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38 Cards in this Set

  • Front
  • Back
What are ways that microbes can enter the lung the produce infection?
• aspiration of oropharyngeal secretion (most common)
• hematogenous spread
• inhalation of aerosolized particles
• spread from a contiguous focus of infection
Patient has pneumonia and a history of exposure to cattle, goats, or sheep. What is the most likely cause?
• Q Fever
• Brucellosis
Patient has pneumonia and exposure to rabbits. What is the most likely cause?
What has pneumonia and history of exposure to birds. What is the most likely cause?
• Psittacosis
• Histoplasmosis
Patient has pneumonia and exposure to rodents. What is the most likely cause?
What can cause a pneumonia for a person who recently traveled to the southwestern US?
Which pneumonia develops from the Mississippi & Ohio River Walley OR cave diving/sperlunking?
• Histoplasmosis
• Blastomycosis
Patient has a pneumonia that develops from travel to a developing country. What is a possible cause?
What is a likely cause of pneumonia from a dog tick?
Patients with pneumonia and fever without a rise in pulse suggest what etiology?
• Legionellosis
• Mycoplasma
Patients with pneumonia and foul breath suggest what etiology?
anaerobic infection
What are physical findings of bacterial pneumonia?
• bronchial breath sounds
• crackles
• dullness to percussion
• evidence of consolidation
• increased fremitus
• whispered pectoriloquy
What does a chest cray of a patient with Mycoplasma pneuomia look like?
• patchy infiltrates (esp. in lower lobes)
• appears much more severe on CXR than symptoms suggests
True/False: A negative radiograph can rule-out the possibility of acute bacterial pneumonia
• A "negative" radiograph can never rule out the possiblity of acute bacterial pneumonia when the patient's symptoms and signs point to this diagnosis

• The correct answer is: False
The presence of cavitation on chest xray helps indentify what type of pneumonia?
necrotizing pneumonia
What are common causes of necrotizing pneumonias?
• anaerobes
• fungi
• gram-negative bacilli
• Pneumocystis carinii
• Staphylococcus
• Tuberculosis
A patient presents with symptoms of pneumonia. Sputum gram stain shows inflammatory cells and no organisms. What are possible etiologies?
• Chlamydia psittaci
• Chlamydia pneumoniae
• Legionella
• Mycoplasma pneumoniae
• prior antibiotic treatment
• Q Fever
• Viral pneumonia
The demonstration of elastin fibers in a KOH prep of sputum establishes a diagnosis of what type of pneumonia?
necrotizing pneumonia
What is the most common cause of pneumonia in children?
• Viruses
• most frequent viral cause is RSV
What is the most common viral cause of pneumonia in adults?
• influenza (most common)
• adenovirus
• parainfluenza
Which patients are at an increased risk for influenzal pneumonia?
• elderly
• patients with chronic disease of heart, lung, kidney
• women in last trimester of pregnancy
What does a chest xray show in patients with a viral pneumonia?
• interstitial pattern
• patchy infiltrates
What are predisposing risk factors for developing pneumococcal pneumonia?
• alcoholism
• chronic lung disease
• hematologic malignancy
• HIV infection
• prior splenectomy
• renal failure
• sickle cell disease
What does chest xray show in patients with pneumococcal pneumonia?
lobar consolidations w/ air bronchograms after 2nd to 3rd day
What are features of Staph aureus pneumonia that differentiate it from pneumococcal pneumonia?
• development of parenchymal necrosis and abscess formation in up to 25% of patients
• development of empyema in 10%
What is the treatment for pneumonia caused by H. Flu?
• ampicillin + ß-lactamase inhibitor
• 2nd or 3rd generation cephalosporin
Patient presents with pneumonia and a history of alcoholism. What is the most likely etiology?
Klebsiella pneumoniae
Patients with a recent history of bacteremias resulting from intestinal or urinary tract infection that develop pneumonia are most likely cause by what organism?
E. coli
Intubated patients or patients with a history cystic fibrosis most likely develop pneumonia from what bacteria?
What are characteristic presenting symptoms of Mycoplasma pneumonia?
• hacking, non-productive cough

• non-pulmonary features
- myalgias
- arthralgias
- skin lesions

• neurologic complications (ex. meningitis, encephalitis, transverse myelitis)
What clinical presentation suggest Legionella pneumonia?
• rapidly progressive pneumonia
• dry cough
• multi-organ involvement
What are 4 methods to diagnose Legionella pneumonia?
• indirect fluorescent antibody
• direct florescence abntibody
• Legionella antigen (detected in urine)
• culture on charcoal yeast extract
What are treatment options for Legionella pneumonia?
• Macrolides
• Tetracyclines
• Fluoroquinolones
What is the initial antibiotic used to treat Chlamydia pneumoniae?
Erythromycin 500 mg PO QID
How long is the pneumococcal vaccine effective in individuals with normal immune response?
5 years
What are bacterial causes of anaerobic pneumonia?
• Bacteroides
• Fusobacterium
• Prevotellta
• Peptostreptococcus
What are does a lung abscess look like on chest xray?
• a thick-walled solitary cavity sourrounded by consolidation
• air-fluid level is usually present
What does necrotizing pneumonia look like on chest xray?
multiple areas of cavitation within an area of consolidation