Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

SFM4 > Respiratory Microbio and Antibiotics > Flashcards

Respiratory Microbio and Antibiotics Flashcards

(58 cards)

Start Studying
1
Q

indications for hospitalization with pneumonia

A
  • hypoxemia r/q O2
  • hemodynamic instability
  • AMS
  • IV abx
  • comorbidities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

strep pneumonia (pneumococcus) usual consolidation pattern

A

lobar (entire lobe of lung)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

staphylococcus usual consolidation pattern

A

bronchopneumonia

multiple small foci centered around bronchioles in >1 lobe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

klebsiella usual consolidation pattern

A

bronchopneumonia

multiple small foci centered around bronchioles in >1 lobe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

typical presentation for bacterial CAP

A
  • rapid onset
  • severe
  • significant infiltrates on CXR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

most common cause of CAP

A

streptococcus pneumoniae

aka pneumococcal pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

strep pneumoniae microscopic appearance

A

paired diplococci
lancet shaped
gram positive
alpha-hemolytic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

common non-pneumococcal causes of “typical” CAP

A

gram –

  • klebsiella pneumoniae (most common gram – pneumonia)
  • H. influenzae
  • Moraxella catarrhalis
  • legionella pneumophilia (severe atypical-typical overlap)

gram +
- s. aureus incl. MRSA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

common causes of “atypical” CAP

A

no gram stain
- mycoplasma pneumoniae (not tb)

gram –

  • chlamydophilia pneumoniae
  • chlamydophilia psittaci (parrot)
  • Coxiella burnetii

viral

  • influenza A & B
  • parainfluenza (children)
  • metapneumovirus
  • adenovirus
  • COVID
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

distinguishing features of strep pneumoniae

A
  • lobar consolidation
  • rust-colored sputum d/t slow bleeding into alveoli
  • quick dissemination in asplenic patients (trauma, sickle cell, other splenectomy)

(usually)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

legionella microscopic appearance

A
  • gram negative bacillus
  • sputum gram stain generally shows many neutrophils and few to no bacteria
  • positive urinary antigen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

distinguishing features of legionella

A
  • lobar pneumonia
  • severe illness
  • high fever
  • diarrhea
  • vomiting
  • bacterium lives in water; hx may indicate exposure to contaminated water

lab findings:

  • hyponatremia
  • hypophosphatemia
  • hematuria
  • proteinuria

risk fx:

  • ^ age
  • s.p. transplant
  • comorbid disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

klebisella microscopic appearance

A

gram negative bacillus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

distinguishing features of klebsiella

A
  • abrupt onset
  • “currant jelly” sputum (sometimes)
  • lobar, bronchopneumonia, and/or lung abscess

risk fx:

  • alcohol use disorder
  • malnourishment
  • debilitation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

mycoplasma pneumoniae microscopic appearance

A

not visible on gram stain as it lacks cell wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

distinguishing features of mycoplasma pneumoniae

A
  • younger age (school-age thru college)
  • atypical
  • – nonproductive cough
  • – “walking pneumonia”
  • – less remarkable physical exam findings
  • – lack of lobar consolidation on CXR
  • non-pulmonary features uncommon, but identifying when seen
  • – erythema nodosum or multiform
  • – meningitis, encephalitis, transverse myelitis, cranial nerve palsies, or cerebellar ataxia
  • – cold agglutinins with hemolysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

distinguishing features of chlamydophilia pneumoniae

A

similar to mycoplasma pneumoniae but with older age

  • atypical
  • – nonproductive cough
  • – “walking pneumonia”
  • – less remarkable physical exam findings
  • – lack of lobar consolidation on CXR
  • non-pulmonary features uncommon, but identifying when seen
  • – erythema nodosum or multiform
  • – meningitis, encephalitis, transverse myelitis, cranial nerve palsies, or cerebellar ataxia
  • – cold agglutinins with hemolysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

distinguishing features of chlamydophilia psittaci

A

get it from a parrot

atypical “walking pneumonia”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

influenza A and B microscopic appearance

A

viral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

distinguishing features of influenza A and B

A
  • viral
  • upper airway
  • – cough
  • – rhinorrhea
  • – sore throat
  • abrupt onset d/t IFN
  • fever
  • myalgia
  • lower airway infection possible on its own but usually due to rebound bacterial pneumonia (usually pneumococcus and s. aureus)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

tx influenza A and B

A

zanamivir or oseltamivir

ideally w/in 48 h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

outpatient tx of uncomplicated CAP

A

amoxicillin ± clavulanate
only covers gram +
strep, staph

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

outpatient tx of CAP w/ comorbidities

A

amoxicillin/clavulanate + azithromycin

    • gram +
    • and moraxella, h. flu

or cefpodoxime + azithromycin

    • broad gram + and gram – coverage
    • no pseudomonas

or respiratory fluoroquinolones (–floxacin)

    • broad gram + and gram –
    • levofloxacin covers pseudomonas
    • moxi does not cover pseudomonas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

azithromycin coverage

Study These Flashcards
A 
gram +
some gram –
- "atypicals"
-- chlamydophilia
-- mycoplasma pneumoniae
-- legionella
25
cefpodoxime coverage
broad gram + and gram – 3rd gen cef "typicals" NO: - pseudomonas - bacteroides - enterococcus
26
ceftriaxone coverage
broad gram + and gram – 3rd gen cef "typicals" NO: - pseudomonas - bacteroides - enterococcus
27
levofloxacin coverage
broad gram + and gram – typicals and atypicals pseudomonas
28
moxifloxacin coverage
broad gram + and gram – typicals and atypicals NO pseudomonas
29
inpatient tx of CAP
- ceftriaxone + azithromycin (preferred) - or other 3rd gen cef + macrolide - or respiratory fluorquinolones (levo or moxi) goal is broad coverage of typicals and atypicals
30
duration of abx with CAP
usually 5 days
31
HAP vs CAP
HAP = hospital-acquired at least 48 h in hospital much more likely to be multi-drug resistant
32
abx pseudomonas
*needed for empiric HAP coverage FIRST LINE 4th gen cef: - cefepime - ceftazidime carbapenem: - imipenem - meropenem piperacillin/tazobactam ADD-ON (severe) some fluoroquinolones: - ciprofloxacin - levofloxacin aminoglycoside: - amikacin - gentamicin - tobramycin
33
MRSA abx inpatient
linezolid | vancomycin
34
duration of abx with HAP
usually 7 days
35
VAP vs HAP
VAP = ventilator acquired subset of HAP very common cause of HAP HAP can often be avoided by using non-invasive (non-intubation) ventilation where possible
36
reducing HAP risk
- non-invasive ventilation where possible - keep bet at 30-45 degrees - oral hygiene
37
chronic vs acute pneumonia, common pathogens
gradual onset, longer duration bacterial: - TB fungal: - coccidioidomycosis - histoplasmosis - blastomycosis
38
CXR primary TB
Ghon complex: tb foci in mid-lung + enlargement of hilar lymph nodes = foci near hilum
39
CXR secondary TB
secondary TB = reactivation of latent TB - fibro-caseating lesions - -- fibrosis + caseating granulomas - apex of lung d/t high V/Q ratio
40
potential outcomes of primary TB
- complete immune clearance - pulmonary containment (--> latency) - extra-pulmonary containment (--> latency) - in i.c. pts - - progressive primary TB - - miliary (systemic) TB
41
dx latent TB
+PPD or IGRA (IFNg release assay) --- only works in immunocompetent pts AND CXR not suggestive of active infection
42
dx active TB
sx: - cough w/ hemoptysis - fever - night sweats - weight loss - exposure hx risk factors - endemic country - jails - homeless shelters dx and labs: - CXR or chest CT - PCR - AFB (acid-fast bacilli) stain - sputum cultures - uncommon: biopsy + special AFB stain w/ caseating granulomas
43
tx latent TB
classic (and cheap): - isoniazid x 9 mo newer ($$): - rifampin x 4 mo - isoniazid + rifampin or rifapentine x 3 mo
44
tx active TB
RIPE x ≥6 mo - rifampin - isoniazid - pyrazinamide - ethambutol
45
fluconazole
anti-fungal | long term tx for cocci
46
histoplasmosis epidemiology
Mississippi and Ohio river | bird and bat droppings, or soil containing bird and bat droppings
47
sx histoplasmosis
often asymptomatic possible: - nodular infiltrates - erythema nodosum - pancytopenia d/t bone marrow involvement - splenomegaly
48
dx histoplasmosis
- granulomatous pneumonia - calcified lesions in lungs, mediastinum, spleen, liver - urine and serum antigen tests
49
tx histoplasmosis
mild - spontaneous moderate - itraconzole po severe - amphoterrible iv
50
itraconzole
anti-fungal | po tx for moderate histoplasmosis or blastomyces
51
blastomyces epidemiology
midwest and east coast
52
sx blastomyces
- abrupt - productive cough - fever - upper lung CXR - acute --> chronic - skin lesions
53
dx blastomyces
- fungal culture - broad based budding on tissue biopsy - epithelial hyperplasia (may be mistaken for lung cancer) - neutrophil recruitment
54
tx blastomyces
mild - spontaneous moderate - itraconzole po severe - amphoterrible iv
55
cocci epidemiology
southwestern and far western US San Joaquin valley inhaled spores from soil disruption earthquake, major construction
56
sx cocci
- varied - fevers (of unknown origin as it is often an initial presenting sx) - cough - pleuritic chest pain - erythema nodosum on shins - abx resistant pneumonia - lung, skin, bone, meningeal involvement if disseminated
57
dx cocci
- spherule w/ endospores on tissue stain (big circles filled with little circles) - granulomas - pneumonia on CXR
58
tx cocci
long course of fluconazole

SFM4 (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions