Pneumonia

Front 1

Strep pneumoniae

Back 1

Gram positive diplococci
Big capsule
Lots of serotypes
Leading cause of lobar bacterial p.
Hist: gram + diplococci
CF: acute onset of fever, chills, chest pain, rusty sputum, lobar consolidation
Pathogenesis: Proliferation in alveoli and influx of PMNs w. minimal structural damage (NO NECROSIS)

Front 2

mycoplasma pneumoniae

Back 2

atypical
No cell wall
•Intracellular
•Long doubling time
Epi: children and young adults, often in epidemics
CF:more insidious onset, brief clinical course,Often cough
Character: infl. confined to interstitium, no alveolar exudate, intra-alveolar hyaline disease
Pathogenesis: Attaches to bronchial epithelium secondary infl. and edema

Front 3

Legionella pneumophila

Back 3

atypical
Lives in water
Gram negative
Epi: contaminated AC
Multilobe involvement
Purulent sputum without visible organisms, hyponatremia, failure to respond to beta-lactams suggests
intracellular pathogen

Front 4

Chlamydophila

Back 4

atypical
Obligate intracellular bacteria
CAP

Front 5

Histoplasma capsulatum

Back 5

fungus
Epi: spelunking, avian droppings
path: just like TB
histo: TINY yeast, granulomas

Front 6

empiric rx for putpatient CAP

Back 6

2nd or 3rd generation cephalosporin OR b-lactam/b-lactamase inhibitor AND macrolide OR fluoroquinolone

Front 7

empiric rx for inpatient CAP

Back 7

b-lactam inh + macrolide OR fluoroquinolone
vancomycin for resistant staph

Front 8

Aspergillus

Back 8

 Epi: Organ-transplantation, iatrogenic
histo: septate hyphae (45)
Path: invade blood vessels

Front 9

PCP

Back 9

 Epi: AIDs
 Pathogenesis: Proliferation within alveoli with edema
 CXR: Batwing infiltrate
o Fungus
o SS
 Develops insidiously, with gradual SOB, fever, dry cough over weeks (can be faster)
 Most common cause of ARDs in HIV pts
 Usually in pts with CD4<200
o CXR: diffuse bilateral infiltrates
o DX:
 Show in sputum (culture or PCR)
o TX: bactrim

Front 10

Haemopholus Influenza

Back 10

CAP
• Small, pleomorphic gram – rod
• Most virulent is type B
 Epi: healthcare setting
COPD --> risk

Front 11

o Psittacosis

Back 11

 Epi: chilling w sick birds

Front 12

Moraxella catarrhalis

Back 12

CAP
 The bug: Gram-negative diplocci
elderly and people w chronic lung disease most susceptible

Front 13

Staph aureus

Back 13

o HCAP
 Pathogenesis: Proliferation within alveoli with destruction
assoc w IV drug abuse

Front 14

• CMV

Back 14

o SS
 Similar to PCP, SOB, non productive cough
o DX:
 Visualize: owl eyes,
• Intracellular inclusion bodies
o TX:
 Ganciclovir

Front 15

klebsiella p

Back 15

CXR: fills like a ball
associated with extensive necrosis (s. aureus as well)
thick capsule

Front 16

Cryptococcus Neoformans

Back 16

 Epi: worldwide
 Loc: often associated with meningitis
 CD4<100 usually
 TX: amphotericin B
 Hist: India Ink, Foamy cells

Front 17

Histoplasmosis

Back 17

 Epi: Ohio and Mississippi river valleys, Central and South America, Carribean
 Very low CD4 count usually
 SS
• Subacute pneumonia
 CXR:
• military infiltrates on CXR
• diffuse
 DX: see in speicim
 TX: amphotericin B or itraconazole for less severe infections

Front 18

o Aspergillosis

Back 18

 CD4<30
 Rare but DEADLY
 Often post bone marrow TX (neutropenia)
 CXR: upper lobar disease with cavitations and hemoptysis
 DX: see organism in normally sterile sites
• 45 branching hyphae
 TX: amphotericin B
Path: infarction and necrosis secondary to vascular involvement

Front 19

Blastomycosis

Back 19

Midwest, southeast
Both CXR diffuse, TX: ampho B
Histo: big yeast, granulomas
CC: similar to TB but inital infection can --> symptoms

Front 20

• Kaposi Sarcoma

Back 20

o Most common malignancy in HIV pts
o Caused by HHV8 (sex transmission probably)
o Usually mucutaneous lesions too
o SS:
 Asymptomatic often
 Cough, SOB, hemoptysis, fever
o CXR:
 Bronchial thickening, kerley b lines, nodules, adenopathy

Front 21

PORT clinical prediction rules

Back 21

to det if ok to send home
<50
doesnt have:
1) neoplastic diseas
2) liver
3) CHF
4) Cerebrovascular disease
5) renal disease

Front 22

Pseudomonas a

Back 22

path: severe necrotzing infl with vasculitis
assoc w CF

Front 23

Lung abscess by which bac?

Back 23

staph aureus, klebsiella (other gram - rods, aspiration p.

Front 24

aspiration p most commonly which lobe

Back 24

RLL

Front 25

atypical p are?

Back 25

chlamydia pneumoniae, myocplasma p, viruses
enter interstitium
cell-mediated: lymphocytes
legionella (clinically, not pathologically)

Front 26

Pathogenesis of TB

Back 26

TB enter macrophages, drains to LN, Th1 --> Il-12 --> prod of IFN-gamma --> macrophages stimulated --> granulomas

Front 27

coccidiomycosis

Back 27

just like TB
hitso: thick walled spherules with endospores

Front 28

candida

Back 28

budding yeast with pseudohyphae

Front 29

• Rhinovirus

Back 29

o Early fall spring
o Highly contagious

Front 30

• Adeno

Back 30

o In military
o DNA virus
o Ped often w conjunctivitis and fevers

Front 31

• Parainfluenza

Back 31

o Croup in young
o Acute

Front 32

• Coronavirus

Back 32

o SARS

Front 33

• Influenza

Back 33

o Often leads to secondary bacterial pneumoniae
o Has a vaccine

Front 34

Virus tx

Back 34

oseltamivir - influenza A and B
amantadine - hit ONLY A

Front 35

Penicillins

Back 35

For Strep p
AE: Rash, cytopenia
b-lactams - excellent anaerobe coverage

Front 36

Macrolides

Back 36

intracellular (atypicals)
gram +
limited gram -
SE: GI, liver Torsades de pointes
Mech: Inhibit RNA dependent protein synthesis at step of chain elongation

Front 37

Strep capsule important in pts with...

Back 37

liver disease, no spleen

Front 38

2nd or 3rd generation Cephalosporin

Back 38

B-lactam
gram +s
gram -s, Pseudomonas
in-patient bc IV
no atypicals therefore used w macrolide

Front 39

Fluoroquinolones

Back 39

gram + strep, staph
Gram - other CAPs, Pseudomonas
atypicals
SE:
TERATOGENIC NOT FOR KIDS
joint cartilage, tendinitis
Photosensitivity
m: inhibits DNA synthesis

Front 40

Bactrim

Back 40

PCP

Front 41

Group A Strep can -->

Back 41

Rheumatic fever

Front 42

Carbapenems

Back 42

B-lactam
broad gram +, - (CAP)
pseudomonas

Front 43

Vancomycin

Back 43

MRSA TX
POST INFLUENZA SYNDROME!
SE:CN VIII
Red man synd
neutropenia
MECH: Cell membrane