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STEP1 > Pneumonias > Flashcards

Pneumonias Flashcards

1
Q

Most common agents typical pneumonia

A

Strep pneumonia e
H flu
Moraxella
Staph aureus

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2
Q

Most common agents atypical “walking” pneumonia

A

Mycoplasma. Pneumonia e
Legionella
Chlamydophilia pneumonia e
Chlamydia_psittaci

All hard to culture can’ t be seen on gram
Most live in host cells

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3
Q

Most abundant immune cell pneumonia

A

Neutrophils

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4
Q

Aspiration pneumonia typical agents

A

Kleibsella
Anaerobes
Acinetobacter

Alcoholism

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5
Q

Hap most common agents

A

MR sa
Pseudomonas
Acinetobacter
Enterobacterlacaec
Legionella
Burkholderia

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6
Q

Agents with a higher risk in smoking and copd

A

Atypical
Pseudomonas

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7
Q

Legionella risks

A

Travel, hotel, cruises

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8
Q

Staph aureus pneumonia risks

A

Secondary after flu
Structural lung disease

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9
Q

Bird pneumonia

A
  • Chlamydia-psittaci
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10
Q

Rabbit pneumonia

A

Francisella-tularensiis

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11
Q

Sheep /goat pneumonia

A

. Coxiella burnetii

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12
Q

Encapsulated bacteria

A

S pneumonia
H flu

Protects from phagocytosis

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13
Q

Legionella defenses

A

Macrophage infector protein
Type 4 secretion system
Grows inside macrophages

Uses iron

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14
Q

S aureus toxin involved in phenomena

A

Alpha-hemolysi n
- pore forming eytotoxin

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15
Q

Mycoplasma penicillins

A

No-go, they don’t have a cell wall

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16
Q

Chlamydophiliavirulenufactor

A

Type 3 secretion system
Lives in macrophages

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17
Q

Enterococci virulence factor

A

MSR - vanA vancomycin

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18
Q

Outpatient cap Tx

A

. Macrolide- azithromycin
Or doxy

If recent ab x or high risk:
- azithromycin with ceftriaxone
- respiratory fluroquinolone eg. Levo floxacin

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19
Q

Inpatient cap Tx

A
  • azithromycin with ceftriaxone
  • respiratory fluroquinolone eg. Levo floxacin,
    In iv form
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20
Q

Pseudomonas empiric coverage

A

Pip/tazo

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21
Q

MRSA empiric coverage

A

Vancomycin or linezolid

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22
Q

Antigenic- shift

A

Major changes due to reassortment
Usually used for flu to mean new subtype

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23
Q

Antigenic drift

A

Minor changes due to point mutations

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24
Q

Pharyngocongunctival fever

A

Pharyngitis- conjuncevitis- fever
Adenovirus

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25
Q

Adenovirus genome

A

Ds DNA

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26
Q

RSV

A

Paramyxovirus
Ssrna
F protein in envelope Fuses neighboring cells together →multinucleated synciftia
G protein in envelopes → attachment

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27
Q

Palivizumab

A

Anti-rsv
Prophylaxis for at-risk infants eg. Cyanotic heart failure, bronchopulmonary dysplasia
Not usually needed for tx

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28
Q

Hantavirus

A

Rural areas, se US
Rodents
Pulmonary edema dt infection ofendothelial cells in lung
Potentially fatal
* thrombocytopenia - prolonged pt and ptt

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29
Q

Measles signs

A

Fever first
Cough- rinorrhea - conjunctivitis
Kopek spots buccal mucosa
Macalopapular rash

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30
Q

Vzv pneumonia

A

Ic
Typical vzv signs plus prolonged fever i cough
N odular lung lesions X-ray

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31
Q

CMV pneumonia

A

Ic
Interstitial pneumonia
Non-productive cough
* Neutropenia (Low)
Elevated lfts
Mucosal ulcers

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32
Q

Flu a/b Tx

A

Peramivir, zanamimi, oseltamivir
All neuraminidase in hibitors

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33
Q

Indirect flu A Tx

A

Amantidine
Rimantadine
Both nicotinic (and mixed other) agonists

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34
Q

RSV t x

A

Ribavirin (also used for hep c)
Palivizumab (mostly prophylactic s

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35
Q

VSV Tx

A

Acyclovir

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36
Q

CMV Tx

A

Ganciclovir, valganciclovir
Foscarnet (DNA/RNA polymerase innibitor)

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37
Q

Coronaviruses structure

A

Enveloped
Linear ss POS sense RNA

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38
Q

COVID entry cell

A

Type 2 pneumocytes
Lack of surfactant worsens sx

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39
Q

Histoplasmosis risk

A

Spelunking
Bird/bat droppings
Ohio and Mississippi river
Ic - systemic
Other - mostly asymptomatic, sometimes pneumonia

40
Q

Histoplasmosis microbe

A

Yeast-oval, resides in mq
Small
Narrow-based budding
Dimorphic

41
Q

Histoplasmosis X-ray

A

Scattered lung nodules with infiltrates
Hilar lymphadenop any
Nonspecific

42
Q

Blastomycosis risk

A

Southeast US
Mississippi and Ohio rivers
Southern Canada

43
Q

Severe blastomycosis presentation

A

Flu like first
Then:
- severe pneumonia
- possiblerespiratory failin
- warty ulcerated skin granulomas - central scarring,well-defined borders
- bone disease
Ic

44
Q

Blastomycosis microbe

A

B dermatitis
Dimorphic
Thick walled yeast-when-warm
Broad based bud

45
Q

Coccidioses risk

A

Southwest us
Mexico, South America
San Joaquin valley fever

46
Q

Cocci sx

A

60% asymptomatic
Mild pneumonia with fatigue, ha, joint pain

Erythema nodosum or erythema multiforme

Severe in ic → meningitis

47
Q

Cocci Micro

A

Highly resistant air borne spores
Spores germinate in thick walled spherules with endospores
Very large
Dimorphic

48
Q

Aspergillis manifestations

A

,allergic:
- hay fever type I
- farmer lung type 3
- allergic bronco pulmonaryaspergillosi3 (abpa) combined 1/3

nonin l vasive, or invasive

49
Q

Aspeogillus risk

A

Farmers, soil-workers

50
Q

Farmer lung

A

Aspirgllosis type 3 Hs ‘”
Dysprea, no wheezing
Fever, chills, cough, sob
Recurring
Exposure-related

51
Q

ABpA

A

Aspergillosiscombined 1/3 Hs
Asthma
Lung infiltrates
Eosinophilia
Risk of permanent lung scarring if recurrent

52
Q

Aspergilloma

A

Noninvasive fungal ball inside preexisting lung cavities
Cavities created by tb, sarcoidosis, emphysema,

53
Q

Aspergilloma st

A

Cough, fatigue
Weight loss
Hemoptysis
Fungal lesions in ear canals, nail beds, and nasal sinuses

54
Q

Invasive aspergillosis

A

Necrotic abscesses:
Lung, brain, liver, kidney, gi

Risk:
Neutropenia pts
CD 4 <100

55
Q

Mucormycosis

A

Necrotic lesions with black exudate
Upper respiratory/sinus
Fungal ball
Severe: skull invasion

Risk:
Diabetes

56
Q

Cryptococous risk

A

Ic ‘
CD 4 <50
Rarely, dt heavy occupational exposure-farmers

57
Q

Cryptococcus_sx

A

Pneumonia
Meningitis - new severe ha
Encephalitis ‘

58
Q

Cryptococcus micro

A

India ink
Budding yeasts
Capsular halo

59
Q

Pneumocystis jiroveci risk

A

Mostly AIDS pts
CD 4 <200

60
Q

PCP sx

A

Indolent
Fatigue
Slowly progressive dyspnea
→
High fever
Nonproductive Cough
Hypoxemia <70% Ra
→
Severe ARDS
Pulmonary edema

Elevated LD H
Diffuse bilateral infiltrates with-ground-glass opacities
Methylamine silver stain

61
Q

PCP microbe

A

Fungal and protozoan characteristics
Airborne
Opportunistic

62
Q

CD 4 cutoffs AIDS associated pneumonia’s

A

PCP <200
Invasive Aspergillus <100
Cryptococcus <50.
Mycobacterium avium <50

63
Q

Fungistatic drugs

A
  • conazole
64
Q

Fluconazole

A

Fungistatic
Narrowspectrum
3 c ‘s:
-Candida
- crypto,occus
-Cocci

65
Q

Itraconazole

A

Fungistatic
Broad-spectrum

66
Q

Voriconazole

A

Invasive aspergillosis, candidemia
In neutropenia or renal insufficiency

67
Q

Amphoterrible

A

Fungitoxic
Severe or disseminated
Broad section

68
Q

PCP Tx

A

Tmp-smx
Pentamidine

Prophylaxis in CD 4 <200

69
Q

Initial Tb response and immune evasion

A

C3b complement → mq c4 receptor → ingestion
Insufficient destruction b y No
Tb prevents fusion of phagosome with lysosome
-Block sintracellular Ca
- prevent liposome acidification

70
Q

Growth stage tb

A

7-21 days post infection
Tb replicates inside mq
Mq rupture → release Tb
Infect more mq → gran. With giant multimucleatd cell, surrounding fibrosis

Il -12 and _ IFN → fever, weight loss

71
Q

Slow growth phase Tb

A

21+ days
Continued gran formation
Ghon focus - cavitory necrotic lesion usually in lower lung I peripheral lung fields creactivation later in apex
Hilar lympha.
Thickened pleura

Fever, weight loss, night sweats, hemoptysis

72
Q

Miliary tb

A

Systemic,
Ic

73
Q

Labs Tb

A

Anemia
High WBC
High esr/crp
Nonspecific

PPD
Quantiferon Gold test- IFN release by T cells in response to mycobacteria

74
Q

Tb Tx

A

Rifampin
Isoniazid
Pyrazinamide
Ethambutol

75
Q

Mycobacterium avium

A

CD4 < 50
Similar to Tb
Tx macrolide

76
Q

Pulmonary absuss risk

A

Aspiration
Most often right lung

77
Q

Pseudomonas gross sputum characteristics

A

Blue -green pigment
Fruity odor

78
Q

Staph aureus gross sputum

A

Yellow pigment
Compare actinomyas Israelis which has yellow granules

79
Q

Nocordia Micro

A

Aerobic
Weaklyacid fast
Branching filaments

80
Q

Empiric for lung abscess

A

Meropenem

81
Q

Nocardia Tx

A

Sulfonamides eg tmp-smx

82
Q

Pulmonary abscess X-ray

A

Air- fluid levels

83
Q

Sarcoidosis risk fx

A

Building supply
Construction
Metalwork
Firefighter

84
Q

Sarcoidosis histology

A

Non-caseating granul Oma.

85
Q

Sarcoidosis sx

A
  • Any system
    Common:
    -Lung-cough, sob, chest pain
  • eyes
  • skin-acne-like lumps

Constitutional
-Malaise
- fever
- weight loss

Young adults >20

86
Q

Sarcoidosis path

A

Th 1 CD 4
- ifn-g
→ mq
- ace - diagnostic
- tnf-a
→ maintains gran.

87
Q

Schaumann bodies

A

Calcium and protein inside giant cells inside granolas
Sarcoidosis

88
Q

Sarcoidosis pft

A

Interstitial
Restrictive
Decreased tl c
Normal to high_fev1/ fvc

89
Q

Sarcoidosis xray

A

Hilar adenopathy
Reticular opacities

90
Q

Sarcoidosis Tx

A

Oral steroids

91
Q

Dvt Tx

A

Heparin
Then warfarin or new gen anticoag if long term indicated

92
Q

Dvt test

A

D-dimer
P ocus

93
Q

Fat emboli risk

A

Long bone Frx

94
Q

Pe phys

A

Low cardi ac output dt low -lv preload
Hypoxem s ia
Tachypnea. -
Dead space

95
Q

Pe sx

A

Sob i
Pleuritic cp(inspiration)
Palpitations
Cough
Fever
Dvt sx
Sometimes hemoptysis
End organ hypoperfusion if unstable - impaired rv emptying

96
Q

Pe EKG

A

Sinus tach
Rv strain
Right bundle branch block dt dilation
Nonspecific_St and T changes

97
Q

Pe Tx

A

Heparin
Xa inhibitors

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