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IDIS > PULM: RTIs - Airway Disease > Flashcards

PULM: RTIs - Airway Disease Flashcards

1
Q

what are the three croup diseases

A

Acute laryngitis

Laryngotracheobronchitis (viral croup)

Epiglottitis (bacterial croup)

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2
Q

viral croup

  • most common etiologic agent?
  • presentation?
  • complications?
A
  • agent - parainfluenza type I
  • presentation
    • mild/severe
      • barking cough
      • inspiratory stridor - @ night
    • severe croup
      • inspiratory stridor at rest
      • suprasternal/intercostal retractions
      • tachypenea, tachycardia
      • cynaosis
  • complications
    • bacterial superinfection
    • tracheal damage/lluinal narrowing
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3
Q

what bacteria are likely to cause a superinfection following viral croup?

A
  • s. aureus, s. pneuononia, h. influenza, m. catarrhalis
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4
Q

epiglottis?

  • etiologic agent
  • presentation
  • complications
A
  • agents:
    • H. influenza (m/c), S**. pyogenes
  • presentation:
    • SEVERE/RAPID sore throat
    • 4Ds: dysphasgia, dysphonia, drooling, distress
    • high fever
  • complications:
    • septic artthritis/ meningitis / osteomyelitis
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5
Q

how to differentiate viral croup from epiglottitis?

A
  • viral croup
    • improvement with water saturated air (shower steam)
    • radiography - positive steeple sign
  • epiglottitis
    • NO improvement with water saturated air (shower steam)
    • radiography - positive thumb sign
    • presentation - higher fever than viral croup + 4Ds
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6
Q

what is this radiograph showing?

A

steeple sign - viral croup (parainfluenza)

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7
Q

what is this radiograph showing?

A

thumb sign - epiglottitis (H. influenza)

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8
Q

treatment / prevention of epiglotitis?

A

prevention - HiB vaccine

treatment - intubation, Ab (rifampin) if not vaccinated

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9
Q

what is the most common cause of viral croup?

A

parainfluenza

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10
Q

acute bronchitis

  • etiologic agent
  • predisposing factors
  • presentation
  • diagnosis
A
  • agent - virus m/c
  • predisposing factors: always follow a URI
    • common in IgG deficiencies, respiratory dz (ex: emphysema)
  • presentation: non-productive cough that becomes purulent
  • dx - radiograph key: CXR negative for filtrates / consildations
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11
Q

how to differentiate between acute bronchitis and pneumonia?

A

get chest X-ray to look for infiltrates.

negative CXR = bronchitis

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12
Q

bronchiolitis

  • etiologic agent
  • predisposing factors
  • presentation
  • diagnosis
A
  • agent - viral (RSV)
  • predisposing factors - children < 1 yr in age
    • esp if bottle feeding or premature
  • presentation
    • cough/dyspnea
    • wheezing/crackles
    • nasal flaring
  • diagnosis:
    • radiography- focal atelectasis / peribronchial cuffing
    • nasal washings - show RSV
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13
Q

discuss the different strains and virulence factors of influenza and their importance.

A

influenza A & B - viral RNA.

influenza A - also segmented.

viral, segmented

  • drift: mutation in the viral RNA amino acids that changes the H antigen- A & B
  • shift: rearrangment of the H and N proteins - A only
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14
Q

pneumonia is an infection of what part of the respiratory tract?

A

lower respiratory tract

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15
Q

what are the two types of pneumonia and how to differentiate them?

A

typical (lobar pneumonia)

  • fluid accumulating within alveolar sacs

atypical (interstitial) pneumonia

  • fluid accumulating in between the cells (in the walls of alveoli/bronchi)
  • this causes walls thickening –> “cow-webbing” on CXR
  • “walking: pneumonia
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16
Q

therapy for influezna?

A

influezna A: “- antadine”

influenza A & B:

  • neuraminidase inhibitors
  • viral cap dependent endonuclease protein inihibitors
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17
Q

whooping cough

  • etioligic agent & its virulence factors
  • diagnosis
  • prevention
A
  • agent - bordatella pertussis
    • ​hemagluttinin: attachment to ciliated epithelium
    • cytotoxin/pertussis toxin: kill tracheal ciliated epitheium
      • cytotoxin also inc IL-1 –> fever
  • dx
    • whoop from inspiratory stridor - pathognomonic
    • lymphocytosis
  • prevention:
    • ​DtAP vaccine
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18
Q

most common means of aquiring pneumonia

A
  1. inhalation
  2. aspiration
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19
Q

typical pneumonia

  • presentation
  • etiologic agents
A

two types - hospital aquired & community aquired

  • agents:
    • community aquired:
      • s. pneumonia (m/c)
      • h. influenza, klebsiella
    • hospital aquired:
      • s. aureus & gram - rods
  • presentation (for both types)
    • PRODUCTIVE cough –> purulent sputum
    • consolidations in CXR
    • HIGH fever
      • pt looks toxic
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20
Q

atypical pneumonia

  • etiologic agents
  • presentation
A

= intersitial pneumonia

  • agents:
    • mycoplasma pneumonia (m/c), SARS-Cov-2
    • l_egionella, chlaydophilia_ phenomina
  • presentation:
    • NON-PRODUCTIVE, paroxysmal cough
    • infiltrates in CXR
    • lower fever
      • pt looks well
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21
Q

aspirational pneumonia

A
  • presentation:
    • typical pneumonia + recurring chills
    • consolidations in DEPENDENT lung segments
      • dependent = lung base when upright, posterior lung with supine
    • +/- foul smelling sputum
    • etiologies:
      • community aquired: oral anaerobes + s. pneumonia
      • hospita laquired: oral anaerobes + gram - rods
22
Q

chronic pneumonia

  • agents
  • presentation
A
  • presentation
    • weeks-months onset
    • night sweats
    • productive cough
    • +/- coin lesions (Gohn complex) - if agent m. tuberculosis
  • etiologies:
    • mycobacterium tuberulosis
    • fungi - blasomyces, coccidiodies, histoplasma
23
Q

what is shown in this radiograph?

A
  • coin lesions (Gohn complex)
    • see in aspirational pneumonia OR chronic pneumonia that is due to a mycobacterium tuberulosis infection
24
Q

most common cause of pneumonia in child < 1 month?

A

= neonate

  • e. coli, s. agalactae
25
Q

what is a common etiology of pneumonia common in alcohol abusers?

list the characteristics of this agent

A

klebsiella pnuemonia

  • gram - rod
  • fermenting (pink maconkey agar)
  • urease +
  • citrase +
26
Q

common etiological cause pneumonia in military recruits & college students?

what are the characteristics of this agent

A

neisseria meningitis

  • gram - diplococci
  • oxidase positive
  • grows on chocolate agar
  • virulence factors
    • protective capsule - prevents phagocytosis
    • pili - promote nasopharyngeal coloniziation
    • IgA protease - promotes adherence
    • LOS - proinflammatory
27
Q

list pneumonia agents in weird circumstances: bird fanciers, farmes

A

birder fanciers = chlamydophilia psittaci

farmers = coxiella burnetti

28
Q

categories pneumonia agents based on onset

A
  • acute - standard?
  • subacute onset = atypical pneummonias
    • mycoplasma pneumonia
    • chlamydia pneumonia
    • legionella pnuemnoia
  • chronic onset
    • m. tuberculosis
    • fungi
29
Q

psueodomonas is the a common cause of pneumonia in what patient populations?

A
  • mechanical respirators (ventilators)
  • malnourished
  • bronchiectasis
  • drugs - steroids, broad spectrum abx
30
Q

cause of pneumonia in bird fanciers?

A

chlamhydophilia psittaci

31
Q

common locations of

histoplasma

coccidioides

blasotomycoses

A

histoplasma: ohio/mississipi river valleys

coccidioides - southwest: san jaoquin valley / south central arizona / rio grande valley

32
Q

cause of pneumonia in farmers during birthing season?

A

coxiella burnetti

*Q fever

33
Q

what clinical manifestations point to Covid-19 pneumonia?

A
  • higher fever
  • loss of taste/smell
  • lymphoPENIA
  • labs: lactate dehydrogenase & ferritin
34
Q

identify disease

A

rough skin lesions

blastomyocis pneumonia

35
Q

this CXR showing is showing

  • what feature?
  • due to what agent?
A
  • bulging fissure
  • klebsiella pneumonia
36
Q
A

think staph aureus (often in children)

37
Q

this CXR has

  • what distinguishing feature?
  • points to what likely etiologic agents?
A
  • lung abscess
  • s. aureus, psuedomonas, anaerobes, gram - bacilli
38
Q

the CXR is showing

  • what distinguishing feature?
  • points to infection by what etiologic agent?
A
  • lung abcess
  • s. aureus, p. areuginosa, anaerobes, gram - bacilli
39
Q

what agent is shown?

what are its pertinent characteristics?

A

histoplasma - monomorphic, narrow based buds

found in soil of ohio / missippi river valleys

40
Q

what is the etiologic agent and its pertinent features?

A

blastomycoses - pleomorphic, broad based bud

found in soil of southeastern & ohio / missippi river valleys

41
Q

identify

note importan t features

A

coccidioides

at body temp - spherules: thick walled spheres containing endospores

at room temp - arthcoconidia

found in southwestern US, mexico, central & south america

42
Q
  • what etiological agents are associated with the following sputum appearances
    • purulent
    • mucoid
    • rust colored
    • green color
    • thick currant / jelly like
    • hemoptysis
    • foul smelling
A
  • purulent & mucoid - typical
  • rust colored - s. pneumonia
  • green color - psuedomonas or h. influenza
  • thick currant / jelly like - klebsiella
  • hemoptysis - cavitary TB or lung abcess
  • foul smelling - anaerobes
43
Q

what microbes are we testing for with the following stains?

  • silver stain?
  • acid fast stain?
  • gomori methamine silver stain (GMS)?
A
  • silver stain - legionella
  • acid fast stain - mycobacterium tuberulosis
  • gomori methamine silver stain (GMS)
    • fungi (histo, blastomycosis, pneumocystis)
    • pneumocystis
44
Q

identify agent

note characteristics

A

strep pneumo

gram + lancet shaped diplococcus

45
Q

identify cause

A

staph aureus

46
Q

identify

explain

A

e. coli
e. coli & s. agalactae m/c causes of pneumonia in chidlren < 1 year old.

  • it is pink (gram -), thus is e. coli
  • s. agalactae would be purple (gram +)
47
Q

other than pneumonia, what disease are e. coli & s. agalactae likely to cause in children

A

meningitis

48
Q
  • NAAT positive
  • stacatto cough
A

chlamhydia

49
Q

what is the agent?

A

“fried egg” appearance on eatons agar

mycoplasma pneumonia

50
Q

what agent?

what stain?

A

pneumocysois jiroveci

high in immunocompromised host

GMS stain

IDIS (12 decks)

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