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Flashcards in Bacterial infx LRT Deck (100):
1

Why are LRTIs more severe?

Lungs are generally sterile, and are full of goodies

2

What are the two major airway defenses?

Ciliated epithelium
Mucociliary escalator

3

What is the main mechanism that protects the lungs from particles?

Mucociliary escalator

4

What is pneumonia?

Inflammation of the lung as a result of a bacterial infection

5

What are the general features of pneumonia? (5)

fever
cough
malaise
pleuritic chest pain
dyspnea

6

What are the respiratory sounds that are present with pneumonia?

Crackles

7

What is pneumonia often associated with?

Viral respiratory tract infx

8

Who is at increased risk for developing pneumonia?

Heart disease, DM, lung issues old and very young

9

What are the local effects of bacterial infx of the lung, that are produced from the inflammatory immune response?

irritation
Pain
Dypsnea

10

What are the common virulence factors on bacteria in the lungs? (5)

Capsules, intracellular growth, IgA protease, exotoxins, and LPS

11

What is accumulated in pneumonia? (4)

Fluid, bacteria, PMNs, and fibrin

12

What are the pathogens that cause typical pneumonia? (5)

Strep penumonia
Staph aureus
Haemophilus influenza
Most gram negative bateria

13

Which general type of bacteria usually cause typical pneumonia?

Gram negative

14

What are the pathogens that cause atypical penumonia?

Mycoplasma pneumoniae
Chlamydophilia pneumoniae

Legionella pneumophila

15

Why aren't CXR 100% diagnostic for the type of bacterial infx?

Changes throughout course of infecion--must use lab results

16

What are things that can impair the mucociliary escalator? (4)

Viral infections, smoke, EtOH, narcotics

17

What are the three pathogens that usually cause typical pneumonia?

Strep pneumoniae
Staph aureus
Haemophilis influenzae

18

What does typical pneumonia look like on a CXR?

Lobar infiltrate

19

What does atypical pneumonia look like?

Patchy infiltrate throughout

20

What is the onset of typical pneumonia? Atypical?

Typical = sudden
Atypical = gradual

21

What is the facies associated with typical pneumonia?

Typical = toxic appearing
Atypical = normal appearing

22

Which type of pneumonia has a productive cough?

Typical = productive
Atypical = non-productive

23

What is the sputum like in typical pneumonia? Atypical?

Typical = Purulent
Atypical = Scant, watery

24

Which type of pneumonia has an associated fever (usually)?

Typical

25

Which type of pneumonia has pleurisy?

Typical

26

Which type of pneumonia has a consolidation present?

Typical

27

Which type of pneumonia has leukocytosis with a L shift?

Typical

28

What does the CXR usually show for typical pneumonia? Atypical?

Typical = lobar
Atypical = patchy

29

What is the most common cause of typical pneumonia? Atypical?

Typical = Streptococcus penumoniae
Atypical = Mycoplasma pneumoniae

30

Which type of pneumonia is also called "walking" pneumonia?

Atypical

31

Infection with what bacteria will not follow the general pattern of symptoms of typical/atypical pneumonia?

Legionella pneumophila

32

What are the three major types of complications for pneumonia?

1. Pleural effusion
2. Hematologic
3. Chronic complications

33

What are the three hematologic complications that pneumonia have?

1. Anemia
2. Disseminated intravascular coagulation
3. Thrombocytopenia

34

What are the chronic complications that can result from pneumonia?

1. lower arterial oxygen levels
2. weight loss/muscle atrophy
3. Bronchiectasis

35

What is pleural effusion?

"excess fluid that accumulates in the pleural cavity, the fluid-filled space that surrounds the lungs. This excess can impair breathing by limiting the expansion of the lungs" wiki

36

What is aspiration pneumonia?

Introduction of foreign material into the bronchial tree (saliva, food nasal secretions etc). This dilutes surfactant immunity.

37

What is aspiration pneumonia associated with?

Alcoholics, coma/stroke pts

38

What is hospital acquired pneumonia usually associated with?

Ventilator use

39

What is the most frequent cause of HOP?

MDR gram negative bacteria

40

What are the gram negative bacteria that usually cause HOP? (5)

Pseudomonas aeruginosa
E.coli
Klebsiella pneumoniae
Acinetobacter spp.
Haemophilus influenzae

41

What are the gram positive bacteria that are associated with HOP? (2)

Staph aureus
Step pneumo

42

What are the three conditions that should be ruled out when seeing a pulmonary infiltrate?

CHF
Carcinoma/lymphoma
Lupus

43

True or false: if a blood culture from a pneumonia pt is positive for the pneumonia causing agent, this is always a serious condition

True

44

What are the diagnostic criteria for evaluating sputum?

Must see >25 PMNs and <10 epithelial cells (to r/o contamination)

45

True or false: strep pneumo is a normal colonizer of the URT?

True

46

What is the gram stain and morphology of strep pneumo

Gram positive cocci

47

What is the blood hemolysis result of strep pneumo?

Alpha

48

What is the test that distinguishes strep pneumo from staph?

Catalase test (is negative for strep)

49

What are the three test results of hemolysis testing?

Alpha = some RBC destruction
Beta = total RBC desctruction
Gamma = none

50

Why type of polysaccharide does strep pneumonia?

Capsular

51

What are the five most important virulence factors that pneumococcal bacteria produce?

Surface adhesins
IgA protease
Pneumolysin
Teichoic caidpeptidoglycan
Thick polysaccharide capsule

52

What is the effect of pneumolysin?

Virulence factor found on strep penumo that forms pores in host cells

53

What is the role of teichoic acid/peptidoglycan in pneumonia?

Inflammation

54

What is rust colored sputum specific for (but not sensitive to)?

Pneumococcal pneumonia

55

Is penumococcal pneumoia a self-limiting disease?

Yes

56

Which type of pneumonia is pneumococcal pneumonia

Typical

57

What are the three tests that can be used to diagnose S. pneumoniae? (4)

Gram stain sputum (positive)
Culture (alpha hemolysis)
Bile solubility
Urine collection for pneumococcal polysaccharide

58

What is the bile test result for S.pneumoniae?

Positive solubility

59

What is the test that can differentiate S. pneumonia from Strep mutans? Result?

Optochin test.

S. pneumonia is sensitive to it

60

What is the treatment for S. pneumo?

Empiric therapy with penicillin or macrolides

61

Serious cases of strep pnuemo should be treated with what?

Azithromycin + cephalosporin

62

What is the gram stain and morphology of staph aureus?

Gram positive cocci

63

What is the catalase test result for staph?

Positive

64

What is the coagulase test result for staph aureus? How does this compare to other staph?

Positive, unlike other staph species

65

What are the virulence factors for staph aureus?

Coagulase
Protein A
Panton valentine leukocidin?

66

What is the protein A part of staph aureus do?

Binds Fc portion of an antibody, and coats itself with antibody

67

What is the panton valentine leukcidin virulence factor that staph aureus produces?

Pore forming cytotoxin that leads to necrotizing penumonia

68

What is MRSA, and what is it resistant to?

Methicillin resistane staph, that is also resistant to all beta lactams

69

Is MRSA more virulent?

No, just harder to treat

70

What is the treatment for MRSA?

vancomycin or linezolid

71

What is the treatment for staph infections that are not MRSA?

Penicillins/cephalosporins

72

What are the five gram negative, facultative anerobes bacteria that cause pneumonia?

Klebsiella pneumoniae
E. coli
Enterobacter
Serratia
Proteus

73

What are the two gram negative aerobes that cause pneumonia?

Pseudomonas aeruginosa
Acinetobacter

74

Which type of bacteria are more likely to be associated with aspiration pneumonia?

Anaerobic

75

Which type of bacteria causes pneumonia more often in patient who already have an underlying disease?

Gram negative

76

Which type of bacteria produce foul smelling sputum?

Anaerobic

77

Which type of pneumonia are gram negative pneumonias (typical or atypical)?

Typical

78

What are the two labs that can aid in the diagnosis of gram negative bacterial pneumonia?

Sputum culture
Blood culture

79

What is the treatment for gram negative pnuemonias?

Broad spectrum abx with abx synergism, including gentamycin/cephelxxin

80

What are the three abx used to treat psuedomonas?

Ticarcillin
Piperacillin
Amikacin

81

What is the gram stain and morphology of klebsiella pneumoniae?

Gram negative rod

82

Is klebsiella motile or note?

Not motile

83

What is the enzyme that klebsiella produces that makes them harder to treat?

Beta lactamases

84

Infection with what bacteria results in currant jelly sputum?

Klebsiella

85

What type of pneumonia does klebsiella produce (lobar vs bronchiolar)

Lobar

86

What are the two virulence factors that klebsiella has?

LPS
Capsule

87

What is the treatment for infection with klebsiella?

Same as other gram-negative pneumonias---

88

What is the gram stain and morphology of pseudomonas aeruginosa? Specialization?

Gram negative rods, with flagella?

89

Is pseudomonas aeruginosa an anaerobe or aerobe? Oxidase positive or negative? sugar fermentation positive or negative?

Obligate aerobe
Oxidase positive
Sugar ferment negative

90

What do pseudomonas aeruginosa colonies smell like?

Grapes

91

pseudomonas aeruginosa usually grows where?

hand soaps, water with minimal nutrients, dilute antiseptics

92

Most infection sources of pseudomonas aeruginosa are what?

Humidifiers, sink traps

93

What are the other infections that pseudomonas aeruginosa can cause?

Septicemia, UTIs, wound infections, meningitis in severe burns

94

What are the 6 virulence factors that pseudomonas aeruginosa has?

1. Toxin A
2. Leukocidin
3. Phospholipase C
4. Capsule
5. Pyocyanin
6. Pyoverdin

95

What is the effect of toxin A that pseudomonas aeruginosa produces?

ADP ribosylation of EF-2

96

What is the effect of phospholipase C that pseudomonas aeruginosa produces?

Membrane disruption

97

What is the effect of pyocyanin that pseudomonas aeruginosa produces?

Toxin

98

What is the effect of pyoverdin that pseudomonas aeruginosa produces?

Green fluorescent virulence factor

99

What is the treatment for pseudomonas aeruginosa?

Ticarcillin or piperacillin plus an aminoglycoside

100

What is the "scourge" of the CF community? Why?

Pseudomonoas aeruginoasa, because it cannot be cleared via the mucociliary escalator, and creates a biofilm.