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Respiratory Exam II > LRT Bugs > Flashcards

LRT Bugs Flashcards

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1
Q

3 parts of the LRT

A
  • trachea
  • primary bronchi
  • lungs
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2
Q

acute bronchitis

A
  • inflammation of the bronchioles
  • results in reduction of air flow
  • encourages mucus accumulation in the lungs
  • triggers coughing = HALLMARK
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3
Q

chronic bronchitis

A
  • cough and excessive mucus production for at least 3 months over a 2 year period
  • COPD pts –> infection, smoking, inhalation of dust or fumes from work/home
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4
Q

what causes the most cases of bronchitis: viruses or bacteria

A

viruses

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5
Q

what are the 4 main bacterial causes of bronchitis? which 3 can also cause URT infections?

A
  • strep pneumo
  • h. flu
  • Moraxella catarrhalis
  • mycoplasma pneumonia (only one that doesn’t cause URTs also)
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6
Q

signs and symptoms of acute bronchitis

A
  • no or LOW GRADE fever
  • ACUTE cough w/ or w/o sputum
  • no underlying chronic lung ds
  • have to EXCLUDE pneumonia
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7
Q

when does acute bronchitis usually occur in pts?

A

during or following a viral infection

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8
Q

symptoms of chronic bronchitis

A
  • increase in cough or sputum production
  • SOB
  • NO evidence of pneumonia
  • main difference from acute = TIMEFRAME
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9
Q

what bugs cause acute vs. chronic bronchitis?

A
  • acute = mycoplasma pneumonia

- chronic = strep pneumo, H. flu, Moraxella catarrhalis

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10
Q

definition of pneumonia

A
  • inflammation of the lungs WITH fluid-filled alveoli and bronchioles
  • most common COD from infection in the elderly
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11
Q

3 ways the bacteria get into the lungs to cause pneumonia?

A
  1. aspiration of normal flora: URT or GI
  2. hematogenous spread from another site of infection
  3. inhalation of aerosols
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12
Q

typical pneumonia signs & symptoms

A
  • similar to pneumococcal pneumonia
  • abrupt onset
  • fever, chills, congestion, SOB, chest pain
  • PRODUCTIVE COUGH
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13
Q

bugs that cause typical pneumonia (5)

A
  • strep pneumo = #1 cause
  • klebsiella pneumonia
  • H. flu
  • Moraxella catarrhalis
  • staph aureus
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14
Q

strep pneumo lab results

A
  • gram (+) in pairs or chains
  • alpha hemolytic on blood agar = incomplete hemolysis
  • CAPSULE
  • adhesion
  • IgA protease
  • pneumolysin: lyses ciliated epithelial cells
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15
Q

optochin (+) vs. (-)

A

(+) means strep pneumo

(-) means Viridans strep

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16
Q

bacitracin (+) vs. (-)

A

no growth or bacitracin sensitive = strep pyogenes

growth or bacitracin resistant = strep agalactiae

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17
Q

typical (strep pneumo) pneumonia: seasonality? CAP or HAP? predisposing factors?

A
  • seasonal = fall and winter
  • CAP
  • predisposing factors: viral infection (flu or HIV), alcoholism, kids, elderly, SPLENECTOMY
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18
Q

how do you dx strep pneumo?

A
  • rust-colored sputum
  • alpha hemolytic
  • optochin sensitive
  • gram (+) cocci and NUMEROUS PMNs
  • antigen agglutination in urine and sputum
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19
Q

strep pneumo vaccines

A
  • pneumovax = 23 most common CAPSULE serotypes –> PPSV23; for adults
  • pneumococcal CONJUGATE vaccine = PCV13 –> kids age 2 months - 59 months
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20
Q

difference b/w capsule and conjugate vaccines

A
  • when you conjugate the capsule it creates a stronger immune response
  • capsule alone doesn’t work well for kids <5yo
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21
Q

what pts should for sure have the pneumonia vaccine?

A

anyone w/ a splenectomy

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22
Q

typical pneumonia caused by klebsiella

A
  • gram (-)
  • capsule
  • CAP & HAP
  • differentiation = thick, bloody sputum aka currant jelly sputum = BUZZ
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23
Q

risk factors for klebsiella pneumonia

A
  • alcoholics
  • hospitalized
  • on a ventilator
  • immunocompromised
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24
Q

mortality rate for klebsiella? why?

A
  • higher mortality than pneumococcal or mycoplasma pneumonia
  • causes necrosis of the lung tissue
  • bacteremia and release of LPS
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25
lab results for klebsiella? what culture do you use?
- gram (-) rods --> MacConkey agar | - lactose (+)
26
tx for klebsiella
- gentamicin or ciprofloxacin
27
what does KPC or CRKP mean?
- means the klebsiella bug is resistant b/c it is producing carbapenamse = destruction of carbapenems = destroys the abx
28
characteristics of H. flu
- short, fat rod - found in normal flora of URT - capsule - adhesins - endotoxin
29
risk factors for H. flu
- elderly - smokers - chronic pulmonary ds
30
dx of H. flu: lab results
- gram (-) coccobacillus | - grows on chocolate agar --> requires factor X (heme) and factor V (NAD)
31
distinctive features of staph aureus pneumonia
- salmon pink sputum | - empyema AKA pyothorax = pus that collects in the pleural cavity
32
what pts do you normally see get aspiration pneumonia? what bug most often involved?
- pts w/ influenza - very young - elderly - COPD - -> usually staph aureus
33
how does staph aureus spread?
- hematogenous pneumonia --> implied in bacteremia and endocarditis
34
what other bacteria cause typical pneumonia? what do you see w/ this bug?
- community-acquired MRSA (CA-MRSA) - rapid, severe form on pneumonia - massive hemoptysis - septic shock - high mortality rate - children and young adults
35
what bugs normally cause atypical pneumonia?
- mycoplasma pneumonia - chlamydophila spp. - legionella pneumophila - coxiella burnetii
36
signs & symptoms of atypical pneumonia? what are the key differences from typical pneumonia?
- fever, HA, malaise - myalgia, nausea, diarrhea = different - NONPRODUCTIVE cough = dry, hacking; no sputum
37
mycoplasma pneumonia atypical pneumonia
- primary atypical pneumonia AKA walking pneumonia | - CAP
38
distinguishing factors of mycoplasma pneumonia
- persistent, nonproductive cough - EXCESSIVE SWEATING, night sweats - can last several weeks - months - no seasonality
39
what populations are predominant for mycoplasma pneumonia?
- high school and college aged students | - generally pts <40yo
40
virulence factors for mycoplasma
- capsule | - adhesion: attaches and destroys the base of the cilia
41
lab results for mycoplasma
- will not gram stain b/c has no cell wall | - will see large number of PMNs
42
what test can you do quickly to see if a bug is mycoplasma?
- cold agglutinins will be (+)
43
tx for mycoplasma
- erythromycin or azithromycin | - could also use doxycycline
44
chlamydophila pneumonias characteristics
- gram (-) - CAP - obligate intracellular bacteria
45
how do you dx chlamydophila pneumonias?
- microscopy/gram stain = no orgs grow but large # of PMNs | - can also do ELISA
46
what is the weird thing about chlamydophila?
- has 2 stages/bodies - the elementary body is the infectious form that gets into the cell - elementary body is changed to reticulate body inside the cell = metabolically active - the elementary body gets released from the cell and goes to infect other cells
47
symptoms and tx for chlamydophila
- symptoms: mild fever, sore throat, malaise, persistent cough - tends to be a mild infection; most don't even seek treatment - tx: erythromycin or azithromycin; can also use doxycycline
48
what bug causes Psittacosis? associated with?
- Chlamydophila psittaci - AKA parrot fever - associated w/ exposure to birds
49
characteristics of Legionella pneumophila
- gram (-) --> doesn't gram stain well - intracellular; lives in amoeba in environment or alveolar macrophages in humans - water cooling towers and A/C units = main source
50
symptoms of legionnaires'
- abrupt onset of fever, HA, pleurisy, chills, myalgia, dry cough - can have complications w/ GI, CNS, liver, kidneys - HYPOTNATREMIA
51
risk factors for legionella
- smokers, COPD, elderly = main ones - alcoholic - immunosuppressed - renal transplant pts or pts on dialysis
52
how can you dx legionella?
- fastidious so only grows on BCYE agar --> needs iron salts and cysteine as growth factors - can do fluorescent antibody staining --> can detect antigen in urine
53
common causes of nosocomial (HAP) pneumonia
- pseudomonas aeruginosa - staph aureus - H. flu - enterics = enterobacter, klebsiella, e. coli, serratia marcescens
54
risk factors for pseudomonas
- think CF pts and hot tub folliculitis | - hospitalized pts on ventilation
55
what happens w/ CF pts and pseudomonas
- CF pts colonized w/ staph aureus first - then colonized w/ pseudomonas by age 5 - then burkholderia cepacia comes on the scene
56
what can clue you in to an anaerobic infection?
- copious amounts of foul smelling sputum
57
risk factors for anaerobes?
- aspiration of resp or gastric material (vomit) - dental work - loss of consciousness - can get mix of bacteroides and fusobacterium from the mouth --> necrotizing; lung abscesses, empyema
58
what are some potential bioterrorism agents
- anthrax - plague - Q fever - tularemia - brucellosis
59
characteristics of anthrax
- gram (+) large rod = "box car shaped" - endospores are what you inhale - has capsule and anthrax toxin
60
symptoms of anthrax? initial vs. later
- initial = sore throat, mild fever, myalgia, cough | - later (after several days) = severe coughing, n/v, lethargy, confusion, shock, death
61
what is different about the anthrax capsule?
it has a protein capsule NOT a polysaccharide one
62
tx and prevention of anthrax
- tx = penicillin, doxycycline, ciprofloxacin; DOC is uually pen or cipro - prevention = vaccine, but only for military or researchers --> high risk individuals
63
what is the bug that causes pneumonic plague
Yersinia pestis
64
symptoms of yersinia
- fever - chills - cough - difficulty breathing - FROTHY, BLOODY SPUTUM
65
lab results for yersinia
- gram (-) coccobacillus - bipolar or safety pin staining = stains darker on the ends than on the middle - stain should be red b/c of gram (-)
66
transmission and treatment of pneumonic plague
- transmission = inhalation or hematogenous spread | - tx = isolation; abx = streptomycin, tetracycline, chloramphenicol
67
what bug causes Q fever
Coxiella burnetii
68
lab results for coxiella burnetii
- gram (-) coccobacillus | - obligate intracellular
69
transmission of Q fever? what are the primary carriers?
- inhalation of contaminated dust - ingestion of unpasteurized milk - carried in cattle, sheep, goats - occupational hazard for slaughterhouse workers, farmers, veterinarians
70
symptoms of Q fever?
- acute onset - severe HA - nonproductive cough - muscle pain - fever
71
tx for Q fever?
doxycycline or erythromycin
72
that bug causes tularemia?
Francisella tularensis
73
characteristics of francisella
- gram (-) coccobacillus - facultative intracellular - fastidious; grows on BCYE
74
how is francisella transmitted? tx?
- ingestion of contaminated water or food or inhalation of aerosolized bacteria --> direct contact w/ infected animals (rabbits) or bites from infected insects - tx = streptomycin

Respiratory Exam II (7 decks)

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