Microbiology Exam 3 > L23-30 > Flashcards

L23-30 Flashcards

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1
Q

pulmonary edema

A

is either cardiogenic or non-cardiogenic

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2
Q

pulmonary embolism

A

should be suspected if pt has new or worsening dyspnea, chest pain, sustained hypotension, w/o alternative obvious cause

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3
Q

Pneumonitis

A

inflammation of lung parenchyma due to chemical exposure, infectious agent, allergic response, or autoimmune disease

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4
Q

Aspiration pneumonitis

A

inhalation of vomitus due to marked disturbance in consciousness

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5
Q

Pneumonia

A

inflammatory response of the lung due to infection, associated with specific lung sounds and x-ray findings, may result in respiratory compromise

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6
Q

ARDS

A

a condition involving acute onset, impaired oxygenation with the PaO2/FiO2 ratio < 200, bilateral pulmonary infiltrates on CXR and pulmonary artery occlusion pressure of <18mmHg, no evidence of legated left arterial pressure

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7
Q

ALI

A

same as ARDS but PaO2/FiO2 ratio < 300

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8
Q

CAP incidence

A

5M cases/yr in US

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9
Q

CAP is the _______ leading cause of death in the US

A

6th

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10
Q

elderly CAP patient has __________________ after being discharged

A

significant functional decline in daily living; even up to 6mo post-discharge

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11
Q

_____% of hospitalized CAP patients released from hospital die within 1 year; _______% of elderly

A

25% ; 33% of elderly

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12
Q

Aspiration

A

common mechanisms for organisms to get in lung; compromise of natural defenses of tracheobronchial tee allows pt’s saliva + oropharyngeal organism to reach alveoli

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13
Q

Common agents that reach the lung via aspiration

A

streptococcus pneumoniae, klebsiella pneumoniae, oral anaerobes

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14
Q

Most common cause of CAP and HAP?

A

aspiration of streptococcus pneumoniae, klebsiella pneumoniae, oral anaerobes

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15
Q

Inhalation of aerosols

A

common mechanisms for organisms to get in lung; organisms from another person or an environmental source are inhaled

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16
Q

Common aerosol agents

A

M. tuberculosis, virus, mycoplasma pneumoniae, chlamydia pneumoniae, fungi (environment), legionella (environment)

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17
Q

Hematogenous Dissemination

A

Spread from a contiguous site or from another site via the blood i.e. staphylococcus aureus

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18
Q

3 categories of pneumonia

A

CAP, HAP, HCAP (health-care-associated)

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19
Q

___% of CAP is treated outpatient

A

80%

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20
Q

Major reason for transfer of patient from nursing home to hospital

A

pneumonia

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21
Q

Lobar/consolidation pneumonia most likely etiological agents

A

extracellular bacteria or fungal agent

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22
Q

Host-compromised pneumonia most likely etiological agents

A

certain bacterial strains

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23
Q

Atypical (interstitial) pneumonia (close populations) most likely etiological agents

A

Mycoplasma, chlamydia, viral, ureaplasma, legionella, pneumocystis

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24
Q

Chronic pneumonia nodules or abscess/cavitations most likely etiological agents

A

Anaerobes, M. tuberculosis, fungi, Nocardiae, actinomycosis

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25
Lobar/Consolidation/Typical pneumonia general mechanism
extracellular agent colonizes alveolar sac lining surface, results in serous fluid collection, RBC's -> rapid multiplication of agent with subsequent infiltration by WBCs displacing air form sac-> white out on CXR
26
CBC for Lobar/Consolidation/Typical pneumonia
predominantly PMN infiltrate, peripheral leukocytosis (elevated WBC with band forms/left-shift)
27
Interstitial, Atypical, Patchy pneumonia general mechanism
agent replicates in interstitium or lung parenchyma -> inflammation of site -> "lacy" appearance on CXR
28
CBC for Interstitial pneumonia
Predominant monocyte-macrophage infiltrate (due to INTRAcellular pathogen and virus), peripheral blood leukocyte count remains normal or only slightly elevated
29
Chronic pneumonia (2-3w -> months) labs (CXR, CBC)
CXR: pulmonary nodules (coin-like), abscess, or consolidation; nodule or consolidation: macrophage infiltrates, abscess: PMN elevation
30
CAP is caused by
aspiration of endogenous flora or inhalation of certain etiologic agents
31
CAP predisposing factors
defective in immune system, impaired respiratory or cardiac function, closed population, increased risk of aspiration
32
Increased risk of aspiration
loss of ciliated mucous escalator or impaired gag reflex due to: antecedent viral infection, drug abuse, deep sleep, cigarette smoker, neuro problems (stroke, coma, seizure)
33
HAP in compromised host is caused by
aspiration of endogenous flora or bacteremia that seeds lung
34
HAP in compromised host predisposing factors
duration of hospital stay (GPR -> GNR), neuro problems (increased aspiration risk), bacteremia that seeds lung (burn patients)
35
HAP iatrogenic is caused by
aspiration of endogenous flora or bacteremia that seeds lung
36
HAP iatrogenic predisposing factors
anesthesia or narcotic use (increased risk of aspiration), catheterization (bacteremia), use of hospital equipment (ventilator), Abx therapy/chemotherapy
37
VAP etiologic agents
S. aureus, S. pneumoniae, H. influenzae, P. aeruginosa, Acinetobacter, enteric bacteria
38
VAP has highest ___________ of any pneumonia
mortality rate
39
VAP mechanism
secretions around endotracheal tube, can occur within 2 days of ventilator
40
HCAP (health-care associated pneumonia) are CAP patients with at least 1/5 of the following
hospitalized for >48hr < 3 mo ago Lived in nursing home < 3 mo ago Received outpatient infusion therapy < 1 mo ago Family member with known MDR-pathogen
41
HCAP patients are treated like
HAP patients
42
CAP likely etiologic agents
s. pneumoniae, mycoplasma, chlamydia, virus, s. aureus, klebsiella, haemophilus influenzae, legionella
43
HAP or HCAP likely etiologic agents
Klebsiella, s. aureus, pseudomonas aeruginosa, acinetobacter, legionella, s. pneumoniae
44
Manifestations of Acute bacterial pneumonia (typical lobar pneumonia)
sudden onset, rapid progression of fever, chills, productive cough, chest pains, lobar presentation, tachycardia, tachypnea, leukocytosis (PMN - EC)
45
Manifestations of Atypical pneumonia
subacute onset, interstitial involvement on CXR, MINIMAL productive cough, fever, chest pain, or leukocytosis
46
Walking pneumonia
atypical pneumonia - mycoplasma
47
Manifestations of chronic pneumonia
subacute onset (weeks - months), FUO
48
Pediatric population and neutropenic population vary because they
will have a non-productive cough
49
Geriatric population vary because they
may ONLY complain of muscle weakness, malaise, disorientation, falling
50
Diagnosis may require
CXR, sputum collection, FOB (IC), needle aspiration (anaerobes), pleural fluid, lung biopsy
51
Sputum must be
>25 neutrophils, <10-25 epithelial cells
52
Foul-smelling sputum =
anaerobes
53
Induced sputum is required for
atypical or chronic (non-productive cough)
54
WBC with predominant PMN =
EC bacteria
55
WBC with predominant macrophages =
IC bacteria
56
WBC with predominant lymphocytes =
viral
57
Lack peptidoglycan
Mycoplasma, Ureaplasma
58
Obligate intracellular pathogens
Chlamydia, Chlamydophila, Coxiella, viruses
59
Facultative Intracellular pathogens
MTB and Legionella
60
MRD-MTB
resistant to rifampin and INH
61
XDR-MTB
resistant to isoniazid and rifampin, and at least 3/6 SLDs
62
DRSP
strep. pneumo resistant to penicillin and others
63
MDRS-P
strep. pneumo resistant to 3 or more classes of Abx
64
MRSA
staph. aureus resistant to methicillin
65
VISA
S. aureus resistant to vancomycin
66
CRKP
Klebsiella resistant to ceftazidime
67
CRPA
p. aeruginosa resistant to ceftazidime
68
Reye's Syndrome
Child with infection of influenza virus type B or Chickenpox + aspirin
69
Primary complication of flu
Abx use --> pneumonia
70
Abx prophylaxis for pneumonia
Do not do this - it will do more harm than good
71
3 vaccines to reduce carriage of pneumonal agents
Hib, pertussis, PVR-13 S. pneumoniae
72
Pure polysaccharide vaccines exist for
S. pneumoniae (23-valent) pneumovax
73
Pure polysaccharide vaccines are
type II T-independent
74
Pneumovax vaccine type
type II T-independent -> IgM induction but no class switch, short-lasting immunity
75
Pneumovax recommended age
>2 y/o
76
Vaccines with T-dependent ag that reduce bronchiolitis/LRT/pneumonia
Diphtheria, Hib, pertussis, flu vaccine, Prenevar (S. pneumo PVR7/13 valent), measles, MTB
77
T-dependent ag vaccines are
T-dependent, resulting in class switch for long-term immunity
78
RSV prevention
passive immunization with anti-rev monoclonal antibodies (palivizumab)
79
antiviral for influenzavirus
neuraminidase inhibitor
80
antiviral for RSV
ribavirin
Microbiology Exam 3
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