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Clinical Medicine- Pulmonary > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

How does a virus enter the host for pneumonia?

A

Hemaggluttin attaches to cell surface glycan allowing it to enter

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2
Q

What would you see on lab test for a bacterial infection compared to viral infection?

A

Elevated CRP and procalcitonin

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3
Q

What are the three types of pneumonia that affect the lung?

A

Bronchopneumonia, lobar, interstitial

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4
Q

Why are individuals that have a decreased or absent spleen at risk for pneumonia?

A

They have a faulty alternate pathway (opsonization) of complement putting them at risk for encapsulated organism like pneumonia

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5
Q

Clinically important encapsulated bacteria?

A

S. pneumoniae, H. influenzae, N. meningitidis

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6
Q

What is the most common cause of pneumonia?

A

Streptococcus pneumoniae, (gram positive, diplococcus)

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7
Q

What is the most virulent type of haemophilus influenzae and what are its characteristics?

A

H. influenza type b (Hib). Gram negative, pleomorphic rod

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8
Q

Other types of invasive H. influenza include?

A

Bacteremia, meningitis, epiglottitis, cellulitis, infectious arthritis

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9
Q

S. aureus has a ____ complication rate and can lead to ______ in the lungs?

A

HIGH, lung abscesses, empyema (collection of pus and fluid), commonly seen following influenza infection

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10
Q

What type of pneumonia is seen in alcoholics? What are some of the signs?

A

Klebsiella pneumonia. Thick, blood tinged sputum

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11
Q

What bacteria commonly invades blood vessels and spreads beyond the lungs

A

Pseudomonas aeruginosa gram -

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12
Q

These patient present with GI symptoms of abdominal pain, nausea, diarrhea, and vomiting. They can have chest pain and neurological abnormalities. Fever present most the time.

A

Legionella pneumophilia

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13
Q

This type of pneumonia presents in children and young adults. They will have a cough but appear well. They can have pharyngeal injection and normal lung auscultation. Gradual onset, low grade fever, fatigue

A

Mycoplasma pneumoniae

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14
Q

Major signs of bacterial pneumonia?

A

Abrupt onset of fever, skaking chills, productive cough, hemoptysis, pleuritis causing pleuritic pain and pleural friction rub

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15
Q

Common microorganisms that cause pneumonia in tobacco users or COPD?

A

Streptococcus pneumonia, legionella pneumonia, H. influenzae

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16
Q

Common pathogen causing pneumonia in alcoholics?

A

Streptococcus pneumoniae, Klebsiella pneumoniae (alcoholics are klebc “clumsy”)

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17
Q

Common pathogen causing pneumonia in nursing home residents?

A

Streptococcus pneumonia, gram negative bacilli, staphylococcus aureus

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18
Q

What are some viral pathogen causing pneumonia?

A

Influenza virus, respiratory synctitial virus (RSV), parainfluenza virus, adenovirus, varicella

19
Q

Two most common type of aspergillus and risk factors?

A

A. fumigatus and A. flavus. Immunosuppression, influenza A, transplant patients, AIDs patients

20
Q

Encapsulated yeast that is found in pigeon dropings?

A

Cryptococcus

21
Q

Found in the mississippi, ohio,, Missouri river valley?

A

Histoplasma capsulatum

22
Q

Found in the soil of California, southwestern US, Mexico, Central/south america?

A

Coccidioides

23
Q

Life threatening emergency in HIV+ patients?

A

Pneumocystis jirovecci

24
Q

Common pathogens of nosocomial pneumonia?

A

E. coli (-), Klebsiella p. (-), Enterobacter (-), P. aeruginosa (-), acinetobacter (-), s. aureus (+), streptococcus (+)

25
Q

What is the gold standard for diagnostic testing in pneumonia? What would you see?

A

Chest xray. Posteroranterior and lateral view. Will see consolidation which is normal air filled alveoli filled with pus and fluid.

26
Q

When would you get a sputum culture?

A

ICU admission, failure of outpatient treatment, cavitary lesions, alcohol abuse, ALL nosocomial pneumonia pts

27
Q

Bacteria responsible for bacteremia with pneumonia?

A

Streptococcus pneumoniae

28
Q

What two bacteria will urinary antigen testing detect?

A

Streptococcus pneumonia and legionella pneumonia

29
Q

If you suspect a Legionella infection, what two test should be performed?

A

Urinary antigen test and sputum culture

30
Q

What kind of procalcitonin levels would you suspect with a bacterial and viral infection?

A

Increased in bacterial infections. Parenchymal cells release it in response to bacteria and toxins. Down regulated in response to viral infections.

31
Q

What would you treat a patient who is healthy, no hx antibiotics last 3 months, no co-morbidities?

A

Macrolides. Azithromycin 500mg day 1, 250mg days 2-5. Clarithromycin 500mg BID x 5 days. OR Doxy 100mg BID x 5 days if macrolide resistance > 25% in the region

32
Q

What would you treat CAP in an individual who has co-morbidities, on antibiotics last 3 months, lives in area where resistance is >25%.

A

Respiratory fluoroquinolone. Levofloxacin 750mg QD x 5 days, Moxifloxacin 400mg QD x 5 days, Gemifloxin 320 qd x days. Can combine beta lactam + macrolide (Augmentin 2mg BID + Clarithromycin 500mg BID x 5 days

33
Q

Physical findings considered higher risk?

A

Altered mental status, RR >30, HR >125, BP104

34
Q

Common CAP that require hospitalization?

A

Streptococcus pneumoniae, Legionella, gram - bacilli, S. aureus, influenza virus

35
Q

Treatment for an individual who is hospitalized with CAP but not in ICU?

A

Fluoroquinoline: Levofloxacin 750mg or Moxifloxacin 400mg daily. OR Macrolide + pick 1 (Ceftriaxone, Cefotaxime, Ceftaroline, Ertapenem, Ampicillin-sulbactam)

36
Q

Treatment for CAP who is hospitalized and in ICU

A

Respiratory fluoroquinolone or macrolide + 1 of following (Ceftriaxone, Cefotaxime, Ceftaroline, Ampicillin-sulbactam)

37
Q

Unusual causes of pneumonia in children?

A

SARS, avian influenza, legionella, afebrile pneumonia

38
Q

Manifestations of viral pneumonia in children?

A

Cough, wheezing, stridor

39
Q

Manifestations of bacterial pneumonia in children?

A

Fever, chills, dyspnea

40
Q

Manifestations of atypical pneumonia in children?

A

tachypnea, cough, crackles, possible conjunctivitis

41
Q

Blood culture results for pneumonia?

A

viral- lymphocytosis
bacterial- WBC >20,000
Chlamydia trachomatis-eosinophilia

42
Q

What pathogen would you be looking for in a urine antigen test for children?

A

Legionella, cytomegalovirus, enterovirus

43
Q

Causes of recurrent pneumonia in children?

A

Cystic fibrosis, asthma, SCD, immunocomprimised, neutrophil dysfunction, immotile cilia, anatomic disorders

Clinical Medicine- Pulmonary (20 decks)

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