Upper Resp Tract Infection

Question 1

Prevalence of pneumonia in community

Answer 1

• Pneumonia + influenza is the 6th leading cause of death
• Leading infectious cause
• Mortality rate hasn’t changed since the invention of penicillin

Question 2

Predisposing factors to Pneumonia

Answer 2

• Old age
• Pulm dz.
• Smoking
• Recent viral illness
• Diabetes
• Chronic Renal dz
• Immunodeficiency

Question 3

Signs and symptoms of pneumonia

Answer 3

• cough, sputum, fever, SOB
• signs of consolidation and elevated WBC
• Elderly may present without a lot of symptoms [only change in mental status]

Question 4

Diagnostic testing for Community acquired Pneumonia

Answer 4

• CXR
• Sample possible pleural effusion
• Rapid flu test (during flu season)
• Yield low on Blood and sputum cultures (gram stain)

Question 5

Most common etiologic agents of pneumonia

Answer 5

• Streptococcus pneumoniae
• H influenza
• Moraxella catarrhalis
• Staph aureus
• –No organism found in 30 - 50%

Question 6

Symptoms caused by Strep pneumoniae

Answer 6

• Fever, shaking chills, rusty sputum, SOB, pleuritic chest pain
• Most common cause of CAP

Question 7

Characteristics of Atypical pneumonia

Answer 7

• subacute onset of symptoms
• prodrome
• milder symptoms [walking pneumonia]
• negative gram stain

Question 8

Most common etiological agents of atypical pneumonia

Answer 8

• Mycoplasma
• Chlamydia
• Legionella
• Viruses

Question 9

Symptoms of Legionella pneumophila

Answer 9

• Pontiac fever
• Headache
• myalgias
• fatigue
• Cough
• Sputum
• Possible to progress to multi-organ system failure

Question 10

How do you acquire Legionella disease?

Answer 10

• Infection with inhalation or drinking contaminated water

- The organism flourishes in artificial aquatic environments

Question 11

How do you diagnose Legionella pneumophila?

Answer 11

-urinary legionella antigen

Question 12

Most common viruses to cause viral infections

Answer 12

• Influenza
• RSV
• adenovirus
• parainfluenza

Question 13

Typical symptoms of influenza

Answer 13

• fever
• cough
• headache
• sore throat
• myalgias

Question 14

Diagnosis and management of influenza

Answer 14

• In flu season, test, isolate and start therapy if within 48 hours of start of symptoms
• Therapy: Oseltamivir or zanamivir

Question 15

CAP symptoms in pediatrics

Answer 15

• Tachypnea
• fever
• cough
• dyspnea

Question 16

Causes of CAP in children under 2 years of age

Answer 16

• RSV

- Rhinovirus

Question 17

Causes of CAP in children between 5 to 10 years of age

Answer 17

Mycoplasma

Question 18

Causes of CAP in children between 10 to 16 years of age

Answer 18

• Strep pneumonia

- Chlamydophila

Question 19

Therapy of CAP for Outpatient

Answer 19

• Macrolide or doxycycline

- Respiratory fluoroquinolone [co-morbid illness or recent antibiotics]

Question 20

Therapy for CAP for Inpatient, non-ICU or ICU

Answer 20

• Respiratory fluoroquinolone

- beta lactam plus macrolide

Question 21

Therapy for CAP if pseudomas is a concern

Answer 21

• Anti-pseudomonal beta lactam plus respiratory fluoroquinolone
• Anti pseudomonal beta lactam plus macrolide plus aminoglycoside

Question 22

Duration and specificity of therapy

Answer 22

• Narrow coverage when pathogen is identified
• Switch from IV to oral meds (when improving have functioning GI tract)
• Duration of 5 days (longer if patient is sick or initial empiric was wrong)

Question 23

Diagnostic criteria for Hospital acquired pneumonia

Answer 23

• Fever
• new infiltrate
• leukocytosis
• change in sputum [not helpful]

Question 24

Etiological agents of Hospital acquired pneumonia

Answer 24

• Klebsiella
• E. coli
• Enterobacter
• Proteus
• Serratia
• Pseudomonas
• Acinetobacter

Question 25

Risk factors for Multi drug resistant Hospital acquired pneumonia

Answer 25

- Antibiotics within 90 days - Inpatient for more than 5 days - Residence in Nursing Home - Dialysis - Immunosuppression

Question 26

Therapy for Hospital acquired Pneumonia

Answer 26

- Early, broad empiric therapy - Narrow guided by culture results - --Anti - pseudomonas cephalosporin or carbapenem - --beta lactam/beta lactamase - --Vancomycin (if worried about MRSA)

Question 27

Characteristics of pneumonia

Answer 27

- subacute onset of symptoms (typically over 6 weeks) - caused by slow growing organisms - difficult to differentiate from recurrent pneumonia

Question 28

Etiologic agents for Chronic pneumonia

Answer 28

- Mycobacterium (TB or atypical) - Nocardia - Actinomyces - Endemic fungi - Coxiella - Tularemia - Anatomic problem

Question 29

Pathology of lung abscess

Answer 29

-Infection leads to tissue destruction and necrosis, suppuration, and cavitation

Question 30

Common organisms in lung abscesses include:

Answer 30

- anaerobic mouth organisms [bacteroides, fusobacterium, peptostreptococcus] - aerobic and anaerobic streptococcus - GNRs - Aspiration, post-pneumonic, septic emboli

Question 31

What is empyema?

Answer 31

- when pneumonia patients have pleural effusions [most are parapneumonic exudates] - If infection spreads into pleural space then it is called empyema - Needs to be drained, antibiotics alone will not work

Question 32

Immunocompromised states that pneumonia exploits

Answer 32

- Neutrolphil dysfunction - T cell dysfunction or deficiency - B cell dysfunction or deficiency

Question 33

Causes of neutrophil dysfunction

Answer 33

Chemotherapy, leukemia, chronic granulomatous disease

Question 34

Causes of T cell dysfunction or deficiency

Answer 34

- AIDS, T cell lymphoma, Transplant, DiGeorge syndrome - CMV pneumonia is a generalized infection - CMV diagnosis with pathology, IF, and PCR on blood - CMV therapy is ganciclovir or valganciclovir

Question 35

Causes of B cell dysfunction or deficiency

Answer 35

Splenectomy, chronic lymphocytic lymphoma, Non hodgkin's lymphoma, myeloma, gamma globulin deficiencies