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Infection and Immunology > Pulmonary > Flashcards

Pulmonary Flashcards

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1
Q

morbidity vs mortality

A

illness vs. death

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2
Q

CAP

A

community acquired pneumonia–significant morbidity and mortality

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3
Q

For Cap–predisposing factors:
Drug use:
Lifestyle:

A
  • H2 blockers, antipsychotic, ACE inhibitor, glucocorticoid

- male, older, tobacco, alcohol, acidosis, malnutrition, COPD

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4
Q

Typical vs atypical pneumonia

A

TYPICAL: pneumonia caused by certain bac and typically causes CHILLS, COUGH, FEVER, and SOB short of breath
ATYPICAL: pneumonia caused by certain bacteria. Called “atypical” because the symptoms differ from those of pneumonia due to other common bacteria

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5
Q

Typical CAP bugs:

A

S. pneumoniae, H. influenzae, S. aureus, group A streptococci, Moraxella catarrhalis, anaerobes, and aerobic gram-negative bacteria

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6
Q

Atypical CAP bugs:

A

Legionella spp, M. pneumoniae, Chlamydophila pneumoniae, and C. psittaci

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7
Q

If pt is elderly w/ underlying pulmonary disease (COPD, cystic Fibrosis) pathogen is likely

A

Hemophilus influenza

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8
Q

Hemophilus influenza characteristics

A
  • pleomorphic
  • Gram- rods
  • oxidase positive
  • facultatively anaerobic
  • nonmotile
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9
Q

Hemophilus influenza treatments

A
  • Beta-lactam agents (amoxicillin)

- Azithromycin

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10
Q

Pt is <40 yo spends much time in close quarters –pathogen is likely

A

Mycoplasma pneumonia–respiratory droplets

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11
Q

Mycoplasma pneumonia characteristics

A
  • smallest organism that can survive alone in nature
  • aerobic/anaerobic
  • “gliding motility”
  • produce biofilms
  • surface parasite–> may move inside cell and reproduce
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12
Q

S&S of Mycoplasma pneumonia

A
  • Gradual Onset-
  • headache
  • malaise
  • low grade fever
  • non-productive cough
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13
Q

Mycoplasma pneumonia treatment

A
  • MACROLIDS
  • (azithromycin, doxycycline)
  • respiratory fluoroquinolone
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14
Q

Pt is middle-aged or ^–been travely recently (w/ in 2 weeks), or exposed to air conditioning or mist0environments. Likely pathogen is…

A

Legionella spp.

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15
Q

Legionella spp. characteristics + S&S

A
  • Gram - bacilli
  • grows on special media
  • 2-10 days before onset of symptoms
  • S&S: usual symptoms, ^ fever, and GI symptoms
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16
Q

Legionella spp treatments and dx

A
  • Macrolides (esp. azithromycin) or
  • Respiratory Fluoroquinolones (esp. levofloxazin)
  • dx w/ sputum or urinary antigen test
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17
Q

Pt is MILDLY ILL, not necessarly in winter, and lives in CLOSE ENVIRONMENT (care facilities, barracks) mostly likely…

A

Chlamydis (Chlamydophila) pneumoniae PTP

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18
Q

Most common infections associated w/ Chlamydia pneumoniae

A

Pneumonia and Bronchitis

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19
Q

Chlamydia pneumoniae characteristics

A
  • Obligate intracellular bacteria
  • 2nd smallest prokaryote
  • No peptidoglycan in cell wall
  • replication intracellularly after ingestion by phagosome
  • short lived immunity
  • very unusual reproductive pattern (slide 26)
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20
Q

Chlamydia pneumoniae S&S

A
  • usual
  • pharyngitis
  • hoarseness
  • airway hyperreactivity
  • wheezing
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21
Q

Chlamydia pneumoniae treatment

A

-azithromycin

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22
Q
  • If pt is not “special group” not severly sick, and possibly becoming sick in winter or early spring. Pathogen is likely…
A

Streptococcus pneumoniae–most common pathogen for CAP worldwide

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23
Q

Streptococcus pneumoniae characteristics

A
  • gram-positive
  • alpha hemolytic bac
  • catalase - unlike other pyogenic orgs
  • capsular polysaccaride provokes immune response and is anti-phagocytic
  • adheres to epithelial cells of nasopharynx
  • “forms bridges” btwn body sites
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24
Q

Streptococcus pneumoniae secretes ______ _______, which…

A

potent cytotoxin (pneumolysin)–binds to cholesterol forming pores in membranes and kills any cell.

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25
Gram-neg bacillie -- uncommon in pneumonia but...
1. Klebsiella pneumoniae 2. E coli 3. Enterobacter spp 4. Serratia spp 5. Proteus spp 6. Pseudomonas aeruginosa 7. Acinetobacter spp
26
hospital acquried
nosocomial
27
Klebsiella pneumoniae characteristics
- Nosocomial, but CAP in alcoholics, diabetics, or COPD - New pulmonary infiltrate w/ fever, cough, ^ sputum, WBC crackles - short, plum bacilli - Gram neg
28
Klebsiella pneumoniae dx
- X-ray--lobar pneumonia like S. pneumoniae | - "currant jelly" sputum (lung necrosis)
29
Klebsiella pneumoniae treatment
based on culture and sensitivity testing by lab
30
VIRAL: | Virus likely to cause pneumonia secondary to bacterial URI or pulmonary infection
influenza
31
Acute viral pneumonia--all ages. Winter. hand-hand transfer. "Apnea in infants"
Respiratory syncytial virus RSV
32
Mild viral URI--S&S fever, rhinorrhea, cough, sore throat
parainfluenza
33
viral pneumonia increased peribronchial markings, patchy alveolar
adenovirus
34
SARS
severe acute respiratory syndrome
35
Fungal pneumonia
unusual but some 1. Cryptococcus 2. hystoplasma 3. coccidoides
36
avian influenza aka
Hantavirus | Varicella
37
higher risk of pneumonia complications
1. persons w/ chronic pulmonary, cardio, renal, hepatic disorder 2. children 65 yo
38
N/V/D
nausea, vomiting, diarrhea
39
pneumonia physical exam (5)
1. 80% febrile (pos. not older pts) 2. possible tachypnea and tachycardia 3. crackles (rales) 4. bronchial breath sounds 5. dullness to percussion if consolidation is present
40
on X-ray -- looks like hole in lung
cavitation
41
If CAP pt is hospitalized order
1. blood culture 2. sputum gram stain 3. sputum culture
42
Imp for CAP treatment
What drug do I suspect--and backup plan.
43
Factors to not use Macrolide for CAP
1. recent antibiotic use 2. comorbitities COPD Liver disease Cancer
44
Macrolides _______ _____ ______ in Strep pneumoniae
block protein assemply
45
Acute bronchitis S&S
1. peristent cough -- lasting 10-20 days 2. possible mucus 3. wheezing 4. low fever 5. chest tightness 6. pain
46
Bronchitis Xray
usually non-specific--important to distinguish from pneumonia
47
Acute bronchitis PE
1. dullness ot percussion 2. decreased breath sounds 3. rales 4 bronchophony
48
for test in regards to bronchitis and pneumonia
know difference--anyone can get bronchitis (higher likelihood in COPD pts)
49
Bronchitis treatment
1. symptomatic care 2. treat cough-- anti tussive 3. humidifier 4. steroids to reduce inflammation
50
Bronchitis etiology
Chlamydiophila pneumoniae--Obligate intracellular parasite
51
UR symptoms followed by LRI w/ inflammation resulting in wheezing or crackles in children <2 yo--often after viral infection
Bronchiolitis
52
Bronchiolitis S&S
- increased respiratory effort- 1. nasal flaring 2. tachypnea 3. hypoxemia 4. accessory muscle use 5. grunting
53
whooping cough aka and characteristics
Bordatella pertussis- - <2 yo - PTP - temp immunity
54
Whooping cough stages (3)
1. Catarrhal stage (2 weeks) 2. Paroxysmal stage--burst of rapid cough followed by deep high pitched inspiration (WHOOP) 3. Convalescent stage (4 weeks)
55
Pertussis treatement
1. Macrolide | 2. Trimethoprim-sulfamethoxazole
56
TB Xray
PA and Later Chest
57
TB treatment
1. 6-9 month med regimen (low compliance)
58
FUNGAL lung infection from bat and bird droppings
Histoplasmosis--aerosolization from disturbed soil
59
Histoplasmosis treatment
1. Itraconazole | 2. IV Amphotericin when illness severe (deadly treatment)
60
Influenza-like symptom fungal infection
Coccidiodomycosis

Infection and Immunology (17 decks)

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