Exam 2 - respiratory infections Flashcards Preview

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Flashcards in Exam 2 - respiratory infections Deck (57):
1

What are the two classifications of Pneumonia

-community acquired (CAP)
(typical and atypical)

-nosocomial (aka hospital acquired)

2

typical CAP: most commonly caused by

bacterial: strep pneumoniae

-in top 10 causes of death in US

3

Typical CAP: bronchopneumonia

-bronchitis -> pna
-locations = lower lobes, RML
-patchy consolidations (microabscesses)

4

Typical CAP: lobar pneumonia

consolidation of lobe (complete or incomplete)

5

typical CAP: pathogenesis

most common: microaspiration of oropharyngeal contents during sleep

second most common: aerosol inhalation

uncommon: blood stream infection

6

typical CAP: clinical findings

-sudden high fever
-productive cough
-CP
-tachycardia

Consolidation signs =
-dullness to percussion
-inspiratory crackles
-bronchial breath sounds

7

typical CAP: chest X-ray (CXR), labs

-screen
-patchy infiltrates (bronchopneumonia)
-lobar consolidation

labs: gram + stain, leukocytosis, blood cultures

8

Nosocomial pneumonia: risk factors

***respirators = most common
-underlying disease
-antibiotics
-immunosuppression

9

Nosocomial pna bugs

Gram (-) = pseudomonas, E.coli

Gram (+) = staph. aureus

10

Rhinovirus

most common cause of common cold

transmission: hand-to-eye/nose

11

Coxsackievirus

-acute chest syndrome
(fever, pleuritis)

12

Parainfluenza

-most common cause of CROUP!!

CXR: steeple sign (mucosal edema in trachea)

treatment: cold water humidifiers, aerosolized racemic epinephrine

13

Cytomegalovirus (commonly cause, pathology, treatment)

-common cause of pna in immunocompromised

-pathology: enlarged macrophages and pneumocytes

-Treatment: anti-virals

14

What are the 2 classifications of influenza?

-Type A (most common, worldwide epidemics)

-Type B (major outbreaks)

15

Hemagglutinins vs neuraminidase

-hemagglutinins: protein on virus. how it binds to cells in nasal passages

-neuraminidase: disolves mucus. facilitates release of virus

16

Influenze: clinical findings and associations

clinical finding: fever, headache, cough, muscle/chest pain

associations:
-guillain-barre syndrome
-Reye syndrome

17

Influenza treatment

-prevention = vaccinate
-neuraminidase inhibitors
(i.e., tamiflu - within 48 hrs of sx)

18

Rubeola: Measles (pathology and clinical findings)

-patho: Warthin-Finkeldey multinucleated giant cells

-clinical findings: Koplik spots in mouth before rash, rash, fever, cough, conjunctivitis, nasal mucus)

19

Respiratory syncytial virus

***Most common cause of pna and bronchiolitis in infants
-winter illness
-pathology = fusion protein
-you want to vaccinate high risk kids

20

Mycoplasma pneumoniae

-most common cause of atypical pna (***"walking pna")
-patient pop = teens, military recruits
-symptoms: insidious onset, low-grade fever
-other pathology = cold agglutinins in blood

21

Chlamydia trachomatis

***NEWBORN PNA (infected during birth)

-symptoms: afebrile, choppy cough, conjunctivitis, wheezing

22

Coxiella burnetii

-associated with: birthing process of infected animals, milking, handling of animal waste (vets, dairy farmers)

-clinical findings: atypical PNA, myocarditis, hepatitis

23

Streptococcus pneumoniae

-most common cause of typical CAP
- Gram (+) diplococcus
-rapid onset of sx = productive cough, consolidation signs

24

Staphylococcus aureus

-Common pts: influenza, measles, CF, IVDA
-yellow sputum

pathology: Gram (+), ABSCESSES!!!, pneumatoceles, hemorrhagic pulmonary edema

25

Bacillus anthracis: classifications

Cutaneous anthrax
-direct contact with contaminated animal products
-eschar formation with central necrosis

Pulmonary anthrax
-"first sign is death"
-inhalation of spores
-findings = necrotizing PNA, meningitis, splenomegaly

26

Bacilus anthracis (pathology)

- Gram (+) rod
-EXOTOXINS!!: edema factor, lethal factor, protective antigen

27

Bordetella pertussis

WHOOPING COUGH!!!

patho:
-Gram (-) rod
-droplet transmission
-bacteria pili attach to cilia in resp tract
-toxin (blahhhh)

28

Haemophilus influenzae

***most common bacterial cause of COPD exacerbations

- Gram (-) rod

causes: epiglottitis, sinusitis, otitis media, conjunctivitis

29

Moraxella catarrhalis

-common cause of typical PNA (especially elderly!)
-major cause of COPD exacerbations
-also causes (chronic bronchitis, sinusitis, otitis media

-Gram (-) diplococcus

30

Pseudomonas aeruginosa

"respirator PNA" *******
-most common cause of nosocomial PNA in CF
-green sputum
-vessel invasion (pulmonary infarctions)

31

Klebsiella pneumoniae

-typical PNA
-patho (gram (-) rod
-elderly nursing home pts
-ALCOHOLICS****
-blood-tinged sputum

32

Legionella pneumophilia (main info)

-atypical PNA
-****sources (moist places)
-patho: ****"Water loving bacteria"***
Gram (-)

risk factors: EtOH, smokers, immunosuppression

33

Legionella pneumophilia: clinical findings and screens

-clinical findings: high fever, dry cough, flu like sx

-screen: *****antigens in urine!

34

Yersinia pestis (the plague): transmission and reservoir

Transmission
-rat flea bite!!****
-person to person via droplet

reservoir
-***ground squirrels

35

Yersinia pestis: the plague (pathology)

-V and W antigens: provide protection and macrophages cannot kill it

-Gram (-) rod

36

Yersinia pestis: the plague (classifications)

-bubonic (most common, rat flea bite, infected lymph nodes, drain to surface)

-pneumonic (aerosol transmission)

-septicemic

37

Mycobacterium tuberculosis

-TB
-strict aerobe
-**ACID-FAST
-resides in phagosomes of macrophages
-produces CORD FACTOR (protein that prevents lysosome fusion, provides virulence)

38

TB screening

-purified protein derivative
-intradermal skin test
-CANNOT differentiate active vs inactive

-(+) test detected bacterium cell wall protein

39

Primary TB

location: *** upper lower lobes and lower upper lobes!!!***

40

Secondary TB

-reactivation of primary TB
-location: **** apices of lungs!** (greatest O2 saturation)
-cavitary lesion (release of cytokines by memory T cells)

41

TB: clinical findings

-fever
-night sweats
-weight loss
-hemoptysis
-bronchiectasis
-scar carcinoma

42

Extrapulmonary TB

-kidneys = most common
-adrenals = addison disease
- vertebrae = Pott disease

43

TB diagnosis and treatment

Diagnosis: screen
treatment: triple therapy
****Treat 9-12 months!!!*****

44

Cryptococcus neoformans: what and where you find

-fungus (budding yeast)
-environmental locations:
****Pigeon waste, windows, bridges, near buildings***

45

Cryptococcus neoformans: clinical findings

-lung disease (granulomatous inflammation, caseation)
-infects (immunocompetent and immunocompromised)

46

Aspergillus fumigatus: structure

-fungus (fruiting body)

Asperilloma: ***fungus ball!*

47

Aspergillus fumigatus: pathology

-invades vessels***
-necrotizing PNA***

48

Mucor species

-fungus (wide angled, no septa)
-pulmonary vessel invasion
-in people with DIABETES!!!***

49

Coccidioides immitis

-fungus (***SPHERULES**)
-found in: ***deserts (valley fever) and earthquakes ***

-pulmonary granulomatous inflammation
-flu-like symptoms and erythema nodosum

50

Histoplasma capsulatum

***most common systemic fungal infection**
-yeast found in macrophages
****-locations***: mississippi river valley!!!!!*

51

Blastomyces dermatitidis

-***yeast with broad-based buds***
-found in ****great lakes***
-associated with ***outdoor activities***
-skin lesions similar to SCC

52

Pneumocystis jiroveci

-similar to fungi in structure
****most common pathogen causing PNA in AIDS
-patho: produces cysts, produces tropozoites

53

P. jiroveci clinical findings

-fever
-dyspnea
-hypoxemia
-intra-alveolar exudates

54

Causes of lung abscesses (4)

-oropharyngeal material aspiration
-bacterial PNA
-septic emboli
-obstructive lung tumor

55

Aspiration

-**most common cause of lung abscess
-risk factors (alcohol, LOC, dental work)

Pathogens: mixed aerobic and anaerobic (anaerobes 60%)

56

Lung abscess: gross pathology

-size and location vary
aspiration abscesses generally on Right side

57

Lung abscess **

-***productive cough (foul sputum)****
-CXR: ***cavitation*** with air fluid level
-treatment: abx and bronchoscopy