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Pulm Final > pneumonia > Flashcards

pneumonia Flashcards

1
Q

granny has acquired a bit of a drinking problem in the nursing home. she presents with a pleuritic chest pain, which kind of pneumonia might she have acquired? How would you treat this?

A

Aerobic, gram negative bacilli such as Legionella or Pseudomonas aeruginosa are seen in alcoholics and in nursing homes. Also seen with Cardiopulm dz.

Macrolides (Azithromycin) and Fluoroquinolones (Levofloxacin) are good for Legionella

For Pseudomonas, use Aminoglycosides (gentamicin), cephalosporin (3rd gen Cefepime) or carbapenems (Imipenem)

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2
Q

A homeless man has a seizure and has poor dental hygiene. What kind of pneumonias may he be at risk for? How would you treat him?

A

Anaerobes such as Bacteroides, Actinomyces and Fusobacterium.

Anaerobes can be treated with Penicillin (Piperacillin/tazobactam for anaerobes) and Clindamycin

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3
Q

A patient who smokes and has COPD may be at high risk for developing which pneumonia? How would you treat this?

A

Haemophilus Influenza.

This can be treated with 2nd and 3rd gen cephalosporin (Ceftriaxone), TMX/SMP, Quinolone (Levofloxacin), Macrolide (Azithromycin)

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4
Q

Granny has gotten her hands on some heroin in her nursing home, and she has just gotten over the cold. She’s at especially high risk for which pneumonia? Treatment?

A

Staph aureus

treat with Oxacillin, Nafcillin, or Cefazosin

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5
Q

someone with structural lung dz, completion of broad spectrum antibiotics, malnutrition or on chronic steroids may get which pneumonia?

A

Pseudomonas aeruginosa,

this is a gram neg rod so treat with amino glycosides such as Gentamicin, 3th or 4th gen cephalosporins, carbapenems, or extended spectrum penicillin

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6
Q

Hospitalized patients are more at risk for which pneumonia?

A

Legionella

also more at risk for aspirating

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7
Q

severe ICU patients more at risk for

A

S aureus and Legionella

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8
Q

Give healthy outpatients these medicines..

A

macrolides (azithromycin, erythromycin or clarithromycin)

or doxycyline (only covers atypicals to some extent)

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9
Q

Which organisms do Macrolides protect against?

A

Strep pneumo, H flu, atypicals (Legionella, mycobacteria, and chlamydia)

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10
Q

Which organisms do doxycycline protect against?

A

C pneumonia, M pneumoniae, Psuedomonas, H flu

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11
Q

What to give an outpatient with underlying comorbities (COPD, CHF, alcoholism) aka at risk for drug-resistant step pneumo

A

use a respiratory fluoroquniolone (levofloxacin)

OR beta lactam (like 4th gen cefepime) plus macrolide

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12
Q

Fluoroquinolones (such as Levofloxacin) are good at covering against which microorganisms?

A

gram pos (strep pneumo, staph aureus), gram neg (H flu, Klebsiella, legionella, psuedomonas, and e coli), and atypicals

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13
Q

Inpatient Non-ICU patients need which medicine?

A

Beta lactam plus a macrolide. The beta lactam helps protect against the gram negatives such as Klebsiella and Proteus.

Use a second or third generation cephalosporin since they have increased act against gram -

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14
Q

severe pneumonia requiring ICU care, which medicine

A

Beta lactam plus azithromycin

or

beta lactam plus fluuroquinolone

Also use Vancomycin to cover MRSA

To cover psuedomonas, use one of the beta lactams (cephalosporin, pipercillin and carbapenams) plus an amino glycoside (gentamycin)

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15
Q

How do you treat an AIDS patient with suspected pneumocystis jiroveci?

A

TMP/SMX, IV pentamadine, corticosteroids (reduced risk of rep failure and death)

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16
Q

Which bacterial pneumonias are AIDS patients at risk for?

A

S pneumo and H influenzae

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17
Q

Which prophylactic therapy should be given to AIDS patients to protect against pneumocystis jirovecii?

A

Trimethoprim/Sulfa, dapsone, pentamidine

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18
Q

How can you make the diagnosis of pneumocystis jirovecii?

A

visualization on a silver stain, bronchoalveolar lavage

also hypoxemia is prominent

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19
Q

Which fungal pneumonia may present as meningitis in AIDs patients?

A

Cryptoccocus neoformans

20
Q

Do patients with pneumonia have high or low CO2, and why?

A

Low CO2 because the hyperventilate due to the low V/Q ratio. The ventilation is low bc the alveoli are full of inflammatory cells.

21
Q

what is the radiology of aspiration?

A

bilateral opacities with air bronchograms

22
Q

how would a patient with typical pneumonia present?

A

rapid onset, ill appearing, high fevers, chest pains, rigors, consolidation/rales, leukocytosis

23
Q

organisms for typical pneumonia

A

S pneumo, S aureus, H flue, Klebsiella, Legionella

24
Q

what are the risk factors for drug resistant S pneumo

A

age>65, Beta lactam therapy within 3 months, exposure to child in daycare

25
Q

when might sputum samples be useful for diagnostics? What can’t it detect?

A

when there’s a large number of bacteria with a single morphology, when there are many PMNs and few squamous epithelial cells

no recent antibiotic admin

can’t detect legionella, mycoplasma, viruses, chlamydia

26
Q

blood cultures are used in _____ patients and are ______, but not _____

A

hospitalized

specific, not sensitive

27
Q

if someone has CAP, and they still have a fever and cough 2 days after treatment started, were they misdiagnosed?

A

no. median duration of fever is about 3 days on appropriate Rx. fatigue, dyspnea, cough often lasts 7-14 days.

28
Q

treatment for HAP is based on..

A

local hospital flora

HAP more likely to be polymicrobial

29
Q

a patient with a splenectomy is at higher risk for

A

encapsulated organisms like S. pneumo, H. flu, N. meningitides

30
Q

a patient with a neutropenia is at higher risk for

A

bacteria, aspergillus, candida

31
Q

what is the most likely diagnosis in a symptomatic HIV+ patient with abnormal CXR

A

bacterial pneumonia (S pneumo and H flu)

32
Q

An HIV+ patient with a low CD4 count has an atypical pneumonia presentation, with lower zone infiltrates and mediastinal adenopathy. Whats top of ddx?

A

M. tuburculosis

33
Q

What fungal infection are HIV+ patients susceptible to when the CD4 gets as low as 50

A

invasive aspergillosis

34
Q

when do you see red hepatization and what causes it?

A

days 3-4 of pneumococcal pneumonia

intraalveolar accumulation of neutrophils and erythrocytes

35
Q

when do you see grey hepatization and what causes it?

A

days 5-7 of pneumococcal pneumonia

intra-alveolar organization and macrophages

36
Q

Which filamentous bacteria is AFB stain negative? What is distinct about these abscesses?

A

Actinomyces israelii

sulfur granules

37
Q

Which filamentous bacteria is AFB positive and often in immuocompromised hosts?

A

Nocardia asteroides

38
Q

What is typical walking pneumonia? What does this look like histologically? Treatment?

A

Mycoplasma pneumoniae

treat with azithromycin

you would see acute inflammation in the wall and lumen of the bronchiole

39
Q

which lung lobe does secondary pneumonia usually show up?

A

granulomas in apical/posterior of upper lobes

40
Q

air crescent sign on radiology is indicative of

A

Aspergilloma

41
Q

What does Histoplasma capsulatum look like histologically?

A

necrotizing granulomatous inflammation

distinguish from TB with silver stains or culture

42
Q

what does Coccidioides Immitis look like? where is it located in US?

A

looks like spheres with endospores

southwestern US and San Joaquin valley

43
Q

Which stain can you use for the caseating granulomas of cryptococcus neoformans? What does a cryptococcoma look like?

A

mucicarmine

cryptococcoma looks like a single dominant mass, may look like a neoplasm

44
Q

what is Type I invasive aspergillosis characterized by?

A

organisms invade blood vessels, leading to infarction and thrombosis

esp in immunocompromised hosts

45
Q

what is Type II aspergilloma characterized by?

A

mycetoma fungus ball in pre-existing cavity

46
Q

what is Type III aspergillosis characterized by? What will you see in blood and sputum?

A

Allergic Bronchopulmonary Aspergillosis (ABPA)

most patients are asthmatics who develop immune reactions to Aspergillis

eosinophilia

47
Q

If you look under a microscope and see filling of alveolar airspaces w/ organisms and proteinaceous fluid in an immunosuppressed patient, which fungi may come to mind?

A

pneumocystis jiroveci

Pulm Final (5 decks)

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