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Infection and Immunology > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

morbidity vs mortality

A

illness vs. death

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2
Q

CAP

A

community acquired pneumonia–significant morbidity and mortality

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3
Q

For Cap–predisposing factors:
Drug use:
Lifestyle:

A
  • H2 blockers, antipsychotic, ACE inhibitor, glucocorticoid

- male, older, tobacco, alcohol, acidosis, malnutrition, COPD

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4
Q

Typical vs atypical pneumonia

A

TYPICAL: pneumonia caused by certain bac and typically causes CHILLS, COUGH, FEVER, and SOB short of breath
ATYPICAL: pneumonia caused by certain bacteria. Called “atypical” because the symptoms differ from those of pneumonia due to other common bacteria

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5
Q

Typical CAP bugs:

A

S. pneumoniae, H. influenzae, S. aureus, group A streptococci, Moraxella catarrhalis, anaerobes, and aerobic gram-negative bacteria

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6
Q

Atypical CAP bugs:

A

Legionella spp, M. pneumoniae, Chlamydophila pneumoniae, and C. psittaci

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7
Q

If pt is elderly w/ underlying pulmonary disease (COPD, cystic Fibrosis) pathogen is likely

A

Hemophilus influenza

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8
Q

Hemophilus influenza characteristics

A
  • pleomorphic
  • Gram- rods
  • oxidase positive
  • facultatively anaerobic
  • nonmotile
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9
Q

Hemophilus influenza treatments

A
  • Beta-lactam agents (amoxicillin)

- Azithromycin

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10
Q

Pt is <40 yo spends much time in close quarters –pathogen is likely

A

Mycoplasma pneumonia–respiratory droplets

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11
Q

Mycoplasma pneumonia characteristics

A
  • smallest organism that can survive alone in nature
  • aerobic/anaerobic
  • “gliding motility”
  • produce biofilms
  • surface parasite–> may move inside cell and reproduce
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12
Q

S&S of Mycoplasma pneumonia

A
  • Gradual Onset-
  • headache
  • malaise
  • low grade fever
  • non-productive cough
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13
Q

Mycoplasma pneumonia treatment

A
  • MACROLIDS
  • (azithromycin, doxycycline)
  • respiratory fluoroquinolone
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14
Q

Pt is middle-aged or ^–been travely recently (w/ in 2 weeks), or exposed to air conditioning or mist0environments. Likely pathogen is…

A

Legionella spp.

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15
Q

Legionella spp. characteristics + S&S

A
  • Gram - bacilli
  • grows on special media
  • 2-10 days before onset of symptoms
  • S&S: usual symptoms, ^ fever, and GI symptoms
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16
Q

Legionella spp treatments and dx

A
  • Macrolides (esp. azithromycin) or
  • Respiratory Fluoroquinolones (esp. levofloxazin)
  • dx w/ sputum or urinary antigen test
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17
Q

Pt is MILDLY ILL, not necessarly in winter, and lives in CLOSE ENVIRONMENT (care facilities, barracks) mostly likely…

A

Chlamydis (Chlamydophila) pneumoniae PTP

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18
Q

Most common infections associated w/ Chlamydia pneumoniae

A

Pneumonia and Bronchitis

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19
Q

Chlamydia pneumoniae characteristics

A
  • Obligate intracellular bacteria
  • 2nd smallest prokaryote
  • No peptidoglycan in cell wall
  • replication intracellularly after ingestion by phagosome
  • short lived immunity
  • very unusual reproductive pattern (slide 26)
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20
Q

Chlamydia pneumoniae S&S

A
  • usual
  • pharyngitis
  • hoarseness
  • airway hyperreactivity
  • wheezing
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21
Q

Chlamydia pneumoniae treatment

A

-azithromycin

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22
Q
  • If pt is not “special group” not severly sick, and possibly becoming sick in winter or early spring. Pathogen is likely…
A

Streptococcus pneumoniae–most common pathogen for CAP worldwide

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23
Q

Streptococcus pneumoniae characteristics

A
  • gram-positive
  • alpha hemolytic bac
  • catalase - unlike other pyogenic orgs
  • capsular polysaccaride provokes immune response and is anti-phagocytic
  • adheres to epithelial cells of nasopharynx
  • “forms bridges” btwn body sites
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24
Q

Streptococcus pneumoniae secretes ______ _______, which…

A

potent cytotoxin (pneumolysin)–binds to cholesterol forming pores in membranes and kills any cell.

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25
Q

Gram-neg bacillie – uncommon in pneumonia but…

A
  1. Klebsiella pneumoniae
  2. E coli
  3. Enterobacter spp
  4. Serratia spp
  5. Proteus spp
  6. Pseudomonas aeruginosa
  7. Acinetobacter spp
26
Q

hospital acquried

A

nosocomial

27
Q

Klebsiella pneumoniae characteristics

A
  • Nosocomial, but CAP in alcoholics, diabetics, or COPD
  • New pulmonary infiltrate w/ fever, cough, ^ sputum, WBC crackles
  • short, plum bacilli
  • Gram neg
28
Q

Klebsiella pneumoniae dx

A
  • X-ray–lobar pneumonia like S. pneumoniae

- “currant jelly” sputum (lung necrosis)

29
Q

Klebsiella pneumoniae treatment

A

based on culture and sensitivity testing by lab

30
Q

VIRAL:

Virus likely to cause pneumonia secondary to bacterial URI or pulmonary infection

A

influenza

31
Q

Acute viral pneumonia–all ages. Winter. hand-hand transfer. “Apnea in infants”

A

Respiratory syncytial virus RSV

32
Q

Mild viral URI–S&S fever, rhinorrhea, cough, sore throat

A

parainfluenza

33
Q

viral pneumonia increased peribronchial markings, patchy alveolar

A

adenovirus

34
Q

SARS

A

severe acute respiratory syndrome

35
Q

Fungal pneumonia

A

unusual but some

  1. Cryptococcus
  2. hystoplasma
  3. coccidoides
36
Q

avian influenza aka

A

Hantavirus

Varicella

37
Q

higher risk of pneumonia complications

A
  1. persons w/ chronic pulmonary, cardio, renal, hepatic disorder
  2. children 65 yo
38
Q

N/V/D

A

nausea, vomiting, diarrhea

39
Q

pneumonia physical exam (5)

A
  1. 80% febrile (pos. not older pts)
  2. possible tachypnea and tachycardia
  3. crackles (rales)
  4. bronchial breath sounds
  5. dullness to percussion if consolidation is present
40
Q

on X-ray – looks like hole in lung

A

cavitation

41
Q

If CAP pt is hospitalized order

A
  1. blood culture
  2. sputum gram stain
  3. sputum culture
42
Q

Imp for CAP treatment

A

What drug do I suspect–and backup plan.

43
Q

Factors to not use Macrolide for CAP

A
  1. recent antibiotic use
  2. comorbitities
    COPD
    Liver disease
    Cancer
44
Q

Macrolides _______ _____ ______ in Strep pneumoniae

A

block protein assemply

45
Q

Acute bronchitis S&S

A
  1. peristent cough – lasting 10-20 days
  2. possible mucus
  3. wheezing
  4. low fever
  5. chest tightness
  6. pain
46
Q

Bronchitis Xray

A

usually non-specific–important to distinguish from pneumonia

47
Q

Acute bronchitis PE

A
  1. dullness ot percussion
  2. decreased breath sounds
  3. rales
    4 bronchophony
48
Q

for test in regards to bronchitis and pneumonia

A

know difference–anyone can get bronchitis (higher likelihood in COPD pts)

49
Q

Bronchitis treatment

A
  1. symptomatic care
  2. treat cough– anti tussive
  3. humidifier
  4. steroids to reduce inflammation
50
Q

Bronchitis etiology

A

Chlamydiophila pneumoniae–Obligate intracellular parasite

51
Q

UR symptoms followed by LRI w/ inflammation resulting in wheezing or crackles in children <2 yo–often after viral infection

A

Bronchiolitis

52
Q

Bronchiolitis S&S

A
  • increased respiratory effort-
    1. nasal flaring
    2. tachypnea
    3. hypoxemia
    4. accessory muscle use
    5. grunting
53
Q

whooping cough aka and characteristics

A

Bordatella pertussis-

  • <2 yo
  • PTP
  • temp immunity
54
Q

Whooping cough stages (3)

A
  1. Catarrhal stage (2 weeks)
  2. Paroxysmal stage–burst of rapid cough followed by deep high pitched inspiration (WHOOP)
  3. Convalescent stage (4 weeks)
55
Q

Pertussis treatement

A
  1. Macrolide

2. Trimethoprim-sulfamethoxazole

56
Q

TB Xray

A

PA and Later Chest

57
Q

TB treatment

A
  1. 6-9 month med regimen (low compliance)
58
Q

FUNGAL lung infection from bat and bird droppings

A

Histoplasmosis–aerosolization from disturbed soil

59
Q

Histoplasmosis treatment

A
  1. Itraconazole

2. IV Amphotericin when illness severe (deadly treatment)

60
Q

Influenza-like symptom fungal infection

A

Coccidiodomycosis

Infection and Immunology (17 decks)

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