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

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

Flashcards in 08.19 - Pneumonia, CAP Part 1&2 (Cross) - Questions Deck (98):
1

Most of the time, the etiologic agent for CAP is

never identified

2

Definition of HAP

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

3

Leading cause of death among hospital-acquired infections

Pneumonia

4

Highest risk for HAP is in patients ____

on mechanical ventilation

5

Gram stain of H Influenze

Gram Positive Diplo

6

Gram stain of Mycoplasma pneumoniae

Gram stain negative

7

Gram stain of Strep pneumoniae

Gram positive Diplo

8

Gram stain of Staph Aureus

Gram positive cocci in clusters

9

3 Main Categories of Risk Factors for Strep Pneumo

Alcohol/Drugs; Respiratory Tract abnormalities; Abnormal circulatory dynamics

10

How does alcohol/drug intoxication predispose to Strep Pneumo

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

11

What abnormal circulatory dynamics predispose to Strep Pneumo

Pulmonary Congestion; Heart Failure

12

Why is sickle cell a risk factor for Strep Pneumoniae

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

13

3 Main Virulence Factors of Strep Pneumo

Capsule; Lipoteichoic Acid; IgA Protease

14

Lipoteichoic Acid (Strep Pneumo)

Activates complement, induces cytokine production

15

IgA Protease (Strep Pneumo)

Enhances ability to colonize mucosa of URT

16

How is Strep Pneumo dx?

Urinary antigen and Gram Stain/Culture

17

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

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

18

Hemolysis, Catalase status of Strep Pneumo

Alpha Hemolytic, Catalase negative

19

Quellung Reaction

Antibodies bind to capsule and it swells

20

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

Any

21

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

Vancomycin

22

For strains of Strep Pneumo with reduced penicillin susceptibility, use

3rd gen Cephalosporin (Ceftriaxone) or Fluoroqinolones

23

For whom is Pneumovax recommended

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

24

For whom is Prevnar recommended

Children and infants

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