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MPAS-PAS 607 Clinical Medicine: Pulmonology > Pulmonary Infections Part 1 > Flashcards

Pulmonary Infections Part 1 Flashcards

1
Q

What are the most common bacterial pathogens that cause community-acquired pneumonia?

A

Streptococcus pneumoniae
Haemophilus influenzae

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2
Q

What are 3 atypical bacteria that can cause community-acquired pneumonia?

A

Chlamydia pneumoniae
Mycoplasma pneumoniae
Legionella pneumonphila

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3
Q

What are 5 common viral agents that can cause community-acquired pneumonia?

A

RSV
Adenovirus
Influenza virus
Metapneumovirus
Parainfluenza virus

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4
Q

What are two common fungal agents that can cause community-acquired pneumonia?

A

Histoplasmosis
Coccidioidomycosis

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5
Q

What are the 4 major symptoms of community-acquired pneumonia?

A

Fever
Chills
Cough
Sputum production

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6
Q

What pathogen(s) do multilobar infiltrate on chest X-ray suggest in community-acquired pneumonia?

A

S. pneumoniae
Legionella pneumonphila

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7
Q

What etiology do interstitial markings on chest X-rays suggest in community-acquired pneumonia?

A

Viral
Mycoplasmal

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8
Q

What etiology do cavities on chest X-rays suggest in community-acquired pneumonia?

A

S. aureus
Fungal
Mycobacterial

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9
Q

What antibiotics should be used for community-acquired pneumonia in healthy patients less than 65 years old?

A

Amoxicillin
Doxycycline

*Macrolides as an alternative

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10
Q

What antibiotics should be used for community-acquired pneumonia in patients with comorbidities?

A

Amoxicillin-clavulanate PLUS:
Macrolide or Doxycycline

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11
Q

What are the 2 best ways to prevent community-acquired pneumonia?

A

Smoking cessation
Vaccines

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12
Q

What vaccines can be used to protect against community-acquired pneumonia?

A

Pneumococcal conjugate vaccine (PCV13)
Pneumococcal polysaccharide vaccine (PPSV23)
H. influenzae type b vaccine (Hib)
Varicella vaccine
Influenza vaccine

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13
Q

How many hours does it need to be to qualify pneumonia as healthcare-associated or ventilator-associated pneumonia?

A

48 hours

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14
Q

Name 3 ways nosocomial infections differ from community-acquired infections.

A

Less common infectious causes
Higher incidence of drug resistance
Pool underlying health of patients

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15
Q

Name 4 common hospital-acquired pneumonia organisms.

A

S. pneumonia (often drug resistant)
Staph. aureus (MSS and MRSA)
Klebsiella pneumonia
E-coli

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16
Q

What 3 symptoms and 1 exam finding can ventilator-associated pneumonia have?

A

Fever
High WBC count
Purulent sputum
Chest x-ray with new or progressive opacity

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17
Q

What two tests can you use in hospital-acquired pneumonia to help determine the severity of the illness and the need for ventilation?

A

Arterial blood gas
Pulse oximetry

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18
Q

True or false: you should always order a sputum stain and culture to diagnose pneumonia

A

False, not always helpful because it is neither sensitive nor specific

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19
Q

What antibiotic should you use on hospital-acquired pneumonia with a patient who is at LOW risk for multiple drug-resistant pathogens?

A

Piperacillin-taz
Cefepime
Levofloxacin

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20
Q

How many antibiotics should you use on hospital-acquired pneumonia with a patient who is at HIGH risk for multiple drug-resistant pathogens?

A

3

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21
Q

You see gram-positive encapsulated “lancet-shaped” diplococci under the microscope. What is the pathogen?

A

S. pneumoniae

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22
Q

How is S. pneumonia spread?

A

Airborne droplets

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23
Q

What is the most common cause of community-acquired pneumonia?

A

Streptococcal pneumonia

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24
Q

What are 6 risk factors for S. pneumonia?

A

Flu
Alcohol abuse
Smoking
Splenectomy
Immunocompromised
COPD/Asthma

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25
Q

What pathogen are you suspicious of when you see “rust” colored sputum?

A

S. pneumonia

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26
Q

What test is best for helping see S. pneumonia really close up?

A

Quellung test (India ink stains the capsule, can also use methylene blue stain)

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27
Q

What antibiotics should you use to treat S. pneumonia?

A

Beta-lactam
Macrolide
Respiratory fluoroquinolone

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28
Q

What is the best prevention for S. Pneumonia

A

Vaccine

29
Q

True or false: Klebsiella is a mild common disease.

A

False, it is a rare and severe disease

30
Q

Is Klebsiella pneumonia more of a community or hospital-acquired infection?

A

Hospital-acquired

31
Q

What are 2 major risk factors for Klebsiella pneumonia?

A

Prior antibiotic use
Use of invasive plastic devices

32
Q

What pathogen are you suspicious of when you see “red currant jelly” colored sputum?

A

Klebsiella pneumonia

33
Q

How do you diagnose Klebsiella pneumonia?

A

Culture and gram stain of sputum or aspirated body fluid + chest x-ray

34
Q

You see gram-positive cocci under the microscope. What is the most likely pathogen?

A

Staph. A causing pneumonia

35
Q

True or false, Staph. pneumonia is a rapidly progressing disease.

A

True

36
Q

What is the key symptom progression of Staph. pneumonia?

A

Short prodrome of fever followed by:
Respiratory symptoms followed by:
Respiratory distress
could also have: GI symptoms

37
Q

True or false: sputum specimens are helpful and diagnostic for Staph. pneumonia.

A

False, they are not helpful due to common upper respiratory tract colonization

38
Q

True or false: empiric therapy for treating Staph. pneumonia may not be enough when using penicillins or cephalosporins.

A

True, this is because of community-associated MRSA

39
Q

Is Staph. pneumonia is more often found in community-acquired or hospital-acquired pneumonia?

A

Community

40
Q

What are 3 meds that can be used to treat Staph. pneumonia?

A

Clindamycin
T-sulfa
Rifampin

41
Q

Where can you usually find Legionella pneumophilia bacteria?

A

Soil
Freshwater

42
Q

What are some extra symptoms of Legionnaires pneumonia besides the common flu-like symptoms?

A

Nausea/vomiting
Diarrhea
Abdominal pain

43
Q

What are some extra symptoms of Legionnaires pneumonia besides the common flu-like symptoms?

A

Nausea/vomiting
Diarrhea
Abdominal pain

44
Q

What are two antibiotics you can use to treat Legionnaires pneumonia?

A

Azithromycin (macrolide)
Levofloxacin (fluoroquinolone)

45
Q

You see patchy, asymmetric, progressive infiltrates on a chest x-ray, what is the most likely diagnosis?

A

Legionnaires pneumonia

46
Q

You see a short rod under the microscope that does not show up on Gram stains. What is the most likely diagnosis?

A

Mycoplasma pneumonia

47
Q

Are young adults, children, adults, or the elderly more commonly affected by Mycoplasma pneumonia?

A

Young adults
Children

48
Q

Mycoplasma pneumonia characteristically shows up in the following locations:

A

Military barracks
University dorms

49
Q

What is the diagnostic method of choice for Mycoplasma pneumonia

A

NAAT: nucleic acid amplification test

50
Q

True of false: there is no vaccine available for Mycoplasma pneumonia?

A

True

51
Q

What are three antibiotics that can be used for outpatient management of Mycoplasma pneumonia?

A

Macrolide
Doxycycline
Respiratory fluoroquinolone

52
Q

What are the 3 most common types of fungal pneumonia?

A

Pneumocystis jirovecii
Aspergillus species (especially A. fumigatus)
Cryptococcus neoformans

53
Q

What patient population is it common to find Pneumocystis pneumonia (PJP)?

A

HIV patients (immunocompromised)
Those receiving systemic corticosteroids

54
Q

What CD4 + T lymphocyte count on a patient with HIV would contribute to a major risk factor for Pneumocytosis pneumonia (PJP)?

A

Less than 200 micro liters
FYI: less than 50 microliters = risk factor for death

55
Q

You see bilateral, diffuse, perihilar infiltrates with a patient who is hypoxic, what is the most likely diagnosis?

A

Pneumocystosis pneumonia (PJP)

56
Q

What CD4 + T lymphocyte count on a patient with HIV would contribute to a major risk factor for Pneumocytosis pneumonia (PJP)?

A

Less than 200 microliters
FYI: less than 50 microliters = risk factor for death

57
Q

What is the appropriate antibiotic used to treat Pneumocystosis pneumonia (PJP) and how long do you give it for?

A

T-sulfa for 14 to 21 days
Can also give corticosteroids

58
Q

What treatment should you use for HIV patients previously infected with PJP or those with CD4+ with T lymphocyte count of less than 200?

A

DAILY t-sulfa

59
Q

What vaccine can reduce bacterial meningitis in children?

A

Hib vaccine

60
Q

What is the preferred treatment for Haemophilus pneumonia?

A

Beta-lactam agents such as Amoxicillin or 2nd or 3rd gen cephalosporins

61
Q

Which community-acquired pneumonia is also referred to as “walking pneumonia?”

A

Chlamydia pneumonia

62
Q

What two types of pneumonia are almost clinically indistinguishable from each other?

A

Mycoplasma pneumonia and Chlamydia pneumonia

63
Q

This type of pneumonia is common for people in closed populations such as nursing homes, prisons, military groups, and university dorms

A

Mycoplasma pneumonia and Chlamydia pneumonia

64
Q

What antibiotics are the first-line treatments for outpatients with Chlamydia pneumonia?

A

Azithromycin (superstar)
Doxycycline

65
Q

What antibiotics are the first-line treatments for inpatients with Chlamydia pneumonia?

A

Respiratory fluoroquinolone
Beta-lactam + macrolide

66
Q

You see gram-negative bacilli under a microscope, you are also suspicious that this was a hospital-acquired infection ESPECIALLY from a ventilator burn patient. What is the most likely disease?

A

Pseudomonas aeruginosa

67
Q

Community-acquired infections are less common for Pseudomonas pneumonia, but can be found in patients with what 2 diseases?

A

HIV patients
Cystic fibrosis patients

68
Q

What is the best way to diagnose Pseudomonas pneumonia?

A

Sputum culture

69
Q

What two types of antibiotics are preferred for Pseudomonas pneumonia?

A

Anti-pseudomonal beta-lactams (piperacillin-taz, ceftizanidime)

Anti-pseudomonal quinolones (ciprofloxacin and levofloxacin)

MPAS-PAS 607 Clinical Medicine: Pulmonology (1 decks)

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