PULM: RTIs - Airway Disease Flashcards
(50 cards)
1
Q
what are the three croup diseases
A
Acute laryngitis
Laryngotracheobronchitis (viral croup)
Epiglottitis (bacterial croup)
2
Q
viral croup
- most common etiologic agent?
- presentation?
- complications?
A
- agent - parainfluenza type I
- presentation
- mild/severe
- barking cough
- inspiratory stridor - @ night
- severe croup
- inspiratory stridor at rest
- suprasternal/intercostal retractions
- tachypenea, tachycardia
- cynaosis
- mild/severe
- complications
- bacterial superinfection
- tracheal damage/lluinal narrowing
3
Q
what bacteria are likely to cause a superinfection following viral croup?
A
- s. aureus, s. pneuononia, h. influenza, m. catarrhalis
4
Q
epiglottis?
- etiologic agent
- presentation
- complications
A
- agents:
- H. influenza (m/c), S**. pyogenes
- presentation:
- SEVERE/RAPID sore throat
- 4Ds: dysphasgia, dysphonia, drooling, distress
- high fever
- complications:
- septic artthritis/ meningitis / osteomyelitis
5
Q
how to differentiate viral croup from epiglottitis?
A
- viral croup
- improvement with water saturated air (shower steam)
- radiography - positive steeple sign
- epiglottitis
- NO improvement with water saturated air (shower steam)
- radiography - positive thumb sign
- presentation - higher fever than viral croup + 4Ds
6
Q
what is this radiograph showing?
A
steeple sign - viral croup (parainfluenza)
7
Q
what is this radiograph showing?
A
thumb sign - epiglottitis (H. influenza)
8
Q
treatment / prevention of epiglotitis?
A
prevention - HiB vaccine
treatment - intubation, Ab (rifampin) if not vaccinated
9
Q
what is the most common cause of viral croup?
A
parainfluenza
10
Q
acute bronchitis
- etiologic agent
- predisposing factors
- presentation
- diagnosis
A
- agent - virus m/c
- predisposing factors: always follow a URI
- common in IgG deficiencies, respiratory dz (ex: emphysema)
- presentation: non-productive cough that becomes purulent
- dx - radiograph key: CXR negative for filtrates / consildations
11
Q
how to differentiate between acute bronchitis and pneumonia?
A
get chest X-ray to look for infiltrates.
negative CXR = bronchitis
12
Q
bronchiolitis
- etiologic agent
- predisposing factors
- presentation
- diagnosis
A
- agent - viral (RSV)
- predisposing factors - children < 1 yr in age
- esp if bottle feeding or premature
- presentation
- cough/dyspnea
- wheezing/crackles
- nasal flaring
- diagnosis:
- radiography- focal atelectasis / peribronchial cuffing
- nasal washings - show RSV
13
Q
discuss the different strains and virulence factors of influenza and their importance.
A
influenza A & B - viral RNA.
influenza A - also segmented.
viral, segmented
- drift: mutation in the viral RNA amino acids that changes the H antigen- A & B
- shift: rearrangment of the H and N proteins - A only
14
Q
pneumonia is an infection of what part of the respiratory tract?
A
lower respiratory tract
15
Q
what are the two types of pneumonia and how to differentiate them?
A
typical (lobar pneumonia)
- fluid accumulating within alveolar sacs
atypical (interstitial) pneumonia
- fluid accumulating in between the cells (in the walls of alveoli/bronchi)
- this causes walls thickening –> “cow-webbing” on CXR
- “walking: pneumonia
16
Q
therapy for influezna?
A
influezna A: “- antadine”
influenza A & B:
- neuraminidase inhibitors
- viral cap dependent endonuclease protein inihibitors
17
Q
whooping cough
- etioligic agent & its virulence factors
- diagnosis
- prevention
A
- agent - bordatella pertussis
- hemagluttinin: attachment to ciliated epithelium
- cytotoxin/pertussis toxin: kill tracheal ciliated epitheium
- cytotoxin also inc IL-1 –> fever
- dx
- whoop from inspiratory stridor - pathognomonic
- lymphocytosis
- prevention:
- DtAP vaccine
18
Q
most common means of aquiring pneumonia
A
- inhalation
- aspiration
19
Q
typical pneumonia
- presentation
- etiologic agents
A
two types - hospital aquired & community aquired
- agents:
- community aquired:
- s. pneumonia (m/c)
- h. influenza, klebsiella
- hospital aquired:
- s. aureus & gram - rods
- community aquired:
- presentation (for both types)
- PRODUCTIVE cough –> purulent sputum
- consolidations in CXR
- HIGH fever
- pt looks toxic
20
Q
atypical pneumonia
- etiologic agents
- presentation
A
= intersitial pneumonia
- agents:
- mycoplasma pneumonia (m/c), SARS-Cov-2
- l_egionella, chlaydophilia_ phenomina
- presentation:
- NON-PRODUCTIVE, paroxysmal cough
- infiltrates in CXR
- lower fever
- pt looks well
21
Q
aspirational pneumonia
A
- presentation:
- typical pneumonia + recurring chills
-
consolidations in DEPENDENT lung segments
- dependent = lung base when upright, posterior lung with supine
- +/- foul smelling sputum
- etiologies:
- community aquired: oral anaerobes + s. pneumonia
- hospita laquired: oral anaerobes + gram - rods
22
Q
chronic pneumonia
- agents
- presentation
A
- presentation
- weeks-months onset
- night sweats
- productive cough
- +/- coin lesions (Gohn complex) - if agent m. tuberculosis
- etiologies:
- mycobacterium tuberulosis
- fungi - blasomyces, coccidiodies, histoplasma
23
Q
what is shown in this radiograph?
A
- coin lesions (Gohn complex)
- see in aspirational pneumonia OR chronic pneumonia that is due to a mycobacterium tuberulosis infection
24
Q
most common cause of pneumonia in child < 1 month?
A
= neonate
- e. coli, s. agalactae
25
what is a common etiology of pneumonia common in alcohol abusers?
list the characteristics of this agent
*klebsiella pnuemonia*
* gram - rod
* fermenting (pink maconkey agar)
* urease +
* citrase +
26
common etiological cause pneumonia in military recruits & college students?
what are the characteristics of this agent
*neisseria meningitis*
* gram - diplococci
* oxidase positive
* grows on chocolate agar
* virulence factors
* protective capsule - prevents phagocytosis
* pili - promote nasopharyngeal coloniziation
* IgA protease - promotes adherence
* LOS - proinflammatory
27
list pneumonia agents in weird circumstances: bird fanciers, farmes
birder fanciers = chlamydophilia psittaci
farmers = coxiella burnetti
28
categories pneumonia agents based on onset
* acute - standard?
* subacute onset = atypical pneummonias
* ***mycoplasma pneumonia***
* *chlamydia pneumonia*
* *legionella pnuemnoia*
* chronic onset
* ***m. tuberculosis***
* **fungi**
29
psueodomonas is the a common cause of pneumonia in what patient populations?
* mechanical respirators (_ventilators_)
* malnourished
* bronchiectasis
* drugs - steroids, broad spectrum abx
30
cause of pneumonia in bird fanciers?
chlamhydophilia psittaci
31
common locations of
histoplasma
coccidioides
blasotomycoses
histoplasma: ohio/mississipi river valleys
coccidioides - southwest: san jaoquin valley / south central arizona / rio grande valley
32
cause of pneumonia in farmers during birthing season?
coxiella burnetti
\*Q fever
33
what clinical manifestations point to _Covid-19_ pneumonia?
* higher fever
* loss of _taste/smell_
* lymphoPENIA
* labs: **lactate dehydrogenase & ferritin**
34
identify disease
rough skin lesions
_blastomyocis pneumonia_
35
this CXR showing is showing
* what feature?
* due to what agent?
* bulging fissure
* *klebsiella pneumonia*
36
**think staph aureus** (_often in children_)
37
this CXR has
* what distinguishing feature?
* points to what likely etiologic agents?
* lung abscess
* *s. aureus, psuedomonas, anaerobes, gram - bacilli*
38
the CXR is showing
* what distinguishing feature?
* points to infection by what etiologic agent?
* lung abcess
* s. aureus, p. areuginosa, anaerobes, gram - bacilli
39
what agent is shown?
what are its pertinent characteristics?
histoplasma - monomorphic, narrow based buds
found in soil of ohio / missippi river valleys
40
what is the etiologic agent and its pertinent features?
blastomycoses - pleomorphic, broad based bud
found in soil of southeastern & ohio / missippi river valleys
41
identify
note importan t features
coccidioides
at body temp **- spherules:** thick walled spheres containing endospores
at room temp - **arthcoconidia**
found in southwestern US, mexico, central & south america
42
* what etiological agents are associated with the following sputum appearances
* purulent
* mucoid
* rust colored
* green color
* thick currant / jelly like
* hemoptysis
* foul smelling
* purulent & mucoid - typical
* rust colored - s. pneumonia
* green color - psuedomonas or h. influenza
* thick currant / jelly like - klebsiella
* hemoptysis - cavitary TB or lung abcess
* foul smelling - anaerobes
43
what microbes are we testing for with the following stains?
* silver stain?
* acid fast stain?
* gomori methamine silver stain (GMS)?
* silver stain - legionella
* acid fast stain - mycobacterium tuberulosis
* gomori methamine silver stain (GMS)
* fungi (histo, blastomycosis, pneumocystis)
* pneumocystis
44
identify agent
note characteristics
strep pneumo
gram + lancet shaped diplococcus
45
identify cause
staph aureus
46
identify
explain
e. coli
e. coli & s. agalactae m/c causes of pneumonia in chidlren \< 1 year old.
* it is pink (gram -), thus is e. coli
* s. agalactae would be purple (gram +)
47
other than pneumonia, what disease are e. coli & s. agalactae likely to cause in children
meningitis
48
* NAAT positive
* stacatto cough
chlamhydia
49
what is the agent?
**"fried egg" appearance** on **eatons agar**
## Footnote
*mycoplasma pneumonia*
50
what agent?
what stain?
*pneumocysois jiroveci*
high in immunocompromised host
GMS stain
