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IM RESPI & CARDIO (VHD) > PNEUMONIA > Flashcards

PNEUMONIA Flashcards

1
Q

Risk Factors for Pathogens Resistant to Usual Therapy for CAP.

  • Hospitalization 2 or more days in previous 90 days
  • Use of antibiotics in previous 90 days
  • Immunosuppresion
  • Nonambulatory status
  • Tube feedings
  • Gastric acid suppression
  • Severe COPD or bronchiectasis
A

Multidrug-resistant gram-negative bacteria and MRSA

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2
Q

Risk Factors for Pathogens Resistant to Usual Therapy for CAP.

  • Cavity infiltrate or necrosis
  • Gross hemptysis
  • Erythematous rash
  • Concurrent influenza
  • Young, previously healthy status
  • Summer-month onset
A

CA-MRSA

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3
Q

Risk Factors for Pathogens Resistant to Usual Therapy for CAP.

  • Hospitalization 2 or more days in previous 90 days
  • Use of antibiotics in previous 90 days
  • Chronic hemodialysis in previous 30 days
  • Documented prior MRSA colonization
  • Congestive heart failure
  • Gastric acid suppression
A

Nosocomial MRSA

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4
Q

Mechanical Factors of CAP

A
  • hair and turbinates of the nares
  • branching architecture of the tracheobronchial tree
  • gag and cough reflex
  • normal flora adhering to mucosal cells of the oropharynx
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5
Q

Microorganisms access to the lower respiratory tract by:

A

– microaspiration from the oropharynx
– small-volume aspiration occurs frequently during sleep
– hematogenous spread
– contiguous extension from an infected pleural or mediastinal space

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6
Q

When the capacity of the alveolar macrophages to ingest or kill the microorganisms is exceeded this become manifested.

A

clinical pneumonia

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7
Q

Host inflammatory response trigger the clinical syndrome of pneumonia

– release of inflammatory mediators (IL6 and TNF)

A

fever

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8
Q

host inflammatory response trigger the clinical syndrome of pneumonia

  • chemokines (IL 8 and GCSF) -> release of neutrophils
A

peripheral leukocytosis and increased purulent secretions

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9
Q

Host inflammatory response trigger the clinical syndrome of pneumonia

  • Inflammatory mediators released by macrophages and the newly recruited neutrophils
A

alveolar capillary leak

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10
Q

Host inflammatory response trigger the clinical syndrome of pneumonia

  • erythrocytes cross the alveolar–capillary membrane
A

hemoptysis

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11
Q

Host inflammatory response trigger the clinical syndrome of pneumonia

  • capillary leak
A

radiographic infiltrate and rales

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12
Q

Host inflammatory response trigger the clinical syndrome of pneumonia

  • alveolar filling
A

hypoxemia

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13
Q

Host inflammatory response trigger the clinical syndrome of pneumonia

  • increased respiratory drive in the systemic inflammatory response syndrome
A

respiratory alkalosis

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14
Q

– presence of erythrocytes in the cellular intra-alveolar exudate
– neutrophil influx is more important with regard to host defense
– bacteria are occasionally seen in pathologic specimens collected during this phase

A

Red hepatization phase

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15
Q

– no new erythrocytes are extravasating, and those already present have been lysed and degraded
– neutrophil is the predominant cell, fibrin deposition is abundant, and bacteria have disappeared
– corresponds with successful containment of the infection and improvement in gas exchange

A

Gray hepatization

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16
Q
  • presence of a proteinaceous exudate—and often of bacteria—in the alveoli
A

Edema

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17
Q

– macrophage reappears as the dominant cell type in the alveolar space
– debris of neutrophils, bacteria, and fibrin has been cleared, as has the inflammatory
response

A

Resolution

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18
Q

Most common etiology of CAP

A

Streptococcus pneumoniae

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19
Q

Atypical pathogens

A

– Mycoplasma pneumoniae,
– Chlamydia pneumoniae
– Legionella species
– respiratory viruses

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20
Q
  • play a significant role only when an episode of aspiration has occurred days to weeks before presentation for pneumonia
  • Risk factors: unprotected airway (in patients with alcohol or drug overdose or a seizure disorder) and significant gingivitis
A

Anaerobes

21
Q

Clinical Manifestation of CAP involving palpitation.

A

increased or decreased tactile fremitus

22
Q

Clinical Manifestation of CAP involving percussion.

A

dull to flat

23
Q

Clinical Manifestation of CAP involving auscultation

A

crackles, bronchial breath sounds, and possibly a pleural friction rub

24
Q

In chest x-ray of CAP, pneumatoceles suggest infection with

A

S. aureus

25
Q

In chest x-ray of CAP, upper-lobe cavitating lesion suggest

A

tuberculosis

26
Q

Adequate sputum sample for Gram Stain and Sputum Culture of CAP

A

> 25 neutrophils and <10 squamous epithelial cells per LPF

27
Q

For CAP patient’s admitted to the ICU and intubated, a ______ has a high yield on culture

A

deep suction aspirate or bronchoalveolar lavage sample

28
Q

Most frequently isolated pathogen in Blood Culture for CAP

A

S. Pneumoniae

29
Q

No longer considered de rigueur for all hospitalized CAP patients

A

BLOOD CULTURES

30
Q

■ Test for Legionella pneumophila detects only serogroup 1
■ Legionella urine antigen test: 70% sensitivity and 99% specificity
■ Pneumococcal urine antigen test: 70% sensitivity > 90% specificity

A

URINARY ANTIGEN TESTS

31
Q
  • Tests amplify a microorganism’s DNA or RNA.
  • Detect the nucleic acid of Legionella species, M. pneumoniae, C. pneumoniae, and mycobacteria
  • Increased bacterial load documented in whole blood by this test is associated with an increased risk of septic shock, the need for mechanical ventilator, and death
A

POLYMERASE CHAIN REACTION

32
Q

has become the standard for diagnosis of respiratory

viral infection

A

PCR of nasopharyngeal swabs

33
Q

■ Fourfold rise in specific IgM antibody titer between acute- and convalescent-phase
serum samples
■ Fallen out of favor because of the time required to obtain a final result

A

SEROLOGY

34
Q

– identification of worsening disease or treatment failure

A

C reactive protein

35
Q

– distinguishing bacterial from viral infection
– determining the need for antibacterial therapy
– deciding when to discontinue treatment

A

Procalcitonin

36
Q

Acquired by direct DNA incorporation and remodeling resulting from contact with closely related oral commensal bacteria, by the process of natural transformation, or by mutation of certain genes

A

S. Pneumoniae Antibiotic Resistance

37
Q

minimal inhibitory concentration (MIC) cutoffs for penicillin in S. pneumoniae pneumonia:

A

■ ≤2 µg/mL for susceptible
■ >2–4 µg/mL for intermediate
■ ≥8 µg/mL for resistant

38
Q

Risk factors for penicillin-resistant pneumococcal infection for S. pneumoniae:

A
  • antimicrobial therapy,
  • age of <2 years or >65 years,
  • attendance at day-care centers,
  • recent hospitalization, and
  • HIV infection
39
Q

Methicillin resistance in S. aureus is determined by the ____, which encodes for resistance to all β-lactam drugs

A

mecA gene

40
Q

____ resistance to macrolides is increasing as a result of binding-site mutation in domain V of 23S rRNA

A

Mycoplasma

41
Q

____species are typically resis- tant to cephalosporins, and the drugs of choice for use against these organisms are usually fluoroquinolones or carbapenems.

A

Gram-negative Bacilli

– Enterobacter

42
Q

Initial Tx Strategies for Outpx with CAP

STATUS: No comorbidities or risk factors for antibiotic resistance

A

Combination Therapy: Amoxicilin + macrolide or doxycycline

or

Monotherapy: Doxycycline or macrolide

43
Q

Initial Tx Strategies for Outpx with CAP

STATUS: With comorbidities w/ or w/o risk factors for antibiotic resistance

A

Combination Therapy: amoxicilin/clavulanate or sephalosporin + either macrolide or doxycycline

or

Monotherapy with a respiratory fluoroquinolone

44
Q

Initial Tx for Inpx w/ or w/o risk factors for infection w/ MRSA or P. aeuroginosa

DISEASE SEVERITY, RISK STATUS: Non-severe
No risk factors

A

Beta lactam + macrolide

or

respiratory fluoroquinoline

45
Q

Initial Tx for Inpx w/ or w/o risk factors for infection w/ MRSA or P. aeuroginosa

DISEASE SEVERITY, RISK STATUS: Nonsevere
Prior respiratory isolation

A

Add coverage for MRSA

46
Q

Initial Tx for Inpx w/ or w/o risk factors for infection w/ MRSA or P. aeuroginosa

DISEASE SEVERITY, RISK STATUS: Nonsevere
Recent hospitalization, antibiotic tx w/ or w/o LV

A

Add coverage for MRSA only if cultures are positive

47
Q

Initial Tx for Inpx w/ or w/o risk factors for infection w/ MRSA or P. aeuroginosa

DISEASE SEVERITY, RISK STATUS: SEVERE
No risk factors

A

Beta lactam + macrolide

or

beta lactam + respiratory fluoroquinolone

48
Q

Initial Tx for Inpx w/ or w/o risk factors for infection w/ MRSA or P. aeuroginosa

DISEASE SEVERITY, RISK STATUS: SEVERE
Prior respiratory isolation

A

Add coverage for MRSA

49
Q

Initial Tx for Inpx w/ or w/o risk factors for infection w/ MRSA or P. aeuroginosa

DISEASE SEVERITY, RISK STATUS: SEVERE
Recent hospitalization, antibiotic tx w/ or w/o LV

A

Add coverage for MRSA

IM RESPI & CARDIO (VHD) (11 decks)

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