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Pulmonology > 08.19 - Pneumonia, CAP Part 1&2 (Cross) - Questions > Flashcards

08.19 - Pneumonia, CAP Part 1&2 (Cross) - Questions Flashcards

(98 cards)

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1
Q

Most of the time, the etiologic agent for CAP is

A

never identified

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2
Q

Definition of HAP

A

Appears >48 hours after hospital admission - Was not incubating at time of admission

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3
Q

Leading cause of death among hospital-acquired infections

A

Pneumonia

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4
Q

Highest risk for HAP is in patients ____

A

on mechanical ventilation

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5
Q

Gram stain of H Influenze

A

Gram Positive Diplo

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6
Q

Gram stain of Mycoplasma pneumoniae

A

Gram stain negative

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7
Q

Gram stain of Strep pneumoniae

A

Gram positive Diplo

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8
Q

Gram stain of Staph Aureus

A

Gram positive cocci in clusters

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9
Q

3 Main Categories of Risk Factors for Strep Pneumo

A

Alcohol/Drugs; Respiratory Tract abnormalities; Abnormal circulatory dynamics

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10
Q

How does alcohol/drug intoxication predispose to Strep Pneumo

A

Cerebral impairment –> Depressed cough reflex and increased aspiration of secretions

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11
Q

What abnormal circulatory dynamics predispose to Strep Pneumo

A

Pulmonary Congestion; Heart Failure

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12
Q

Why is sickle cell a risk factor for Strep Pneumoniae

A

Auto-splenectomy –> Encapsulated pathogens normally cleared from circulation by spleen

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13
Q

3 Main Virulence Factors of Strep Pneumo

A

Capsule; Lipoteichoic Acid; IgA Protease

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14
Q

Lipoteichoic Acid (Strep Pneumo)

A

Activates complement, induces cytokine production

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15
Q

IgA Protease (Strep Pneumo)

A

Enhances ability to colonize mucosa of URT

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16
Q

How is Strep Pneumo dx?

A

Urinary antigen and Gram Stain/Culture

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17
Q

4 features of Gram Stain/Culture of Strep Pneumo, other than Gram positive diplot lancet

A

A-Hemolytic; Catalase negative; Optochin Sensitive, Quellung Reaction

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18
Q

Hemolysis, Catalase status of Strep Pneumo

A

Alpha Hemolytic, Catalase negative

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19
Q

Quellung Reaction

A

Antibodies bind to capsule and it swells

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20
Q

Which can be used for Strep Pneumo: Ceftriaxone, Amoxicillin, Levofloxacin, Azithromycin

A

Any

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21
Q

If you have penicillin allergy and bad strep pneumo pneumonia, use what Ab?

A

Vancomycin

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22
Q

For strains of Strep Pneumo with reduced penicillin susceptibility, use

A

3rd gen Cephalosporin (Ceftriaxone) or Fluoroqinolones

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23
Q

For whom is Pneumovax recommended

A

All >65; 19-64 who are at increased risk

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24
Q

For whom is Prevnar recommended

A

Children and infants

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25
Classic beta hemolytic bug
Strep pyogenes
26
Optochin test is used to distinguish
S Pneumoniae (sensitive) from Strep Viridans (resistant)
27
OVR,PS
Optochin Viridans Resistant, Pneumoniae Sensitive
28
S Pneumoniae pneumonia is usually of the ___ type
Lobar (as opposed to bronchial)
29
Leading cause of invasive bacterial disease in children, the elderly, and immunocompromised
S. pneumoniae
30
Most important virulence factor of Strep Pneumo
Capsule
31
Initial event in invasive pneumococcal disease
Attachment to epithelial cells, enhanced by pili
32
Cell wall componentes of strep pneumo contribute to
Inflammatory processes
33
Which strep pneumo component causes much of inflammatory processes
Cell Wall components
34
Walking pneumonia in 16 y/o
Mycoplasma Pneumoniae
35
Who gets Mycoplasma pneumonia most commonly
School-age children and military recruits
36
Most common cause of pneumonia in school-age children
Mycoplasma Pneumoniae
37
CXR in Mycoplasma pneumonia
usually looks worse than disease
38
Capsule that protects against phago is a property of
Strep Pneumo
39
Adhesin
Mycoplasma: Binds to ciliated epithelial cells and causes reduced ciliary clearance
40
How does Mycoplasma pneumoniae cause disease
Adhesin binds to ciliated epithelial cells and causes reduced ciliary clearance
41
What bugs produce endotoxins that stimulate release of cytokines
Gram negatives in general
42
4 dx tests used in workup of Mycoplasma infection
Serology, Eaton agar culture, PCR on respiratory secretions, Cold Agglutinins
43
Why no gram stain with Mycoplasma
No cell wall
44
What are Cold Agglutinins
IgM auto-Ab's against Type O RBCs that agglutinate the cells at 4deg C, but not higher
45
__ % of patients with Mycoplasma with have cold agglutinins
50%
46
Cold Agglutinins =
Mycoplasma
47
What is Bactrim
Sulfamethoxazole + Trimethoprim
48
Sulfamethoxazole + Trimethoprim
What is Bactrim
49
Vancomycin covers
Gram positive infections
50
Why no penicillin for Mycoplasma
No cell wall
51
Most common cause of Walking Pneumonia in 40 y/o
Chlamydia Pneumoniae
52
Chlamydia pneumonia is very similar to __ in clinical presentation
Mycoplasma Pneumonia
53
Tx of Chlamydia pneumonia
Doxycycline
54
Dx test for Chlamydia pneumonia
No good test
55
Principal Human Mycoplasma Disease
Mycoplasma Pneumoniae
56
Mycoplasma pneumonia symptoms
Mild respiratory infection - sore throat and pharyngitis
57
Primary Atypical Pneumonia
Mycoplasma Pneumonia
58
Structure of Mycoplasma Pneumoniae
Pleomorphic, but polar (no cell wall)
59
Relationship of Mycoplasma Pneumoniae to host cells
Attaches to surface of respiratory epithelia
60
Inflammatory response in Mycoplasma Pneumonia is both __ and __
Protective and Pathogenic
61
Chlamydia is often called the ___ epidemic
Silent
62
Transmission of Chlamyidia Pneumoniae
Person to person by respiratory droplets or secretions
63
Onset and symptoms of Chlamydia pneumonia
Most commonly asymptomatic; but can appear as gradual onset of cough --> Pneumonia or Bronchitis
64
Chlamydia Pneumonia is most common in
School age children, but all ages at risk
65
2 most common causes of Walking Pneumonia in school age children and adults
Mycoplasma and Chlamydia
66
Why can't you see Chlamydia Pneumo on Gram Stain?
Intracellular
67
2 organisms that live in gut but cause HAP
Klebsiella and Enterobacter
68
Fruity odor and Bluish-Green Pus
Pseudomonas
69
Biggest risk factor for HAP
Mechanical Ventilation
70
Where is Pseudomonas found
Wet environments
71
Small, pleomorphic; Facultatively anaerobic; Nonmotile
H influenzae
72
Non-fermentive, motile, oxidase positive, green pigment
Pseudomonas
73
Lactose fermenting, indole-neg, incabable of growth at 10degC
Klebsiella
74
Gram neg coccobacilli, non-motile, strictly aerobic, catalase positive, oxidase neg
A baumanii
75
Mycoplasma pneumo: Capsule, Enterotoxin, Endotoxin and Exotoxin A, Adhesin
Adhesin
76
Pseudomonas: Capsule, Enterotoxin, Endotoxin and Exotoxin A, Adhesin
Endotoxin and Exotoxin A
77
Staph Aureus: Capsule, Enterotoxin, Endotoxin and Exotoxin A, Adhesin
Enterotoxin
78
Strep pneumo: Capsule, Enterotoxin, Endotoxin and Exotoxin A, Adhesin
Capsule
79
Exotoxin A
Blocks protein synthesis by inactivating EF-2 via ADP-ribosylation
80
Blocks protein synthesis by inactivating EF-2 via ADP-ribosylation
Exotoxin A
81
Action of virulence factors in Pseudomonas results in extensive
Vasculitis w/ thrombosis; Hemorrhage with necrosis
82
Cefepine vs Ceftriaxone
4th gen cephalosporin vs 3rd: Pseudomonas coverage with 4th
83
Good drug combo before susceptibility results in Pseudomonas
Cefepine + Cipro
84
Zosyn
Piperacillin + Tazobactam
85
Piperacillin + Tazobactam
Zosyn
86
For cephalosporins, as you move up in generations:
Gram neg activity increases; Pseudomonas coverage increasese; CSF penetration increases
87
Pneumonia in large group, think -->
Legionella
88
Altered mental status, diarrhea, fever, dry cough
Legionella
89
Legionella is a ___ pneumonia
Atypical
90
CXR in Legionella pneumonia
Variable
91
Gram stain in Legionella pneumonia
Macrophages
92
Why no gram stain in Legionella
Intracellular
93
Major virulence factor in Legionella
Cell Wall Endotoxin
94
What causes host inflammatory response in Legionella
Cell Wall Endotoxin
95
2 drugs for Legionella
Levofloxacin, Azithromycin
96
Transmission of Legionella pneumo
Fomites and vehicles (esp water)
97
Where does Legionella pneumo replicate
Alveolar macrophages (amoebas in resorvoir)
98
Dot/Icm-
Type 4 secretion system in Legionella that prevents phagosome/lysosome fusion

Pulmonology (31 decks)

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