Micro Atypical Pneumonia

Front 1

Where is atypical pneumonia usually located in the lungs?

Back 1

Lower lobe

Front 2

What usually causes pneumonia (typical or atypical) in ages 0-6 months?

Back 2

RSV, chlamydia trachomatis.

Front 3

What usually causes pneumonia (typical or atypical) in ages 6 months to 5 yrs?

Back 3

RSV, parainfluenza, influenza, adenovirus, metapneumovirus.

Front 4

What usually causes pneumonia (typical or atypical) in ages 5 yrs to adult?

Back 4

Mycoplasma (walking pneumonia), influenza, adenovirus, chlamydia pneumoniae.

Front 5

What usually causes pneumonia (typical or atypical) in adults?

Back 5

Strep pneumo, H. flu, Legionella.

Front 6

Host defense mechanism against atypical pneumonia, for physical?

Back 6

filtration, cough, cilia.
Affected by smoking, aspiration, viral infection (flu paves the way)

Front 7

Host defense mechanism against atypical pneumonia, for non-specific antimicrobials?

Back 7

Alpha 1 antitrypsin, lysozyme, lactoferrin.

Front 8

Host defense mechanism against atypical pneumonia, for immune?

Back 8

humoral: IgA, IgM, IgG, cell mediated (T cells, phagocytic, normal flora).

Front 9

Onset for Bacterial Pneumonia?

Back 9

SUDDEN, ACUTE

Front 10

Onset for Viral or Atypical Pneumonia?

Back 10

Sub-acute

Front 11

Fever for Bacterial Pneumonia?

Back 11

>103

Front 12

Fever for Viral or Atypical Pneumonia?

Back 12

None/low grade

Front 13

Chils for Bacterial Pneumonia?

Back 13

Common

Front 14

Chills for Viral or Atypical Pneumonia?

Back 14

"Chilled"

Front 15

Cough for Bacterial Pneumonia?

Back 15

Productive, Bloody, Rusty

Front 16

Cough for Viral or Atypical Pneumonia?

Back 16

NONE

Front 17

Appearance for Bacterial Pneumonia?

Back 17

TOXIC

Front 18

Appearance for Viral or Atypical Pneumonia?

Back 18

Non-toxic

Front 19

WBC for Bacterial Pneumonia?

Back 19

>15,000 with Left shift

Front 20

WBC for Viral or Atypical Pneumonia?

Back 20

<15,000

Front 21

Mortality for Bacterial Pneumonia?

Back 21

Up to 50%

Front 22

Mortality for Viral or Atypical Pneumonia?

Back 22

<5%

Front 23

Course for Bacterial Pneumonia?

Back 23

> 7 days, except myco

Front 24

Course for Viral or Bacterial Pneumonia?

Back 24

5-6 days

Front 25

Which pneumonia is worse, bacterial or viral/atypical?

Back 25

BACTERIAL!

Front 26

Mycoplasma pneumoniae ("walking pneumo") YOUNG.

Characteristics

Back 26

Gram negative but no cell wall. Fried eff look. Surface adhesin, attaches to epi cells, destruction, lasts up to three weeks, increase cold agglutinins.

Front 27

Mycoplasma pneumoniae ("walking pneumo") YOUNG.

Epidemiology

Back 27

Ubiquitous worldwide, long incubation, shed before sx, DROPLET SPREAD.

Front 28

Mycoplasma pneumoniae ("walking pneumo") YOUNG.

Sx

Back 28

Not sick looking, URI, pharyngitis, tracheobronchitis, persistent cough, fever, CXR = worse than expected.

Front 29

Mycoplasma pneumoniae ("walking pneumo") YOUNG.

TX

Back 29

Tetracyclines, Erythromycin

Front 30

Mycoplasma pneumoniae ("walking pneumo") YOUNG.

Complications

Back 30

Erythema multiforme, hemolytic anemia (agglutinins, myocarditis, pericarditis.

Front 31

Chlamydia pneumoniae
Characteristics

Back 31

Gram negative INTRA cellular (chlamys = cloak INSIDE) (see inclusions)

Others: trachomatis (STD/eye)
Psittaci (from birds)

Front 32

Chlamydia pneumoniae
Epidemiology

Back 32

10% of all atypical pneumoniae
DROPLET SPREAD

Front 33

Chlamydia pneumoniae
Sx

Back 33

Not sick looking, URi, Pharyngitis, tracheobronchitis, persistent cough, fever, CXR worse than expected.

Front 34

Chlamydia pneumoniae
Tx

Back 34

Tetracycline, Erythromycin

Front 35

SARS
(Severe Acute Respiratory Syndrome)

Ask about exposure.
Characteristics

Back 35

Coronavirus (same as common cold!)

Front 36

SARS
(Severe Acute Respiratory Syndrome)

Ask about exposure.
Epidemiology

Back 36

Jumped from an animal?
Found in SE China

DROPLET SPREAD

Front 37

SARS
(Severe Acute Respiratory Syndrome)

Ask about exposure.
Sx

Back 37

Fever, myalgia, cough, SOB, rales

Front 38

SARS
(Severe Acute Respiratory Syndrome)

Ask about exposure.
Tx

Back 38

Maybe ventilator, ribavirin, steroids

Front 39

Strep pneumonia (Classic)
>40 y/o

Clinical presentation

Back 39

Rusty sputum, acute onset, chest pain, fever, maybe URI first, consolidation, (ee-> aa), CXR lobar.

Front 40

Strep pneumonia (Classic)
>40 y/o

Microbiology

Back 40

Capsule, gram + diplococci, bile soluble, quellung positive (swells because of the capsule), optochin sensitive (grown inhibited)

Front 41

Strep pneumonia (Classic)
>40 y/o

Virulence Factors

Back 41

Capsule helps it avoid phagocytes and invade tissues.

Front 42

Strep pneumonia (Classic)
>40 y/o

Dx

Back 42

Sputum gram stain and culture, blood culture

Front 43

Strep pneumonia (Classic)
>40 y/o

Tx

Back 43

PCN, cephalosporins, erythromycin, vaccine for 23 types.

Front 44

Strep pneumonia (Classic)
>40 y/o

Complications

Back 44

Sepsis, meningitis (do LP), death.

Front 45

Strep pneumonia (Classic)
>40 y/o

Other

Back 45

Men > Women, common in asplenia. 4 stage penumonia, Congestion, red hepatization, white hepatization, resolution.

Front 46

Haemophilus influenza, think type B.

Clinical

Back 46

Like strep pneumo, but less explosive.

Invasive (spreads) vs. NON (resp tract).

Front 47

Haemophilus influenza, think type B.

Microbiology

Back 47

Capsule (6 types)
Gram NEGATIVE ROD

Front 48

Haemophilus influenza, think type B.

Virulence Factors

Back 48

Capsule avoids phagocyes, pilli, IgA protease.

Front 49

Haemophilus influenza, think type B.

Dx

Back 49

Sputum gram stain and Cd, Blood Cx.

Front 50

Haemophilus influenza, think type B.

Tx

Back 50

Ceftriaxone, vaccine for type b. Polyribositol capsule.

Front 51

Haemophilus influenza, think type B.

Complications

Back 51

Coexisting Otitis Media, meningitis, epiglotitis, pleural effusion

Front 52

Haemophilus influenza, think type B.

Other

Back 52

Growth factors required,
V: NAD from lysed RBCs
X: Hematin

Front 53

Legionella pneumophilia
(From the American LEGION Convention)

Clinical

Back 53

Pontiac Fever (flu)
Legionnaire's Dz (cough with pain, Nausea, Vomiting)

Front 54

Legionella pneumophilia
(From the American LEGION Convention)

Microbiology

Back 54

No capsule
Gram negative rod
INTRAcellular
Charcoal yeast required

Front 55

Legionella pneumophilia
(From the American LEGION Convention)

Virulence Factors

Back 55

INTRAcellular helps it avoid phagocytes.
MOMP surface protein (inhibits phagosome(
MIP (inhibits phago/lyso)
Macrophages are the 1st infected.

Front 56

Legionella pneumophilia
(From the American LEGION Convention)

Dx

Back 56

Sputum gram stain and Cx

Front 57

Legionella pneumophilia
(From the American LEGION Convention)

Tx

Back 57

Erythromycin, Tetracycline, Bactrim, Quinolones.

NO PCN!

Front 58

Legionella pneumophilia
(From the American LEGION Convention)

Complications

Back 58

Pleural effusion, abscess.

Front 59

Legionella pneumophilia
(From the American LEGION Convention)

Other

Back 59

Water Water Water WATER.
Lakes, rivers, cooling towers, via aspiration, summer, disinfect > 140 degrees, chlorine does not work.

Front 60

Destructive pneumonia

Clinical

Back 60

Flu, then staph! Nosocomial

Front 61

Destructive pneumonia

Microbiology

Back 61

Staph Aureus
E. Coli
Pseudomonas

Front 62

Destructive pneumonia

Virulence Factor

Back 62

Altered normal flora, paves the way

Front 63

Destructive pneumonia

Dx

Back 63

Sputum gram stain and Cx

Front 64

Destructive pneumonia

Tx

Back 64

Abx

Front 65

Destructive pneumonia

Complications

Back 65

Cavity or abscess

Front 66

Destructive pneumonia

Other

Back 66

Cystic fibrosis: pseudomonas. (& > 50% mortality rate)

Front 67

Aspiration Pneumonia

Clinical

Back 67

Slower onset, fever, wt. loss, cough, putrid sputum, post. R upper lobe.

Front 68

Aspiration Pneumonia

Microbiology

Back 68

Anaerobes:
Bacteroides, fusobacteria (mouth flora)

Aero + Anaero

Front 69

Aspiration Pneumonia

Virulence Factors

Back 69

Risk factors:
ALOC
Abnormal gag/swallow reflex
Alcoholism
Prior stroke
Poor dentition (OH THE TEETH)

Front 70

Aspiration Pneumonia

Dx

Back 70

Sputum gram stain and Cd, CXR, see air-fluid level

Front 71

Aspiration Pneumonia

Tx

Back 71

Community: clindamycin
Nosocomial: timentin

Front 72

Aspiration Pneumonia

Complications

Back 72

Significant! Necrotizing pneumo, abscess, empema (DRAIN)

Front 73

Abscess

Clinical

Back 73

Foul breath

Front 74

Abscess

Microbiology

Back 74

Anaerobes:
Bacteroides, fusobacteria (mouth flora)

Aero + Anaero

Front 75

Abscess

Virulence factors

Back 75

Risk factors:
ALOC
Abnormal gag/swallow reflex, alcoholism, prior stroke, poor dentition (oh the teeth)

Front 76

Abscess

Dx

Back 76

Sputum gram stain and CXR, see air-fluid level.

Front 77

Abscess

Tx

Back 77

Long term Abx, drain and resect

Front 78

Acute bronchitis

Clinical

Back 78

Cough with URI (productive)
Low grade fever.

Front 79

Acute bronchitis

Microbiology

Back 79

Viruses: flu, adeno, RSV, corona, rhino

Bacteria: myco, pertussis, chlamydia

Front 80

Acute bronchitis

Virulence factors

Back 80

causes inflammation especially with smoking and air pollutants

Front 81

Acute bronchitis

Dx

Back 81

By exclusion

Front 82

Acute bronchitis

Tx

Back 82

Symptomatic: ASA, bedrest, cough suppressant

Front 83

Acute bronchitis

Complications

Back 83

Pneumonia.

Front 84

Some host defects that lead to increased risk for pneumonia:
1) Cystic Fibrosis
2) Kartagener's
3) Immune disorders

Back 84

1) Cystic Fibrosis: lack of mucociliary clearance
2) Kartagener's: lack ciliary fx
3) Immune disorders: complement, spleen, etc.

Front 85

Additional host defects that lead to increased risk for pneumonia:

Back 85

Pre-infected with virus (such as influenza), smoking, COPD/asthma, EtOH abuse (aspiration of vomit), poor gag swallow, ALOC --> aspirate, pollution, poor dentition (BRUSH YOUR TEETH!)