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Respiratory 2 > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q 
Cough +/- sputum
Chest pain
Fever
Fatigue
Shortness of breath
Crackles
Elevated WBC
Abnormal CXR
A

signs/symptoms of pneumonia

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2
Q

Most common route of bacterial infection in the lung is…

A

Aspiration (from oral microflora or GI)

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3
Q 
Smoking
Meds
Intubation
Leukemia/Lymphoma
COPD
Viral infection
AIDS
Immunosuppression
A

Things that can cause a weakening of natural lung defenses

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4
Q

What are the steps to diagnostic evaluation for CAP

A
  1. Establish the diagnosis of pneumonia
    - based on clinical signs/symptoms and lab/xray results
  2. Identify the pathogen (if possible)
    - s. pneumo is the most likely
    - Gram stains/culture/blood maybe used
    - patient history can help
  3. Assess the severity of illness
    - based on demographics, clinical findings, lab and x ray results
    - CURB-65
    - decide outpatient or inpatient
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5
Q

Typical vs. atypical pneumonia: rapid, ill, high fever, chest pain and sputum; consolidation and crackles; lobar infiltrate

A

typical

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6
Q

Typical vs. atypical pneumonia: slow, less ill, milder fever, headache and cough; crackles with no consolidation; patchy infiltrates (interstitial)

A

atypical

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7
Q

“Typical” pneumonia is usually caused by what organisms?

A

S. pneumoniae
S. aureus
GN bacilli

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8
Q

“Atypical” pneumonia is usually caused by what organisms?

A

Mycoplasma
Chlamydia
P. jiroveci
Viruses

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9
Q

Interstitial (atypical) pneumonia looks like what in a CXR?

A

Diffuse, stringy infiltrates (like a spider web)

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10
Q

Typical pneumonia looks like what in a CXR?

A

lobar

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11
Q

Most common bacterial cause of pneumonia (either ambulatory, hospitalized or severe/ICU)

A

Streptococcus pneumoniae

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12
Q

Drug resistant pneumoniae is typically found in what populations?

A

Age >65
Daycare

  • why they get vaccinated maybe
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13
Q

P. aeruginosa infection is typically found in what populations?

A

CF

Bronchiectasis

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14
Q

H. influenzae infection is typically found in what populations?

A

Smokers

COPD

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15
Q

What factors increase the severity of pneumonia?

A
  • age >60
  • abnormal vital signs (low BP/RR, high HR)
  • WBC>30k or <4k
  • multilobar on cxr
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16
Q

Initial treatments for pneumonia are nearly always empiric

A

True (tests take time and 50% of time you’ll never know)

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17
Q

Which etiologic agents of pneumonia typically need hospitalization?

A

Legionella
S. aureus
Gram- bacilli

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18
Q

Outpatients with pneumonia typically receive what treatment?

A

Macrolides or doxycycline

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19
Q

Outpatients with DRSP, or inpatients not in the ICU, with pneumonia typically receive what treatment?

A

Beta-lactam + macrolide
OR
Respiratory fluoroquinolone

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20
Q

Inpatients in the ICU with pneumonia typically receive what treatment?

A

Beta-lactam + azithromycin or fluoroquinolone

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21
Q

Empiric drug therapy for CAP in children is dependent on

A

age

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22
Q

You know your chosen treatment for pneumonia was effective if..

A

better within 24-48 hours

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23
Q

When to suspect an atypical (other) cause of pneumonia?

A 
Upper lobe infiltrate (TB)
Indolent
Non-resolving with treatment
Outdoors (Blastomycosis)
SW (Coccidioides)
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24
Q

What are the steps to diagnostic evaluation for HAP

A

Basically the same as CAP

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25
Q

Hospital Acquired Pneumonia (HAP) affects 1% of hospitalized patients, has a mortality of 33%, and is highest in…

A

intubated patients

26
Q

Typical Hospital Acquired Pneumonia pathogens

A 
Gram- bacilli
P. aeruginosa
Enterobacter
E. coli
MRSA
Klebsiella
27
Q

Treatment for HAP is based upon

A

local hospital flora

28
Q

Typical Hospital Acquired Pneumonia pathogens

A

Gram- (P. aeruginosa, E. coli, MRSA, Klebsiella)

  • HAP more likely to be polymicrobial
29
Q

What pathogens are not covered by empiric CAP therapy so must be included with HAP empiric therapy?

A

MRSA (Vacomycin)
P. aeruginosa (gentamicin)

*CAP empiric therapy includes E.coli and klebsiella)

30
Q

Wider variety of pathogens (fungal) should be considered for HAP patients that are

A

immunocompromised

31
Q

What opportunistic pathogen should be considered for AIDS patients with pneumonia if their CD4 count is < 200?

A

Pneumocystis

  • bacterial pneumonia still remains the most likely culprit
32
Q

What clinical presentation is the prominent feature of AIDS patients with pneumocystis?

33
Q

Typical presentations (upper lobe cavitary infiltrates) are seen with AIDS patients with TB when they have

A

higher CD4 count

34
Q

atypical presentations (lower zone infiltrates) are seen with AIDS patients with TB when they have

A

low CD4 count

35
Q

Neutropenia can make you more susceptible to what infections?

A 
Bacteria
Opportunistic Pathogens (Candida & Aspergillus)
36
Q

Splenectomy can make you more susceptible to what infections?

A

Encapsulated organisms

37
Q

Neutrophils are involved in what type of inflammatory response?

A

Acute inflammation in alveolar SPACE in response to BACTERIA

38
Q

Lymphocytes are involved in what type of inflammatory response?

A

Chronic inflammation in alveolar SEPTAE (interstitial) in response to VIRUSES

  • alveolar space is clear
39
Q

A granuloma is an inflammatory response to what pathogens?

A

in response to FUNGI and MYCOBACTERIA

40
Q

What cells make up granulomas?

A
  • Langhans giant cells
  • Histiocytes (macrophages)
  • Some lymphocytes & neutrophils
41
Q

What are two major patterns of bacterial pneumonia?

A
  1. Bronchopneumonia
    - scattered patchy foci of consolidation
  2. Lobar Pneumonia
    - complete consolidation of a lobe w/wo hepatization
    - Strep. pneumo
42
Q

Organisms causing bacterial pneumonia can be largely divided into

A

CAP or HAP

43
Q

Describe pneumococcal pneumonia caused by Strep pneumo

A
  1. Pathogen: Strep pneumo
    - Encapsulated gram + diplococci
    - extracellular
  2. Pathology
    - Early: red hepatization (intra-alveolar neutrophils and RBCs)
    - Later: grey hepatization (intra-alveolar macrophages)
  3. Lobar pattern
44
Q

Describe pneumonia caused by Anaerobic bacteria

A

Anaerobic bacteria often cause necrosis +/- abscess and foul-smelling sputum

  • higher risk in alcholism
45
Q

Describe pneumonia caused by Filamentous Bacteria

A
  1. Pathogens: gram +
    - Nocardia (acid fast +)
    - Actinomyces (acid fast -)
  2. Abscesses
    - Nocardia: abscesses in immunocompromised
    - Actinomyces: abscesses with sulfur granules
46
Q

Complications of bacterial pneumonias (3 total)

A
  1. Abscesses
  2. Pyothorax/empyema (infection of pleural fluid/space)
  3. Bacteremia (in blood)
47
Q

Abscess vs. Granulomas: macrophages, lymphocytes, langhan cells surrounding necrotic center with neutrophils and bacteria

A

Granulomas + necrosis

48
Q

Abscess vs. Granulomas: center full of neutrophils and bacteria and fibrosis surrounding the center

A

Abscess (pus)

49
Q

Describe pneumonia caused by Mycoplasma

A
  1. Milder (chronic walking pneumonia) than usual bacterial pneumonia
  2. inflammation in the wall and lumen of bronchiole; alveoli is clean
50
Q

Describe tuberculosis caused by Mycobacterium tuberculosis

A
  1. Primary TB
    - inhalation of m. tuberculosis
    - Ghon Complex (ghon focus + infected hilar lymph node)
    - Granulomatous inflammation +/- necrosis
    - 90% asymptomatic
  2. Secondary TB
    - reactivation of primary TB or new infection in sensitized/HIV patient
    - Granulomas cavitary lesions in apex of upper lobes
    - granulomas can deteriorate and disseminate hematogenously (miliary TB)
51
Q

Complications of TB (4 total)

A
  1. Miliary TB (multiple small granulomas)
  2. Hemoptysis: angioinvasion of pulmonary artery
  3. Broncho-pleural fistula: erodes into pleural space leading to empyema
  4. Cavity formation: site for aspergilloma growth
52
Q

Describe pneumonia caused by Fungi

A
  • Pathogens: Histo, Blasto, Coccidioides; crypto
  • often in immunocompromised patients
  • Granulomatous host response
  • silver stains for detection
53
Q

What fungal pathogen is very small and found in bird droppings?

A

Histoplasma
- necrotizing granulomatous inflammation

  • pomegranate shaped
54
Q

What fungal pathogen is thick walled (double contoured) and had broad based budding?

A

Blastomyces

  • dumbbell-shaped
55
Q

What fungal pathogen is most found in SW US and has spherules (w/ endospores inside)

A

Coccidioides

  • half-cut fig shaped
56
Q

What fungal pathogen is found in pigeon droppings and has halo or narrow based budding?

A

Cryptococcus

57
Q

type of fungus; seen in soil and decaying plant material; septate hyphae with acute (V-shaped) branching

A

Aspergillus

58
Q

3 types of Aspergillosis disease

A
  1. Invasive aspergillosis
    - invasion of blood vessel wall and lumen
  2. Aspergilloma
    - Mycetoma (fungal ball) in cavity from TB
  3. Allergic Bronchopulmonary Aspergillosis (ABPA)
    - allergic response to aspergillus
    - high IgE and eosinophils
59
Q

Describe pneumonia caused by Pneumocystis

A
  • HIV/AIDS patients with <200 CD4 count at risk
  • frothy exudates within alveolar spaces
  • broncho-alveolar lavage useful for diagnosis (silver stain)
60
Q

Describe pneumonia caused by Viruses

A
  • Interstitial lymphocytes
  • CMV (owl eye cells with large intra-nuclear inclusions)
  • HSV (cells with 3 Ms: multinucleation, margination, molding)

Respiratory 2 (6 decks)

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