Lower Respiratory Tract Infections

Question 1

what are the three components of the infectious disease triad?

Answer 1

host
pathogen
environment

Question 2

diagnosis of pneumonia requires what?

Answer 2

a chest radiograph showing parenchymal infiltrates

Question 3

acute pneumonia typical findings

Answer 3

• community acquired (CAP)
• measured in hours to days
• onset with chills, fever, and wet cough
• pleura often involved giving chest pain with inspiration (pleuritis)
• micro-aspiration of upper respiratory tract colonizing bacteria

Question 4

what is the most often found bacteria to causes acute pneumonia?

Answer 4

Strep. pneumoniae

Question 5

what is the progression of pneumonia in regards to the lungs?

Answer 5

sub-segmental->segmental->lobar consolidation

Question 6

why has H. influenzae largely disappeared as a cause of pneumonia?

Answer 6

the vaccine

Question 7

what gram negative bacteria can causes pneumonia?

Answer 7

Klebsiella pneumoniae

Question 8

what causes walking pneumonia?

Answer 8

mycoplasma pneumoniae

Question 9

what is lung hepatization?

Answer 9

seen in lobar pneumonia and is when there is a major infiltration of alveoli by PMNs

Question 10

bacteria that can causes walking pneumonia

Answer 10

mycoplasma pneumoniae

Chlamydophila pneumoniae

Question 11

what three bacteria can causes environmentally acquired pneumonia?

Answer 11

Legionella pneumophilla (legionnaire's)
Coxiella burnetii (Q fever)
Chlamydophila psittaci

Question 12

pulmonary actinomycosis

aspiration pneumonia

Answer 12

Actinomyces spp. anaerobic/microaerophic Gm + bacillus

• oral flora in carious teeth and gingivitis
• aspiration often with unconsciousness
• organism can penetrate any tissue
• *requires long-term treatment (6-12 months)
• Penicillin IV then PO or clindamycin
• sulfur granules

Question 13

viral pneumonia

Answer 13

respiratory viruses
----common in children; rare in adults 
Hantavirus (Sin Nombre V.)
Coronavirus (SARS, MERS)
Bacteria pneumonia with or in the wake of influenza

Question 14

complications of acute bacterial pneumonia

Answer 14

necrotizing pneumonitis
lung abscess
empyema

Question 15

what is necrotizing pneumonitis

Answer 15

death of lung parenchyma

Question 16

what is a lung abscess

Answer 16

excavation of lung parenchyma

Question 17

what is empyema

Answer 17

spread of infection into potential space between parietal and visceral pleura-

• requires drainage as part of management
• diagnostic via thoracentesis

Question 18

management of acute pneumonia

Empiric treatment

Answer 18

• microbiological diagnosis is not possible, new tests for antigens and nucleic acids may offer etiological diagnosis
• possible pathogens of acute pneumonia are well established
• Broad spectrum antibiotics to cover most possible pathogens, allowing empiric therapy
• *exception due to resistance of pneumococcus, the leading pathogen for lobar and bronchopneumonia

Question 19

chronic pneumonia

Answer 19

weeks to months
differential diagnosis
NO empiric treatment
**Requires diagnosis by bronchoscopy or lung biopsy

Question 20

what would be a classic case of chronic pneumonia?

Answer 20

pulmonary TB

Question 21

Oral anaerobic bacteria

gram + cocci

Answer 21

peptostreptococcus

Question 22

Oral anaerobic bacteria

gram+ bacilli

Answer 22

actinomyces
eubacterium
leptotrichia

Question 23

Oral anaerobic bacteria

gram-cocci

Answer 23

veillonella

Question 24

Oral anaerobic bacteria

gram - bacilli

Answer 24

fusobacterium
prevotella
porphyromonas

Question 25

aspiration pneumonia characteristics

Answer 25

stupor, coma, seizures
oropharyngeal flora
community acquired: gram + and anaerobes
hospital-aquired: gram - and S. aureus

Question 26

is Step pneumoniae alpha, beta, or gamma hemolytic?

Answer 26

alpha