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83 Cards in this Set

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Pneumonia: Def
acute infection of lung parenchyma incl. alveolar spaces and interstitial tissue.
Common Bacterial PNA causes
S. pneumoniae
H. influenzae
K. pneumoniae
Uncommon Bacterial PNA causes
S. aureus
P. aeruginosa
N. meningitis
Acquiring Bacterial PNA
Bronchogenic spread of the path.
Incidence increases w/ age.
Above 50, who have an underlying COPD, CV dz, or other chronic dz
S. pneumoniae etiology
Affects children and adults. A leading cause of illness in young children. Illness and death for elderly w/ underlying med conditions
S. pneumoniae organism attacks how?
Colonizes the upper resp. tract
What 3 things can S. pneumoniae cause?
Disseminated invasive infections
PNA and other lower resp tract infections.
URI, incl. otitis media, and sinusitis
S. pneumoniae is associated with what?
Pneumococcal bacteremia 60-87%
Severe infections result from bacteria into bloodstream and CNS. Get blood cultures!!!
H. influenzae and K. pneumoniae are more commonly seen in?
COPD, ETOH abusers, elderly
H. influenzae PNA infection causes?
Pleural effusions (common)
Bacteremia, other infections: Otitis, sinusitis, Meningitis, epiglottitis, facial infection.
K. pneumoniae PNA population
ETOH abusers, COPD, Neonates nosocomial
K. pneumoniae PNA infection causes?
Large gram neg rod w/ capsule
"Currant Jelly" sputum
Bulging fissure
Lung necrosis
S. aureus PNA lab results
Gram positive cocci in clusters
S. aureus PNA population?
IVDA, elderly, recent influenza virus infection, CF
S. aureus PNA S/Sx
pleuritic CP, asssociates w/mult.thin walled abscesses: pneumatoceles. cardiac murmurs.
S. aureus PNA other infections:
endocarditis, abscesses, skin furuncles.
P. aeruginosa PNA etilogy:
Often cause of PNA in pt. w/ CF or severely compromised resp. defenses. Pts on ventilator
P. aeruginosa PNA S/Sx
Green sputum, fulminating course
necrotizing w/ mult. small and large abscesses, skin lesions ecthyma gangrenosum, gram neg rods (encapsulated in CF pts)
S. pyogenes PNA
Less common due to ABX txs.
N. meningitidis PNA
Occasionally seen epidemics in military recruits.
Y. pestis PNA
infection due to environmental exposure to an infected rat pop.
B. pseudomallei PNA
Soil contamination in SE Asia.
Bacterial Pneumonia S/sx
malaise, fever, dyspnea, chest discomfort, pleuritic pain, cough productive w/ purulent or blood-tinged sputum, tachypnea, tachycardia, confusion
PNA chest sounds
Fine crepitus rales over involved portion of lung. Lobar consolidation results in: dullness to percussion, vocal fremitus, whispered pectoriloquy, brochial breathing (lower airways)
Bacterial PNA PE shows:
Pleural effusion s/sx: pleural friction rub, <breath sounds, dull percussion, egophony, referred abd. pain from diaphragmatic inflammation.
Bacterial PNA labs:
Sterile sites: Blood cultures, pleural fluid from empyema, special cultures and stains, serologic assays, lung bxs.
Bacterial PNA CXR results
*Dense lobar consolidation*
may involve one or more lobes, unilateral or bilateral. Pleural effusion may exist.
CXR: K. pneumoniae
"Bulging fissure" sign. Upper lobar consolidation w/a bowing fissure.
CXR: S. aureus
Multiple bilateral nodular infiltrates w/ central cavitation. Children: pneumatoceles, bronchopleural fistulas, empyema.
Bacterial PNA Tx:
Resp. support w/O2 if needed, ABX on basis of Gram stain, if not performed, ABX on pt age, epidemiology, host risk factors, and severity of illness.
Bacterial PNA Tx con't
Atypical PNA Bacterial etiologies
Atypical PNA Fungi etiologies
Histoplasma capsulatum (histoplasmosis), Coccidioides immitis (coccidioidomycosis), Pneumocystis carinii (pneumocystosis), Aspergillus fumigatus (aspergillosis)
Mycoplasma pneumonia etiology
Most common cause, second only to s. pneumoniae. It is the cause in 20-25% of all age groups, causing prolonged reduced pulm. clearance and hyper-responsive airway.
M. pneumonia etiology con't
AKA: Walking or Eaton agent PNA
Incubation: 10-21 days, occurs year round, > in adolescents/ young adults M>F, Person-person transmission.
M. pneumonia S/Sx initial:
resembles influenza: malaise, sore throat, dry cough +/- productive, sputum mucoid, mucopurulent, blood streaked. Dz. progresses gradually, Acute sx for 1-2 weeks, spontaneous recovery.
M.pneumonia severe S/Sx:
ARDS, maculopapular rashes in 10-20%,important dx tool. Erythema multiforme or SJS syndrome. PE unimpressive compared to pt c/o or CXR changes.
M.pneumonia Labs:
Gram stain: sparse bacteria, pmn's & mononuclear cells, clumps desquamated resp. epithelial cells. WBC: norm or slight elev. Difficult to grow culture 7-21 days. ELISA, IgM by latex agglutination, Indirect flourescent antibody test, compliment fixation test
M.pneumonia Cold agglutination
Positive if 4 fold > in titer w/ sequential specimens or single titer>/=1:64, most practical method of confirming dx, use serologic assays 2-4 wks post onset.
M.pneumonia Tx
Most pts recover w/ or w/o tx. Mycoplasmas don't respond to abx that interfere w/ cell walls, including beta-lactam abx. TCN or erythromycin for adults or Erythromycin for kids<8years.
Clamydia pneumonia etiology
C.pneumonia S/Sx
Resembles M.pneumonia, primarily in older children and young adults. Pharyngitis, bronchitis, pneumonitis, persistent cough, fever, sputum production. C. trachomatis is common cause of pneumoia in infants age 3-8wks
C.pneumonia Labs
Cultures, direct stains w/ immunoflourescence or polymerase chain reaction. Serial serological tests to show seroconversion. Very expensive tests
C.pneumonia Tx
Response slower than M.pneumonia
Cx may recur if tx is stopped early. TCN or erythromycin, for 10-21 days as for M.pneumonia.
C. psittacosis
Infectious PNA transmitted to humans from certain birds.
C. psittacosis etiology
Parrots, parakeets, lovebirds, poultry, pigeons, canaries,Snowy Egrets, Herring gulls, Petrels, Fulmars
Psittacosis Def
Caused by inhaling dust from feathers or excreta of infected birds or bite. Poss. from inhaling infected droplets of pts. Human- human transmission is assoc. w/ virulent strains`
Psittacosis S/Sx
1-3wk incubation, onset abrupt & insidious,gradual fever remains elevated for 2-3wks, chills, malaise, cough, PNA & consolidation w/ secondary lung infection.
Psittacosis Severe S/Sx
Progressive, pronounced increase in resp. rate & pulse bad sign. 30% mortality rate in untreated severe cases. Convalescence may be long in severe cases.
Psittacosis Tx
Avoid sick birds, TCN 1-2 G/day or Doxycycline 100mg po, tx should be for 10 days at least. Strict bed rest, O2 prn, cough control as needed
Legionnaires Dz
> 30 species Legionella, 19 causitive agents: L.pneumophilia most common, L.micdadei next, L.bozemanii & L.dumoffii last.
legionnaires' Dz
>30 species, Most common L.pneumophila, L.micdadei, L.bozemanii, L.dumoffii.
Legionnaires' Risk factors
> middle age men, smokers, etoh abusers, immunosuppressed esp. corticosteroids
Legionnaires' etiology
Outbreaks in bldgs., hotels & hosp. in A/C and showerheads. Contaminated H2O supply w/ organisms.
Legionnaires' S/Sx
Incubation 2-10 days, Malaise, fever, HA, myalgias (Prodrom). Cough w/o production the w/ mucoid sputum, >fever, poss. diarrhea, brady, alt. mental status
Legionnaires Labs
WBC: 100000-15000, Legionella stained w/ Dieterle silver & direct flourescent antibody stain.Urine test available and can culture Legionella.
Legionnaires' CXR
Unilat. patchy alveolar infiltrates, progressing to bilat. and pleural effusions common. Lung abscesses may occur and embolic emboli
Legionnaires' Tx
Erythromycin DOC, w/ Rifampin in severe cases. Tx should be for 3 weeks to prevent relapse. Ciprofloxacin and Azithromycin used also.
Atypical Pneumonia: Viruses
Bronchiolar epithelium invaded, causes bronchiolitis. Infection mobes to pulm. interstitium and alveoli causing PNA
Atypical PNA Virus pathology
Affected areas: congested, poss hemorrhagic, inflammatory rx composed of mononuclear cells. Alveoli contain fibrin, mono. cells, neutrophils, hyaline mem.
Atypical PNA: S/Sx
HA, fever, myalgia, cough w/ scanty sputum. Flu: epidemics
Atypical PNA: Labs
WBC: low, poss. norm, elevated w/ superinfection. Sparse bacteria, monocytes dominate smears of sputum. Throat wash, viral culture, serologic assay.
Atypical PNA: CXR
Interstitial PNA or peribronchial thickening most common. Lobar consolidation and pleural effusion not common but may occur.
Atypical PNA: TX
Acyclovir. CMV PNA tx w/ Ganciclovir and Immune globulin.
Atypical PNA: Viruses complications
Superimposed bacterial infection
S.pneumoniae, S.aureus, Haemophilus influenza, group A hemolytic streptococci, Neisseria meningitis.
Atypical PNA: Fungi
Histoplasma capsulatum (histoplasmosis)
Coccidioides immitis (coccidioidomycosis)
Histoplasmosis def
Dz causes by Histoplasma capsulatum, causes primary pulm. lesions and hematogenous dissemination.
Histoplasmosis etiology
H.capsulatum grows in soil, becomes airborne when disturbed, inhalation of spores cause infections. No person-person transmission
Histoplasmosis Acute S/Sx
Asymptomatic; non-specific fever, cough, malaise.Acute PNA sometimes evident w/CXR
Histoplasmosis Progressive Disseminated S/Sx
Uncontrolled hematogenous spread from lungs, hematosplenomegaly, lymphadenopathy, oral or GI ulcers. Occur most in infants and immunocompromised. Defining opportunistic infections for AIDS
Histoplasmosis Chronic Cavitary S/Sx
Pulm. lesions that are often apical and resemble cavitary TB. Worsening cough & dyspnea progressing to resp dysfunction. No dissemination occurs.
Histplasmosis Labs: Smears and cultures
Stained tissue samples: clusters of sm. oval yeast cells w/in macrophages, blood monocytes, or neutrophils. Wright's or Giemsa stain: Intracellular yeasts.
Histoplasmosis Labs: Serology
Culture:sputum, lymph nodes, bone marrow, liver bx, blood, urine. Antigen can be detected.
Histoplasmosis: Tx
Acute: self-limiting. Chronic: death from resp. insufficiency. Untreated progressive disseminated mortality >90%. Itraconozole or Ampho B IV
Coccidioides immitis Def
Caused by fungus, acute benign asymptomatic or self-limiting resp. infection.
Coccidioidomycosis etiology
Endemic in SW, central valley CA
AZ. Infections by inhalation of spores in dust. Spherules enlarge then rupture. Lesions form granulomatous coin lesions.
Primary Coccidioidomycosis: S/Sx
Asymptomatic non-specific resp. sx flu-like. Scattered rales, w/ or w/o dullness. Leukocytosis, eosinophilia. Desert rheumatism syndrome.
Progressive Coccidioidomycosis Risk Factors
HIV, immunosuppressive tx, 2nd half of preg. or postpartum, age, ethnic background (Filipino Blacks, Am. Indian, Hispanic, and Oriental)
Progressive Coccidioidmycosis S/Sx
Dev. over weeks, months, years after infection. Men > women, low grade fever, anorexia, wt loss, weakness. Pulm inf. may cause cyanosis, dyspnea, bloody sputum.
Coccidioidmycosis Labs
Culture tissues or fluids, silver or PAS stain, complement fixation for IgG anticoccioidal antibodies the most useful test. Titers >1:4 are consistent w/ infection.
Coccidioidmycosis Tx
Primary: no tx; fluconazole for mild-mod., Ampho B for severe. Meningeal: months to lifelong tx
Untreated: usually fatal
P.carnii found in rats, P.jiroveci affects humans. Occurs in 80% of AIDS pts. CXR: diffuse interstitial pattern Bactrim/Septra tx.
Occrus w/ tissue invasion or immunologic response ie: severe asthma exacerbation. Immune competent pt: chronic sinusitis. Invasive dz in HIV/AIDS necrotizing PNA disseminating throughout body.