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Pneumonias Flashcards

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1
Q

Most common agents typical pneumonia

A

Strep pneumonia e
H flu
Moraxella
Staph aureus

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2
Q

Most common agents atypical “walking” pneumonia

A

Mycoplasma. Pneumonia e
Legionella
Chlamydophilia pneumonia e
Chlamydia_psittaci

All hard to culture can’ t be seen on gram
Most live in host cells

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3
Q

Most abundant immune cell pneumonia

A

Neutrophils

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4
Q

Aspiration pneumonia typical agents

A

Kleibsella
Anaerobes
Acinetobacter

Alcoholism

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5
Q

Hap most common agents

A

MR sa
Pseudomonas
Acinetobacter
Enterobacterlacaec
Legionella
Burkholderia

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6
Q

Agents with a higher risk in smoking and copd

A

Atypical
Pseudomonas

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7
Q

Legionella risks

A

Travel, hotel, cruises

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8
Q

Staph aureus pneumonia risks

A

Secondary after flu
Structural lung disease

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9
Q

Bird pneumonia

A
  • Chlamydia-psittaci
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10
Q

Rabbit pneumonia

A

Francisella-tularensiis

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11
Q

Sheep /goat pneumonia

A

. Coxiella burnetii

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12
Q

Encapsulated bacteria

A

S pneumonia
H flu

Protects from phagocytosis

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13
Q

Legionella defenses

A

Macrophage infector protein
Type 4 secretion system
Grows inside macrophages

Uses iron

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14
Q

S aureus toxin involved in phenomena

A

Alpha-hemolysi n
- pore forming eytotoxin

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15
Q

Mycoplasma penicillins

A

No-go, they don’t have a cell wall

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16
Q

Chlamydophiliavirulenufactor

A

Type 3 secretion system
Lives in macrophages

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17
Q

Enterococci virulence factor

A

MSR - vanA vancomycin

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18
Q

Outpatient cap Tx

A

. Macrolide- azithromycin
Or doxy

If recent ab x or high risk:
- azithromycin with ceftriaxone
- respiratory fluroquinolone eg. Levo floxacin

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19
Q

Inpatient cap Tx

A
  • azithromycin with ceftriaxone
  • respiratory fluroquinolone eg. Levo floxacin,
    In iv form
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20
Q

Pseudomonas empiric coverage

A

Pip/tazo

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21
Q

MRSA empiric coverage

A

Vancomycin or linezolid

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22
Q

Antigenic- shift

A

Major changes due to reassortment
Usually used for flu to mean new subtype

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23
Q

Antigenic drift

A

Minor changes due to point mutations

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24
Q

Pharyngocongunctival fever

A

Pharyngitis- conjuncevitis- fever
Adenovirus

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25
Adenovirus genome
Ds DNA
26
RSV
Paramyxovirus Ssrna F protein in envelope Fuses neighboring cells together →multinucleated synciftia G protein in envelopes → attachment
27
Palivizumab
Anti-rsv Prophylaxis for at-risk infants eg. Cyanotic heart failure, bronchopulmonary dysplasia Not usually needed for tx
28
Hantavirus
Rural areas, se US Rodents Pulmonary edema dt infection ofendothelial cells in lung Potentially fatal * thrombocytopenia - prolonged pt and ptt
29
Measles signs
Fever first Cough- rinorrhea - conjunctivitis Kopek spots buccal mucosa Macalopapular rash
30
Vzv pneumonia
Ic Typical vzv signs plus prolonged fever i cough N odular lung lesions X-ray
31
CMV pneumonia
Ic Interstitial pneumonia Non-productive cough * Neutropenia (Low) Elevated lfts Mucosal ulcers
32
Flu a/b Tx
Peramivir, zanamimi, oseltamivir All neuraminidase in hibitors
33
Indirect flu A Tx
Amantidine Rimantadine Both nicotinic (and mixed other) agonists
34
RSV t x
Ribavirin (also used for hep c) Palivizumab (mostly prophylactic s
35
VSV Tx
Acyclovir
36
CMV Tx
Ganciclovir, valganciclovir Foscarnet (DNA/RNA polymerase innibitor)
37
Coronaviruses structure
Enveloped Linear ss POS sense RNA
38
COVID entry cell
Type 2 pneumocytes Lack of surfactant worsens sx
39
Histoplasmosis risk
Spelunking Bird/bat droppings Ohio and Mississippi river Ic - systemic Other - mostly asymptomatic, sometimes pneumonia
40
Histoplasmosis microbe
Yeast-oval, resides in mq Small Narrow-based budding Dimorphic
41
Histoplasmosis X-ray
Scattered lung nodules with infiltrates Hilar lymphadenop any Nonspecific
42
Blastomycosis risk
Southeast US Mississippi and Ohio rivers Southern Canada
43
Severe blastomycosis presentation
Flu like first Then: - severe pneumonia - possiblerespiratory failin - warty ulcerated skin granulomas - central scarring,well-defined borders - bone disease Ic
44
Blastomycosis microbe
B dermatitis Dimorphic Thick walled yeast-when-warm Broad based bud
45
Coccidioses risk
Southwest us Mexico, South America San Joaquin valley fever
46
Cocci sx
60% asymptomatic Mild pneumonia with fatigue, ha, joint pain Erythema nodosum or erythema multiforme Severe in ic → meningitis
47
Cocci Micro
Highly resistant air borne spores Spores germinate in thick walled spherules with endospores Very large Dimorphic
48
Aspergillis manifestations
,allergic: - hay fever type I - farmer lung type 3 - allergic bronco pulmonaryaspergillosi3 (abpa) combined 1/3 nonin l vasive, or invasive
49
Aspeogillus risk
Farmers, soil-workers
50
Farmer lung
Aspirgllosis type 3 Hs '" Dysprea, no wheezing Fever, chills, cough, sob Recurring Exposure-related
51
ABpA
Aspergillosiscombined 1/3 Hs Asthma Lung infiltrates Eosinophilia Risk of permanent lung scarring if recurrent
52
Aspergilloma
Noninvasive fungal ball inside preexisting lung cavities Cavities created by tb, sarcoidosis, emphysema,
53
Aspergilloma st
Cough, fatigue Weight loss Hemoptysis Fungal lesions in ear canals, nail beds, and nasal sinuses
54
Invasive aspergillosis
Necrotic abscesses: Lung, brain, liver, kidney, gi Risk: Neutropenia pts CD 4 <100
55
Mucormycosis
Necrotic lesions with black exudate Upper respiratory/sinus Fungal ball Severe: skull invasion Risk: Diabetes
56
Cryptococous risk
Ic ' CD 4 <50 Rarely, dt heavy occupational exposure-farmers
57
Cryptococcus_sx
Pneumonia Meningitis - new severe ha Encephalitis '
58
Cryptococcus micro
India ink Budding yeasts Capsular halo
59
Pneumocystis jiroveci risk
Mostly AIDS pts CD 4 <200
60
PCP sx
Indolent Fatigue Slowly progressive dyspnea → High fever Nonproductive Cough Hypoxemia <70% Ra → Severe ARDS Pulmonary edema Elevated LD H Diffuse bilateral infiltrates with-ground-glass opacities Methylamine silver stain
61
PCP microbe
Fungal and protozoan characteristics Airborne Opportunistic
62
CD 4 cutoffs AIDS associated pneumonia's
PCP <200 Invasive Aspergillus <100 Cryptococcus <50. Mycobacterium avium <50
63
Fungistatic drugs
- conazole
64
Fluconazole
Fungistatic Narrowspectrum 3 c 's: -Candida - crypto,occus -Cocci
65
Itraconazole
Fungistatic Broad-spectrum
66
Voriconazole
Invasive aspergillosis, candidemia In neutropenia or renal insufficiency
67
Amphoterrible
Fungitoxic Severe or disseminated Broad section
68
PCP Tx
Tmp-smx Pentamidine Prophylaxis in CD 4 <200
69
Initial Tb response and immune evasion
C3b complement → mq c4 receptor → ingestion Insufficient destruction b y No Tb prevents fusion of phagosome with lysosome -Block sintracellular Ca - prevent liposome acidification
70
Growth stage tb
7-21 days post infection Tb replicates inside mq Mq rupture → release Tb Infect more mq → gran. With giant multimucleatd cell, surrounding fibrosis Il -12 and _ IFN → fever, weight loss
71
Slow growth phase Tb
21+ days Continued gran formation Ghon focus - cavitory necrotic lesion usually in lower lung I peripheral lung fields creactivation later in apex Hilar lympha. Thickened pleura Fever, weight loss, night sweats, hemoptysis
72
Miliary tb
Systemic, Ic
73
Labs Tb
Anemia High WBC High esr/crp Nonspecific PPD Quantiferon Gold test- IFN release by T cells in response to mycobacteria
74
Tb Tx
Rifampin Isoniazid Pyrazinamide Ethambutol
75
Mycobacterium avium
CD4 < 50 Similar to Tb Tx macrolide
76
Pulmonary absuss risk
Aspiration Most often right lung
77
Pseudomonas gross sputum characteristics
Blue -green pigment Fruity odor
78
Staph aureus gross sputum
Yellow pigment Compare actinomyas Israelis which has yellow granules
79
Nocordia Micro
Aerobic Weaklyacid fast Branching filaments
80
Empiric for lung abscess
Meropenem
81
Nocardia Tx
Sulfonamides eg tmp-smx
82
Pulmonary abscess X-ray
Air- fluid levels
83
Sarcoidosis risk fx
Building supply Construction Metalwork Firefighter
84
Sarcoidosis histology
Non-caseating granul Oma.
85
Sarcoidosis sx
* Any system Common: -Lung-cough, sob, chest pain - eyes - skin-acne-like lumps Constitutional -Malaise - fever - weight loss Young adults >20
86
Sarcoidosis path
Th 1 CD 4 - ifn-g → mq - ace - diagnostic - tnf-a → maintains gran.
87
Schaumann bodies
Calcium and protein inside giant cells inside granolas Sarcoidosis
88
Sarcoidosis pft
Interstitial Restrictive Decreased tl c Normal to high_fev1/ fvc
89
Sarcoidosis xray
Hilar adenopathy Reticular opacities
90
Sarcoidosis Tx
Oral steroids
91
Dvt Tx
Heparin Then warfarin or new gen anticoag if long term indicated
92
Dvt test
D-dimer P ocus
93
Fat emboli risk
Long bone Frx
94
Pe phys
Low cardi ac output dt low -lv preload Hypoxem s ia Tachypnea. - Dead space
95
Pe sx
Sob i Pleuritic cp(inspiration) Palpitations Cough Fever Dvt sx Sometimes hemoptysis End organ hypoperfusion if unstable - impaired rv emptying
96
Pe EKG
Sinus tach Rv strain Right bundle branch block dt dilation Nonspecific_St and T changes
97
Pe Tx
Heparin Xa inhibitors

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