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43 Cards in this Set
- Front
- Back
Risk factors for severe pneumococcal disease?
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1. Asplenia
2. Abnormal immunoglobulin •myeloma - an accumulation of malfunctioning or "cancerous" plasma cells •lymphoma - group of cancers that affect the lymphocytes •HIV |
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10 major pathogens for CA pneumonia?
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1. Strep pneumoniae
2. H. influenzae 3. Staph aureus (elderly, post influenza) 4. Mycoplasma pneu. “walking” 5. Mixed anaerobes-aspiration/abscess 6. Moraxella catarrhalis - elderly, COPD (chronic bronchitis) 7. Gram – (PEK-alcoholics) 8. Legionella (goofy/confused) 9. Chlamydia 10. viruses (kids) |
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What organism?
Destroys respiratory epithelium May disrupt normal ciliary activity May inhibit neutrophil and macrophage function |
Viruses
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If the airway is sterile below the larynx then why does Acute pneumonia develop?
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• Defect in host defenses
• Challenge by especially virulent organisms • Overwhelming inoculums |
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What G(-) bugs cause CA pneumonia?
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Gram-negative
– Klebsiella pneumoniae – Escherichia coli – Proteus mirabilis |
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What disrupts mucocillary fxn and macrophage activity leading to interference of the normal host defenses against pneumonia?
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Cigarette smoke
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What organisms are associated with Nosocomial or health (hospital) care aquired pneumonia (HCAP)?
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Gram(-) aerobes
Staph aureus Anaerobes common Candida common-does not cause disease |
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Infection?
Patient history is of very indolent course (slow progression of symptoms**)-like 2 months |
Tuberculosis-usually reactivation
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What bug is associated with causing CA pneumonia in the following :
– Older age group – Underlying COPD, especially chronic Bronchitis |
Moraxella catarrhalis
note: mentioned in lecture and in lecture slides |
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Diagnostic sputum must contain?
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<10 epi cells and >25 PMNs per low power field
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Possible orgs if absent on gram stain ?
*Do the gram stain-don’t be a lazy doctor and go straight for the x-ray |
Mycoplasma
TB Viruses Legionella PCP (pneumocystis) |
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Type of pneumonia?
– Mixed anaerobes – May lead to lung abscess or empyema – Foul smell – Risk factors (loss of consciousness) |
Aspiration Pnuemonia
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Pathogen?
General risk factors: ↑ age 50+ Smoking Malnutrition COPD CHF |
Streptococcus pneumoniae
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Symptoms of pneumonia?
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Chest pain (often pleuritic)
Cough, often sputum Shortness of breath Difficulty and pain on breathing note: pleuritic chest pain: -sudden, intense chest pain that is usually located over the area of inflammation -pain is usually described as shooting or stabbing -holding one's breath or exerting pressure against the chest causes pain relief |
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Bug?
-Kids over 5,teens, young adults (Dorms/barricks) -Sore throat->FREQUENT INTIAL FINDING -Bullous myringitis (blebs on tympanic membrane) -Pleuritic pain, splinting, respiratory distress UNCOMMON -X-ray worse than physical findings |
Mycoplasma pneumoniae
Walking pneumonia |
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How does ALTERED CONSCIOUSNESS effect normal host defenses against pneumonia?
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epiglottic closure, bugs go down respiratory tract
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Classic clinical symptoms of community acquired (bad term) pneumonia?
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Chronic underlying diseases common
Fever Pleuritic chest pain -> sudden, intense chest pain that is usually located over the area of inflammation -> pain is usually described as shooting or stabbing -> holding one's breath or exerting pressure against the chest causes pain relief Productive cough (>80%) ->when some type of secretions come up during coughing |
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What organism causing pneumonia that is acid fast?
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TB
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What organism associated with CA pneumonia cause the following sx?
• High fever (> 40o C) • Multi-lobar involvement • Rapid progression • GI and neurologic abnormalities • Elevated liver enzymes, creatinine |
Chlamydia
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What stain is used to ID pnenumocytis?
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Giensa,GMS, toluidine blue
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Should blood cultures be done on pt with pneumonia? And if so, why?
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Yes
– Positive 20-30% – Proves etiology – Provides susceptibility of organism |
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What organism is associated with foul smelling sputum?
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Mixed anaerobes
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How do viruses interfere with normal host defenses against pneumonia?
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-destroy resp epithelium
-may disrupt normal ciliary activity -may inhibit neutrophil and macrophage fxn |
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What organism is associated with rusty sputum?
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Pneumococcus also known as Strep pneumoniae
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What organism is associated with Dark red, mucoid “currant jelly” sputum?
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Klebsiella
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What organisms are ID by Serologic tests?
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Mycoplasma
Legionella (also urine Ag) Chlamydia serologic test: -test to detect serum antibodies or antibody-like substances that appear specifically in association with certain diseases |
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Factors that interfere with normal host defenses and HOW?
Note: imp to not just list but to understand mechanism |
1. Altered consciousness
-epiglottic closure, bugs go down respiratory tract. 2. Cigarette smoke -disrupts mucocilary function and macrophage activity 3. Viruses -inhibit host defense 4. Alcohol -impairs cough/reflexes 5. Iatrogenic manipulation may bypass host defenses 6. Drugs (ex: cortosteriods) -variety may inhibit host defenses |
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Methods for diagnosis for pneumonia?
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1. sputum
2. transtracheal aspirate-rare 3. bronchoscopy 4. lung biopsy 5. exam of pleural fluid 6. blood culture-do it* 7. serologic tests 8. radiology (chest x-ray) *proves etiology of infecton and provides susceptibility of organism |
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6th most common cause of death in US?
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Pneumonia
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Lab findings in CA pneumonia?
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Elevated WBC (stress)
Neutropenia poor prognostic sign Sputum–rust colored (classic but uncommon) ** Gram Stain may be diagnostic** |
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How does ALCOHOL interfere with normal host defenses against pneumonia?
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- impairs cough/reflexes
- inc risk of aspiration - associated with G(-) colonizations - associated with dec PMN mobilization, fxn |
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Prevention of pneumonia?
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Pneumovax-very effective
Influenza vaccine |
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Host Defense mechanisms for pneumonia?
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Anatomic barriers
Mechanical barriers Humoral immunity -> IgA in nose Cellular immunity -> phagocytosis |
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Disease?
Advanced age Severity of underlying disease Intubation Use of respiratory equip. Nasogastric tubes Altered mental status Surgery Prior antibiotics *major** H2 blockers |
Nosocomial pneumonia
or Health (hospital) Care Aquired Pneumonia (HCAP) |
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Best id for atypical pneumonia?
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No bugs on Gram stain
Why? bc the 2 organisms that are associated with atypical pneumonia, Chlamydia pneumoniae and Mycoplasma pneumoniae have no cell wall so they stain poorly with Gram stain. |
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How does age play a role in increase risk of pneumonia?
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- Diminished mucociliary clearance
– Abnormal elastic recoil – Alteration of humoral and cell mediated immunity |
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Virus pathogens causing pneumonia?
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Most common in kids-some adults
Sets stage for bacterial superinfection RSV Parainfluenza type 3 Adenovirus Influenza CMV in immunocomp. Varicella-zoster |
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Type of Pneumonia?
Loss of consciousness Mixed anaerobes Periodontal disease May lead to lung abscess *don’t use Metronidazole |
Aspiration pneumonia
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Begins as mild respiratory tract, followed by dyspnea and cough without sputum?
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Atypical pneumonia
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What is often a misleading diagnosis?
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A sputum culture
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General Physical exam findings for pneumonia?
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Fever
Cough with sputum HSV labialis (cold sore) (pneumococcal pneumonia) Bullous myringitis (mycoplasma) -> blebs on tympanic membrane Poor dentition |
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What population?
Diminished mucociliary clearance, abnormal elastic recoil Alteration in humoral and cell-mediated immune function |
Older adults (age related defects)
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What virus is associated with pneumonia in immunocompromised pt?
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CMV
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