus
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8
Q

How does pertussis present?

A
  • incubation
    • 3 to 21 days
    • has cold symptoms - runny nose
  • second paraoxysmal stage
    • severe & uncontrollabl ecoughing
    • burst eye vessels
    • seizures
  • convalescent phase - bacteria decrease and no ongoing symptoms. Other organisms could cause 2’ infection.
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9
Q

What does pertussis grow on?

A
  • Bordet-Gengou Agar - allows for selective growth of Bordetella species.
  • regan - Lowe medium - blood charcoal and antibiotic
  • direct fluorescent antibody test
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10
Q

What are the traits of pertussis?

A

gram negative

coccobacilli

pleomorphic

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11
Q

What are the traits of influenza?

A

RNA virus

helical capsid

ss - Class IV segmented

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12
Q

When are those with influenza infectious

A

1 day before symtpoms and up to 5 to 7 days after becoming sick

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13
Q

Are most people tested for influenza?

A

No, because results usually do not change treatment.

performed on nasal or throat swipe. Rapid test can yield false negatives (longer test is more accurate).

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14
Q

If detection is made of influenza in 1-2 days, what can be used?

A

antivirals -

Tamiflu

Relenza

rapivab

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15
Q

How does the influenza virus attach?

A
  • viral hemagglutinin (HA) envelope protein makes contact w/sialic acid on cell surfaces - leads to endocytosis.
  • viral NA envelope protein cleaves HA bound to permit spread.
    • NA is target of antivirals
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16
Q

Antigenic drift

A

occurs when minor changes in antigen occur due to gene mutation - occurs in amino acids not essential for HA binding.

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17
Q

antigenic shift

A

occurs in influenza A only.

major changes in antigens due to gene reassortment in influenza virus.

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18
Q
A
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19
Q

What is found in the inactivated, triavlent influenza vaccine?

A
  • H1N1 virus, H3N2 virus, and a B
  • has standard and high doses
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20
Q

What is found in the influenza quadrivalent formulation?

A

two B lineages - IIV4

direct evidence for the additional B lineage is lacking.

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21
Q

What bugs cause influenza that can progress to pneumonia?

A

Influenza A and B

S. aureus

H. influenza.

S. pneumonia

S. pyogenes

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22
Q

What is seen with pneumonia?

A
  • inflammatory condition of lung - fluid fills alveoli
  • caused by wide range of pathogens.
  • diffuse consolidation on x-ray
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23
Q

What is the most common cause of pneumonia?

A

S. pneumoniae

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24
Q

Characteristics of S. agalactiae (group b strep)

A

Gram +

Cocci.

Catalase -

B hemolytic

Bacitracin resistant

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25
Q

What are the traits of nocardia asteroides

A
  • Gram +
  • beaded filaments
  • weakly acid fast
  • obligate aerobe
26
Q

Rust colored sputum =

A

S. pneumoniae

27
Q

Green sputum

A

pseudomonas

Haemophilius

Pneumococcal species

28
Q

Red currant jelly sputum =

A

Klebsiella

29
Q

Foul smelling or bad tasting sputum

A

Anaerobic infections

30
Q

typical symptoms of active TB:

A

coughing up blood

coughing for 3 or more weeks.

chest pain, pain with breathing or coughing.

unintential weight loss.

fatigue

fever.

night sweats

chills

loss of appetite

31
Q

What are traits of mycobacterium

A

Acid-fast (mycolic acid and waxy barrier)

Aerobic.

Bacilli

growth takes 3-8 weeks on media.

10,000 organisms/ml required on sputum smear

32
Q

When are antibiotics useful with pertussis?

A

when you catch it in the first stage.

33
Q

How do organisms avoid phagocytosis?

A
  • capusle production
  • toxin production - leukocidins
  • parasites and fungi too large
  • replication inside cells
  • mimicry
34
Q

how do bacteria survive in the phagocyte?

A
  • inhibition of lysosome fusion with the phagosome
  • escape from phagosoem
  • resistance to killing and digestion in the phagolysome
  • growth in the phagocytic cell
35
Q

What is unusual about lab data from children with pertusis?

A

have lymphocytosis even though it is a bacterial infection.

36
Q

common pneumonia causes in neonates (birth to 6 weeks)

A

Streptococcus agalactiae (group B strep)

E. coli

37
Q

Common causes of pneumonia in children 6weeks to 18 yeras

A
  1. Viruses - RSV
  2. Mycoplasma pneumonia
  3. chlamydia pneumonia
  4. streptococcus pneumoniae
38
Q

common causes of pneumonia in adults 18-40 years

A

Mycoplasma

Chlymdia

streptococcus pneumonia

39
Q

common causes of pneumonia in adults 40-65 years

A
  • Streptococcus pneumonia
  • Haemophilus influenza
  • Anaerobic bacteria
  • Viruses
40
Q

Common causes of pneumonia in elderly (> 65 years)

A
  • streptococcus pneumonia
  • viruses
  • anaerobic bacteria
  • Haemophilus influenza
  • gram negative rods
41
Q

Nosocomial pneumonia

A

Gram - rods

staph aureus

42
Q

Immuncompromised pneumonia

A
  • gram negative rods
  • strep pneumo
  • fungi
  • filamentous bacteria
  • pneumocysitis jiroveci
  • viruses
43
Q

alcoholic pneumonia

A

Strep pneumo

Klebsiella pneumo

Anaerobes

44
Q

IV drug use pneumonia

A

Staph aureus

45
Q

Chronic steriod use + pneumonia

A

Nocardia

46
Q

Virluence of pertussis

A

adheres to respiratory epithelium via filamentous hemagglutinin (FHA)

AB toxin inactivates Gi increasing cyclic AMP

47
Q

Strep pnemo traits

A

Gram + diplococcic

alpha-hemolytic

catalase negative

susceptible to optochin

Quellung reaction

48
Q

How to treat strep pnumo infections

A

penicillin or cephalosporins

vanco for meningitis

49
Q

Streptococcus agalactiae traits

A

Gram +

beta-hemolytic

Bacitracin RESITANT

50
Q

How is mycoplasma pneumonia “walking pneumo” diagnosed?

A

presence of cold hemagglutinin

no cell wall

fired egg appearce

51
Q

How do we treat mycoplasma pneumonia?

A

erythromycin or tetracycline

52
Q

How is chlamydia pneumonia diagnosed and how is it treated?

A
  • giemsa stain to visualize intracyctoplasmic influsions
  • treat w/doxycycline
53
Q

how does staph aureus pneumonia commonly present?

A

Nosocomial or with IV drug users.

see cavitations.

54
Q

What are virulence factors of staph aureus?

A
  • protein A
  • coagulase
  • hemolysins
  • leukocidins
  • hyaluronidase
  • staphylokinase
  • lipase
55
Q

Who is legionella pneumonia common in?

A

community acquired pneumonia in ELDERLY SMOKERS

56
Q

What is the pathology of Legionella?

A
  • natrually in water
  • can be spread through aerosols from AC
  • adheres via pili, phagocytosed by alveolar macrophages
  • surives and proliferates in macrophages. macrophages attract neutrophils. They form abscesses.
57
Q

How is legionella detected and how is it treated?

A
  • silver stain (gram stains poorly)
  • charcoal yeast extract culture w/iron and cysteine
  • Treat with erythromycin
58
Q

What is the most common bug pneumonia with AIDs patients?

What is given for prophylaxis?

A
  • Pneumocystis jirovecii
  • tmp-smx
59
Q

What is the treatment for nocardia?

A

TMP-SMX

drainage of abscesses

60
Q

Pathology of nocardia

A

Found in soil –> inhaled –> mycolic acid alows for intracellular survival and proliferation –> caseous granulomas wall off infectious particles –> pneumonia and cavitations form

aerobic, beaded filaments, weakly acid fast

gram pOSITIVE

CRRAB II Part 2 Respiratory (18 decks)

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