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39 Cards in this Set

  • Front
  • Back
The normal lower respiratory tract is normally ____.
Five routes of bacterial entry to lower resp tract:
trauma, hematogenous dissemination, aerosolized particles, large volume aspiration, small volume aspiration (most common)
What is the most common mechanism for pneumonia?
small volume aspiration
How does a pneumonia caused by hematogenous dissemination look on CXR?
diffuse or nodular
How much bacteria is necessary to reliably produce pneumonia?
10^5 bacteria/ml
What augmenting mechanisms are recruited in times of crisis to fight infection?
prolonged inflammatory response, initiation of humoral and cell-mediated immunity
What are the three main categories of host immunity patterns done on the wards?
primary neutrophil defense
humoral immunity
cell-mediated immunity
Normall neutrophils are found in the _____.
pulmonary capillaries, waiting to activated to enter the alveoli
What does a bug enounter first when it reaches the alveolus?
alveolar macrophages
What do macrophages secrete to attract neutrophils?
IL-8 and LTB-4
Macrophages interact w/ B and T cells to ?
activate them and induce clonal expansion
What diseases can cause an impaired neutrophil response?
inborn disease, diabetes, COPD, renal failure, bone marrow suppression from chemotherapy
What bacteria are you likely to get if you have an impaired neutrophil response?
bugs that are easy to eat and easy to kill
GNR, Pseudomonas, Staph, anaerobes, fungi (esp. aspergillus)
What bacteria are you likely to get if you have a defect in humoral immunity?
bacteria that are hard to eat, hard to kill: encapsulated organisms
Pneumococcus, H flu, encapsulated GNR like Klebsiella
What diseases can cause a defect in cellular immunity?
multiple myeloma, CLL, and asplenia
What can cause a defect in cell mediated immunity?
HIV/AIDS, immunosuppression after transplant
What bugs are you likely to get w/ a defect in cell mediated immunity?
bugs that are easy to eat, hard to kill
Legionella, mycobacteria, Nocardia, Fungi, CMV, PCP, Chlamydia, Listeria
What are the most severe predisposing factor for pneumonia?
primary immune problems
What living situation is the greatest risk for developing pneumonia?
in the ICU
Have an underlying metabolic or other disease that impairs their immune system.
Secondarily susceptible hosts
____ don't work as well in alcoholics.
Alveolar macrophages
In COPD, renal failure, malnutrition, and alcohol abuse there is documented ___ dysfxn.
Secondarily susceptible hosts have greater _____.
oropharyngeal colonization w/ bad bugs
What is the most common infection among secondarily immunosuppressed patients?
T/F: You shouldn't wait to find out what the bug is b/f you treat.
What are some forms of non-infectious pneumonia?
pulmonary edema, alveolar hemorrhage, or PE
What type of infection most often causes pneumonia (generally)?
T/F: A negative CXR in a symptomatic patient rules out pneumonia
What are four criteria on CXR that help determine the etiology of pneumonia?
time frame, distribution, type of infiltration, other associated findings
If you see acute consolidation the pneumonia is most likely?
Dense infiltrate that is chronic/sub-acute indicates ?
fungal, viral, Nocardia, TB, pneumocystis
Peribronchal opacities acutely indicate?
viral influenza, RSV, or CMV
Peribronchal opacities chronically is probably?
Acute nodular infiltrates?
Subacture nodular infiltrates?
fungus, Nocardia, TB, PCP
Lack of opacity on CXR in a pneumonia patient could be due to?
no immune cells to trigger response
Steroids impair the ____ immune system.
cell mediated
Holding a patient's ____ is just as important as giving antibiotics.
T/F: Because of immunesuppression, patients may not displace all the typical signs of infection.