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52 Cards in this Set
- Front
- Back
List the different Pneumonia syndroms.
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Community-acquired pneumonia
Hospital-acquired/nosocomial pneumonia Atypical pneumonia Aspiration pneumonia Pneumonia in the immunosuppressed host Chronic pneumonia |
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What is the pathophysiology of pneumonia?
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Infection of the lung parenchyma by particular organism
Neutrophils migrate out of the pulmonary capillaries into the air spaces After phagocytosis, neutrophils kill ingested microbes Inflammation results in neutrophilic exudate in the alveolar spaces |
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How can acute pneumonia develop?
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Aspiration of upper airway flora into lower respiratory tract
Inhalation of aerosolized micobes Metastatic seeding from blood Invasion of infection in contiguous structures Direct inoculation Reactivation |
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What does development of acute pneumonia signify?
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Impairment of host defenses
Exposure to a particularly virulent organism Overwhelming inoculum of low-virulence organism |
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What are the defense mechanisms for the nasopharynx?
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nasal hair, nasal turbinates, aerodynamic filtration and impaction, mucociliary epithelium
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What are the defense mechanisms for the oropharynx?
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flow of saliva, sloughing of epithelial cells, bacterial interference of resident flora, local production of complement
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What are the defense mechanisms for the trachea and bronchi?
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cough, epiglottic reflexes, mucociliary apparatus, production of immunoglobulins (IgA, IgM, IgG)
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What are the defense mechanisms for the lower respiratory tract?
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Cough
Physical structure of airways Epithelial cells in conducting airways production of surface liquid |
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What are some commonly impaired host defenses?
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Impaired cough reflex
Depressed mucociliary transport Anatomic changes Inflammatory cells Blunted cellular and humoral immune response Reduced granulocyte chemotaxis Neutropenia Dysfunctional alveolar macrophages Diminished antibody production or function Iatrogenic manipulation Tobacco Aging |
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Important aspects of a history when pneumonia is suspected?
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High fever, chills, productive cough, dyspnea, pleuritic chest pain with typical pathogens
Low-grade fever, nonproductive cough more common with atypical pathogens Past medical history (COPD, HIV, bronchiectasis) Look for specific exposures to animals, occupational exposures Ask about travel and sexual history |
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How does someone with typical pneumonia present?
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High fever
chills productive cough dyspnea pleuritic chest pain |
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How does someone with atypical pneumonia present?
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Low grade fever
non productive cough "Walking Pneumonia" |
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What is fieget's sign?
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fever + bradycardia; atypical and commonly seen in Legionella and atypical pneumonia
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How do patients with legionella present?
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fieget's sign, tachypneic, thonchi, egophony
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What is toxic pneumonia?
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high temperature, high respiratory rate, high pulse
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What is non-toxic appearance on pneumonia?
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they look mild or normal
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How to diagnose pneumonia?
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clinical presentation, epidemiologic considerations, gram-stain of sputum, characteristic x-ray appearance, blood cultures, antigen tests
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What defines a good sputum sample?
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less than 10 epithelial cells and more than 25 neutrophils in high field
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What is the most common form of community-acquired pneumonia?
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streptococcus pneumoniae
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Presentation of streptococcus pneumoniae
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high fevers, chills, productive rusty spurum, focal infiltrate on x-ray; if left untreated, neutrophilic pus could invade pleural cavity (empyema)
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Which pneumonia has the highest fatality rate?
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streptococcus pneumoniae
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What are suppurative complications of streptococcus pneumoniae?
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sinusitis, otitis media, endocarditis, meningitis, parapneumonic effusion (empyema)
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How does streptococcus pneumoniae appear on culture?
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alpha-hemolytic, gram postiive diplococci
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How does hemophilus influenzae present?
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high fever, productive sputum, chills
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In which populations is hemophilus influenzae common?
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individuals with COPD and alcoholics
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What is a complication of untreated h. influenzae pneumonia?
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pleural effusion
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To which antibiotics does h. influenzae show resistance?
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all penicillin based antibiotics becasue of beta-lactamase
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How does haemophilus influenzae appear on culture?
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gram negative diplococci
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Which population does Klebsiella pneumoniae most affect?
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alcoholics
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How does Klebsiella pneumoniae present?
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high fever, chest pain, dyspnea, hemopstysis, sputum, lethargic
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What is a common name for Klebsiella pneumoniae?
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Friedlander's Pneumonia
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How does Klebsiella pneumoniae appear on x-ray?
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bulging infiltrate; k pneumoniae is very mucoid and its exudate pushes on the lung
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How does Klebsiella pneumoniae appear on culture?
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whtie mucoid colonies of gram-negative bacillus
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What is a typical prsentation of Staphylococcal pneumoniae?
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someone who has the flu and gets pneumonia immediately after; sputum, fever, rhinitis
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What are the most common causes of atypical pneumonia?
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legionella, and then mycobacterium (tb)
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How does legionella pneumonia present?
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high fever, feiget's sign, gi symptoms, hyponatremia, multilobar pna, rapid progression
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How is legionella diagnoses?
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serology
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how is streptococcus pneumonia diagnoses?
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antibody urine test
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how does legionella appear on culture?
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gram negative rods
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How does mycoplasma pneumoniae present?
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sore throat, nonproductive cough, headache, bullous myringitis; x-rays often appear worse than clinical findings
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How is a clinical diagnosis of mycoplasma pneumoniae confirmed?
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serology or culture
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What is atypical pneumonia?
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"walking pneumonia"; patients do not have a fever, look normal, have normal WBC, but have cough
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What causes aspirational pneumonia?
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mostly bacterial of chemical; a lot of times its due to the natural flora in your mouth and airway
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How is nosocomial pneumonia caused?
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colonization of oropharynx with pathogen followed by aspiration; second most frequent nosocomial infection
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Which pathogen commonly causes parapneumonic effusion?
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streptococcus pneumonia; exudate into pleural cavity can causes empyema if left untreated
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Which organisms commonly cause nosocomial pneumonia?
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60% due to gram negative bacilli, 13-40% due to s aureus
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What are the risk factors for viral pneumonia?
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HIV/AIDS, transplant patients, underlying lung disease, premature infants
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What are the causes of viral pneumonia?
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CMV, influenza, parainfluenza, adenovirus, respiratory syncytial virus, SARS
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Which pneumonia causing pathogens are more common in immunosuppresed hosts?
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fungal (aspergillus, cryptococus pneumocystis), nocardia, rhodococcus equi, and tb
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What is the treatment for aspergillus pneumonia?
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long-term antifungal Rx and reversal of immunosuppresion
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What is a major cause of PJP pneumonia?
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defective t cell immunity
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What is a parapneumonic effusion?
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pleural effusion that arises as a result of pneumonia; pleural fluid with pH <7.2, glucose <60, high LDH, and bacteria
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