Pulm 2 Shea Flashcards
- Which type of PNA are debilitated elderly patients who are confined to a bed most likely to get?
- What vaccine should they get?
- What does the organism look like under microscope?
Alveolar PNA, it is superimposed on pulmonary edema or chronic heart failure.
Elderly should get Strep Pneumoniae vaccine to guard against the gram positive dipococci
Pneumonia limited to the segmental bronchi and surrounding parenchyma
Bronchopneumonia
Which type of of the Alveolar PNAs happens first?
- Bronchopneumonia (patchy)
- Lobar pneumonia (confluence of patchy areas) –> lung can collapse
Widespread or diffuse alveolar PNA
Lobar PNA
- Refers to the alteration of lung tissue such that it resembles liver tissue.
- It is a finding of which type of PNA?
- Pulmonary hepatisation
- Lobar PNA (Alveolar PNA) - bacterial
What is the #1 bacterial cause of Lobar PNA (alveolar/bacterial)?
Strep Pneumo
Which type of PNA is usually diffuse and often bilateral?
Intersititial (viral) PNA
Are most PNAs acute or chronic?
Both bacterial and viral PNAs are most often acute, but if untreated or incompletely treated, they may become chronic.
Which type of PNA has lots of “mono-nuclear” cells?
Interstitial (viral) PNA
6 causes of PNA and which is most common
- Bacteria (most common, 75% of all cases dx clinically)
- Viruses (2nd most common)
- Fungi (less common)
- Protozoa (less common)
- Parasites (less common)
- Aspiration
Which 3 bacteria are the most common causes of PNA?
- Streptococcus (gram + diplococci)
- Staphylococcus
- Hemophilus influenza
The normal upper respiratory tract does not harbor which kind of bacteria?
Anaerobic gram negative bacteria
(E. coli or Pseudomonas aeruginosa)
Gram negative bacteria are not found in the respiratory tract, so how do gram negatives such as E. coli and Pseudomonas aeruginosa make their way to the lungs to cause PNA?
They are located in the enteric flora and contaminate the blood to make their way to the lungs to cause PNA.
Which 2 things are not normally present in the nasopharyngeal flora, but may cause PNA if inhaled accidentally?
- Legionella
- TB
How did Legionella pneumophilia get the name (genus and species)?
1976, members went to American Legion convention in Philadelphia where the cooling tower was harboring the bacteria
Inhalation of air droplets, is the route for which pathogens of PNA?
- Viruses
- TB
(MOST COMMON)
Aspiration of infected secretions from the upper respiratory tract is typical of which pathogens of PNA?
- Strep pneumo
- Staph
Aspiration of infected particles in gastric contents (aspiration PNA) is often associated w/ which pathogen of PNA?
- Anaerobic bacteria
Common in these 3:
- People w/ neurologic defects
- Unconscious people
- Alcoholics who have vomited and lost control of gag reflex (opiates also depress gag reflex)
Hematogenesis spread of PNA causes bacteria to go from blood to the lungs. What 3 things develop from this?
- Sepsis
- UTI
- GI tract infections (ruptured diverticulus)
What 3 things are needed to dx aspiration PNA?
- Acute inflammatory cells
- Bacterial colonies around food debris in the lung
- Neutrophils
What age groups are most affected by PNA?
- Children younger than 5
- Elderly older than 70
What are the 2 types of “Clinical PNAs?”
- Primary / CAP (community acquired pneumonia)
- Secondary pneumonias (nosocomial/hospital acquired)
Which “clinical” PNA affects previously healthy people?
Primary / CAP
Which “clinical PNA” affects persons w/ pre-existing illnesses?
Secondary PNA (nosocomial/hospital acquired)
3 risk factors for developing Secondary PNA
- smoking
- alcoholism
- immunosuppression
Inflammatory exudates cause tissue destruction and bleding which causes a mucopurulent blood tinged, “Rust-colored sputum.” What bacteria causes this PNA?
Strep pneumo
Which bacteria causes PNA to have a “currant red jelly sputum?”
Klebsiella species pneumonia
Apart from clinical findings of rales, rhonchi, and other signs of pulmonary consolidation, what 4 diagnostic studies are used to dx/confirm PNA?
- Chest X-ray (localizing infiltrates/consolidation)
- Bacteriologic Studies of Sputum (figure out which bacteria so you get most lethal abx)
- Peripheral Blood Smears (Leukocytosis = bacterial) (Lymphocytosis = viral)
- Blood Gas Analysis (detects hypoxia or resp acidosis)
Which bacteria is this?
Strept pneumococcus
“Diplococci”
Which bacteria is this?
Staphylococcus aureus
“grape-like clusters”
- Accounts for >50% of all bacterial pneumonias
- Usually reach the alveoli in droplets of mucus or saliva
- Which lobes are affected?
- Pneumococcal Pneumonia
(St. pneumoniae)
- Usually affects the lower lobes due to gravity.
Sudden onset of chills, fever, pleuritic chest pain, cough and rust-colored sputum.
Pneumococcal Pneumonia
(Strep Pneumo)
- How effective is the vaccine for strep pneumococcus?
- Who is the vaccine given to? (7)
- sickle cell
- multiple myeloma
- diabetes
- cancer
- alcoholics
- splenectomy patients
- elderly.
- Tends to produce multiple abscesses.
- A virulent form of pneumonia
- Common in debilitated hospitalized patients.
- The mortality rate is over 50%.
Staphylococcus aureus pneumonia
What are the 2 gram negative bacteria which cause pneumonia?
- Pseudomonas
- Klebsiella
- Oval, budding yeast surrounded by a wide polysaccharide capsule
- India Ink Prep
- World-wide distribution
- Systemic opportunistic mycosis
Cryptococcus neoformans
- The most common hospital acquired PNA (nosocomial)
- Vascular lesions which cause infarcts and necrosis of lung parenchyma
Pseudomonas
- The most common cause of lung infections in Cystic Fibrosis patients
- Source: contaminated ventilatory equipment
- What is the mortality rate?
- Pseudomonas
- Over 70%
- Occurs in middle aged, alcoholic males
- Thick currant-red jelly sputum
Klebsiella PNA
Which PNA? Which organism?
- Pt does not present w/ classic sxs
- Diffuse PNA
- Interstitial PNA
- Mild clinical sxs (no chills, low fever, mild cough, no bloody or purulent sputum)
- No signs of septicemia, leukocytosis, or abscesses
- Atypical PNA (Walking PNA)
- Mycoplasma PNA (bacterial-like organism)
- (more viral)
- “missing link between virus–>bacteria”
- Opportunistic (affects immunocompromised)
- Affects meninges and lungs
- Main reservoir: pigeon droppings in soil (birds not affected)
- Fungus
Cryptococcus neoformans PNA
- No human to human transfer (not communicable)
- Interparenchymal disease
- Occurs in AIDS, leukemia, and lymphoma patients
- Asymptomatic in healthy patients (good immune systems)
Cryptococcus Neoformans PNA
Contains “Mucoid (clear) Capsules” on gram stain
Cryptococcal Neoformans PNA
- Chronic, necrotizing infection which resembles TB
- Endemic to arid regions of SW U.S. & Latin America
- Common in San Joaquin Valley, CA and here in Phx, AZ
Coccidioides immitis PNA
(Coccidioidomycosis)
- Forms hyphae w/ arthrospores in the soil which are very light, can be carried by wind –> inhaled
- Very contagious when grown in laboratory (concentrated), compared to diffuse in the air
- Dimorphic fungi
Coccidioides immitis PNA
(Coccidioidomycosis)
- Coccidioides immitis (Coccidioidomycosis) PNA is a mold or yeast?
- How do you treat it?
- It is a dimorphic fungi.
- In environment: Mold
- In body: yeast
- Tx w/ anti-fungals
How does Cocciodoidomycosis/Coccidioides PNA cause disease in the lungs?
- Arthrospores for Spherules
- Spherules are large vacuoles w/ thick wall
- Spherules are filled w/ endospores
- Walls rupture, endospores released and they form new spherules
- New spherules spread via blood or direct extension and form granulomas (similar to TB)
- Open lung biopsy
- AFB is test for which disease?
- Fungal stain for which disease?
- Silver stain / GMS
- Open lung biopsy for TB and Cocci
- AFB for TB
- Fungal stain for Cocci
- Silver / AMS for Coccidioides PNA
Which 2 diseases have caseating granulomas?
TB and Cocci
In the beginning:
- is focal and asymptomatic
- limited to lungs
- regional lymph nodes
Coccidioidomycosis PNA
- Disseminates in immunocompromised, spreading granulomatous lesions to virtually any organ (esp. which 5 areas?)
- Most patients ( >60% ) are asymptomatic and others develop flu like sxs
Coccidioidomycosis PNA
- bones
- skin
- liver
- spleen
- CNS (meninitis)
