Respiratory Tract

Question 1

What is the leading cause of infectious death and the fifth leading cause overall?

Answer 1

Pneumonia

Question 2

What the three ways infectious agents gain entry to the lower respiratory tract?

Answer 2

Aspiration of upper airway resident flora, inhalation of aerosolized material, and, less frequently, metastatic seeding of the lung from blood

Question 3

What size of particle is ideal for evading anatomic barriers, yet having an impact on alveoli? What size are most bacteria?

Answer 3

2 to 5 microns, 0.5 to 2 microns

Question 4

What host defenses are present at terminal airways and alveoli?

Answer 4

Humoral and cell mediated defenses but not mucociliary apparatus

Question 5

Examples of mucociliary apparatus inhibitors

Answer 5

Smoking impairs ciliary and macrophage activity, congenital defects impair secretion clearance and promote mucus compaction (Kartagener`s syndrome and Cystic Fibrosis)

Question 6

What increases one`s risk for aspiration?

Answer 6

Nasogastric and endotracheal tubes

Question 7

What is the most useful classification of pulmonary pathogens?

Answer 7

Community acquired vs nosocomial

Question 8

Most pulmonary infection patients with complain of some difficulty breathing, associated with cough and fever. When present with a physical exam suggesting consolidation should prompt what?

Answer 8

More detailed evaluation, including chest x-ray

Question 9

Community acquired pnemonia (CAP) is divided into typical and atypical groups. What does typical CAP present with?

Answer 9

acute illness with fever, chaking chills, purulent sputum, and dense lobar infiltrate on x ray

Question 10

Typical CAP is most commonly caused by:

Answer 10

Streptococcus pneumonia

Question 11

What is Faget`s sign?

Answer 11

Patients with atypical CAP are more likely to have relative bradycardia or pulse/temperature deficit on physical exam

Question 12

What months are most viral infections, including influenza, usually seen?

Answer 12

December to March

Question 13

What are important nosocomial respiratory pathogens? What pathogen targets cystic fibrosis patients?

Answer 13

Gram negative enteric flora, S. aureus; Pseudomonas

Question 14

Why is specimen collection key to recovery of Strep pneumoniae?

Answer 14

Streptococci have an autolytic mechanism activated when adverse conditions are encountered, older cells die to give younger cells the best chance of survival, this can greatly reduce number of streptococci in 30 mins

Question 15

What are the four criteria that suggest an infectious source in hospital acquired pneumonia?

Answer 15

1) New or changing infiltrate on chest x-ray 2) Change in respiratory secretions 3) Change in ventilatory requirements 4) Positive culture from sterile site with same organism found in respiratory culture

Question 16

Definition of sputum

Answer 16

bolus of respiratory secretions coughed from deep in the lung and expectorated by the patient

Question 17

What is considered an adequate specimen based on PMN leukocytes and epithelial cells?

Answer 17

> 25 PMN leukocytes and

Question 18

Rapid antigen tests have clinical utility for which organisms?

Answer 18

influenza A, S. Pneumoniae, Legionella

Question 19

Which imaging study is an integral part of pneumonia diagnosis? Why is the test not definitive? What test has both high sensitivity and specificity?

Answer 19

X-ray; non-specific; CT scan

Question 20

Blood cultures are prognostic of an increasing risk of what, especially in pneumococcal disease?

Answer 20

Morbidity

Question 21

If pleural fluid is visible on chest x-ray, what should be obtained next and why?

Answer 21

Lateral decubitus film to see if the fluid can be drained

Question 22

How is an exudative effusion classified? Transudative?

Answer 22

pleural fluid /serum protein ratio > 0.5, pleural fluid/serum LDH ratio > 0.6, or pleural fluid LDH >200; protein and LDH ratios less than 0.5 and 0.6 respectively

Question 23

How is empyema classified?

Answer 23

purulent pleural fluid pH1000mg/dl)

Question 24

True False: For most commonly acquired pneumonia, measurement of oxygenation is unnecessary.

Answer 24

True

Question 25

When is assessment of pulmonary function via spirometry best performed?

Answer 25

When patient has recovered from the acute episode

Question 26

What methods are useful to obtain an adequate specimen when the patient is unable to produce one?

Answer 26

Fiberoptic bronchoscopy and also bronchoalveolar lavage in immunocompromised patients

Question 27

What is the criteria used to identify patients with a low risk of dying in the next 30 days? Which classes should be admitted based on the criteria?

Answer 27

Fine criteria; Class IV and Class V

Question 28

Fifty percent of adults have antibodies against Chlamydophila pneumoniae but what is unique about these antibodies?

Answer 28

They are not protective against the disease

Question 29

Which pneumonia gives extrapulmonary symptoms?

Answer 29

Legionella - GI (nausea, vomiting, diarrhea), neurologic (headache, delirium), renal, hepatic, electrolyte disturbances, and SIADH (antidiuretic hormone hypersecretion)

Question 30

What causes aspiration pneumonia and what are symptoms?

Answer 30

Aspiration of oropharyngeal contents, can present as acute, subacute, or chronic febrile illness, productive cough, putrid sputum, hemoptysis, chest pain

Question 31

In aspiration pneumonia, what bacteria are responsible for CAP, nosocomial, or diabetic and alcoholic patients?

Answer 31

oral anaerobic bacteria; Staphylococci, aerobic gram negatives; , aerobic gram negative rods

Question 32

What viral pneumonias occur in immunosuppressed patients?

Answer 32

Herpes Simplex, Cytomegalovirus, and Measles

Question 33

The different possible fungal pneumonias are:

Answer 33

Histoplasmosis, Coccidiomycosis, Cryptococcus, Blastomycosis, and Pneumocystis jiroveci

Question 34

Indications for hospitalization with pneumonia:

Answer 34

Arterial hypoxemia, severe viral sign abnormalities (low BP, high RR), coexist medical problems requiring hospitalization, severe lab abnormalities

Question 35

Additional risk factors in pneumonia patients which predicts a prolonged course:

Answer 35

> 65y.o., immunosuppression, comorbid illness (diabetes, etc.), Temp >38.3, high risk etiology

Question 36

Therapy for pneumonia must be individualized to likely pathogens in a particular patient based on these characteristics:

Answer 36

Age, General health, Immune status, Community acquired vs nosocomial vs Nursing home, Exposure, Clinical presentation