Unit 3 Day 5 (Mon 4/27)

Question 1

Definition and Features of Pneumonia

Answer 1

• PNM
• disease of lungs characterized by inflammation of parenchyma and accumulation of abnormal alveolar filling with fluid
• most commonly caused by infection

Question 2

Pathogenesis of Pneumonia

Answer 2

• inhalation of infectious particles
• inhalation of oropharyngeal or gastric contents
• hematogenous spread
• infection from adjacent or contiguous structures
• direct innoculation
• reactivation

Question 3

Pneumonia Classification

Answer 3

• Airways Disease
• -cryptogenic oragnizing pneumonia (COP)
• -allergic bronchopulmonary aspergillosus
• -bronchiectasis
• -bronchopulmonary sequestration
• -bronchocentric granulmatosis

-Vascular Diseases
•  AlveolarHemorrhageSyndromes" 
•  Eosinophiliclungdiseases"
•  Pulmonaryinfarction"
•  Fatemboli"
•  Vasculitis"
•  CollagenVascularDiseases"
•  Vasculartumors"
•  Acutechestsyndromeinsicklecellcrisis"

-Parenchymal Diseases
•  Hypersensitivitypneumonitis" 
•  Drugreaction"
•  Transfusionreaction"
•  Alveolarproteinosis"
•  Granulomatouslungdiseases" 
•  Lipoidpneumonia"
•  Pulmonaryedema"
•  Neoplasms"
•  ARDS"
•  Radiationpneumonitis"
•  Idiopathicinterstitialpneumonias"

Question 4

Pneumonia Types

Answer 4

– Community Acquired Pneumonia (CAP)- streptococcus pneumoniae
– Hospital (Nosocomial) Acquired Pneumonia (HAP)”
– Ventilator Associated Pneumonia (VAP)”
– Healthcare-Associated Pneumonia (HCAP)
-HAP/VAP/HCAP organisms: SPACE gram- organisms, MRSA gram+

Question 5

PNA Treatment

Answer 5

• AntipseudomonalAgent:
• Cephalosporin
• Carbopenem
• Plus1oftheFollowing:
• Anti-pseudomonal Fluoroquinolone
• Anti-GramNegativeAminoglycoside
• Plus1Anti-MRSAMedication:
• Linezolid
• Vancomycin

-Critical to De-escalate Therapy Based on Culture Data and Clinical Response in 48-72 Hours”

Question 6

Commonly Acquired Respiratory Viruses

Answer 6

•  Orthomyxovirus
--Influenza viruses Types A, B, C
•  Paramyoviruses
--Parainfluenza viruses Types 1-4
--Respiratory Syncytial Virus Types A, B
•  Picornaviruses
--Enteroviruses - Coxsackie and Echo Virus
--Rhinovirus- Types 1-100
•  Herpes Viruses
•  Adenovirus
•  Coronavirus
•  Papilloma Virus
•  Hantavirus

Question 7

Treatment of Flu

Answer 7

2 Classes of Antiviral Medications

• Neurominidase Inhibitors - Active against IFN A and B
• Oseltamivir and Zanamivir

Benefit of Treatment

• Can shorten duration and severity of symptoms
• Greatest Benefit if given within the first 24 - 30 Hrs

Question 8

Who Should Be Tested for TB?

Answer 8

• HIV+ people
• anti-TNFa therapy patients
• immigrants from TB prevalent regions
• recent contact with active TB case
• apical fibronodular disease
• organ transplant
• recent skin test converter
• other high risk groups: homeless, alcoholics, nursing home residents, hospital employees

Question 9

Treatment of Latent TB

Answer 9

1. 9 months isoniazid (INH) (QD, BIW)
2. rifampin daily for 4 months
3. INH + rifapentene once weekly x 3 months

Question 10

Vitamin D and TB

Answer 10

-vitamin D shown induces expression of cathelicidin, an antimicrobial peptide that kills MTB

Question 11

TB Tests

Answer 11

• tuberculin skin test (TBT)
• IFNgamma release assays- more sensitive and specific than TBT
• -quantiferon
• -T spot TB- more sensitive in immunocompromised hosts who are deficient in T cells

Question 12

BDG Vaccine

Answer 12

• raised center scar

- positive TBT, but negative IFNgamma release assay test

Question 13

Active vs. Latent TB

Answer 13

Latent

• normal chest x ray (may have ghon complex)
• sputum smears and cultures negative
• no sx
• not infectious

Active

• abnormal chest x ray
• sputum smears and cultures positive
• symptomatic with cough, fever, night sweats, and weight loss
• often infectious before tx