Typical Pneumonia

Question 1

Pneumonia

Answer 1

Inflammation of lung parenchyma (alveoli)

S/S - cough , fever, dyspnea and radiographic infiltrates

Question 2

Why are elderly predisposed?

Answer 2

Cumulative effect of conditions such as smoking related COPD, heart failure, demetia, seizures, diabetes, alcoholism.

Question 3

CAP Common MO

Answer 3

Strep Pneumonia 
Mycoplasma Pneumonia
Hemophilus influenza
Clamydophila pneumonia 
Viruses (Inf A and B, adenovirus, RSV and parainfluenza)

Question 4

Typical Pneumonia CAP

Answer 4

Purulent! productive cough
Strep, hemophilus, moraxella
Tends to be severe

Question 5

Atypical Pneumonia CAP

Answer 5

Dry non productive cough

MO - mycoplasma, chlamydophila, legionella

Question 6

Defenses in alveolar lining fluid

Answer 6

Alveolar macrophages
Fibronectin - adhesin involved in cell-cell adhesion, by attaching to both bacteria and PMNs - promotes phagocytic function
Surfactant - act as opsonins to enhance phagocytosis by macrophages and PMNS

Question 7

Diagnostic Test for CAP

Answer 7

Sputum gram stain and culture
Blood culture
PCR not routinely done

Question 8

differential test for strep species

Answer 8

add a P disk (optochin) to the blood culture. Inhibits Strep pneumonia growth

Question 9

Streptococcus pneumonia - VF

Answer 9

Capsular polysaccharide - inhibits phagocytosis
Surface adhesin A
Surface protein C binds complement factor H - inhibiting C3 convertase
Pneumolysin - cytotoxic, activates complement

Question 10

Pathogenesis of Strep Pneumonia

Answer 10

1. colonization
2. reach trachea and bronchi - if clearance is impaired due to allergies, smoking, URI
3. MO escape phagocytosis by having capsule
4. in alveoli bacteria proliferate, activate complement , generate cytokines, and attract PMSs and exudate into alveolar spades.
   NO Inflammation of intersititium, no necrosis no abscess formation
   Can spread to pleura, cause pleural effusion and emphysema

Question 11

Pathogenesis of Strep Pneumonia

Answer 11

1. colonization
2. reach trachea and bronchi - if clearance is impaired due to allergies, smoking, URI
3. MO escape phagocytosis by having capsule

Question 12

fatalities by Strep - 2 pathway

Answer 12

Respiratory failure - hypoxemia, cyanosis, labored breathing, need for mechanical ventilation
Sepsis with spread sometimes to meninges. Sepsis can lead to shock with poor perfusion of multiple organs including kidney and brain

Question 13

Hemophilus Influenzae

Answer 13

Gram - rod. Non encapsulated strains are normal URT flora
Encapsulated cause pneumonia

Grow on chocolate agar - need protoporhyrin (X) and NAD (V)

Question 14

Prevention of pneumonia

Answer 14

Polysaccharide - for adults >65 years
Conjugate - Kids

or u could just not smoke