Term
|
Definition
- acute community acquired
- atypical
- aspiration
- nosocomial
- immunosuppresed host
- chronic
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Term
| Pathophysiology of pneumonia |
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Definition
- lungs parenchyma infected by an organism
- neutrophils migrate out of pulmonary capillaries into the air spaces
- after phagocytosis, neutrophils kill injested microbes
- inflammation results in neutrophilic exudate in alveolar spaces
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Term
| Causes of acute pneumonia |
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Definition
- most common- apsiration of oropharyngeal bacteria
- other causes
- inhale aerosolized microbes
- metastatic seeding of microbes from blood
- invasion of infection in contiguous structures
- direct inoculation of microbes
- reactivate latent infection (ex: TB)
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Term
| Major host defense against upper resp. tract infections |
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Definition
-
nasopharynx- turbinates, filtration, impaction, mucociliary epithelium
-
oropharynx- flow of salivea, sloughing of epithelium, bacterial interference of resident flora, produce complement
-
trachea, bronchi
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Term
| Development of acute pneumonia signifies what? |
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Definition
-
Aka, you have either exposure to particularly virulent organism
-
defect in host defense
-
overwhelming inoculum of low virulence organism
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Term
| defense mech from lower resp. tract infection |
|
Definition
- cough
- resp. tract structure
- alveolar macrophages that produce cytokines that lead to neutrophil recruitement
- alveolar lining in resp. zone- surfactant, fibronectin, complement, IgG, macrophages
- epithelial cells in conducting airways produce surface liquid w/:
- lactoferrin
- lysozyme
- secretory leukocyte proteinase inhibitor
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Term
|
Definition
| glycoprotein covering cell R's that prevents microbial adherance |
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Term
|
Definition
| bactericidal for gram positive bacteria |
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Term
| Function of surfactant in host defense |
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Definition
| increase macrophage microbicidal activity |
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Term
|
Definition
| rotein that is bateriostatic for gram negative bacteria |
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Term
| What could impair the cough reflex? |
|
Definition
- stroke
- neuromusc. disease
- sedatives
- alterations in consciousness
- poor nutrition
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Term
| What could depress mucociliary transport |
|
Definition
- smoking
- aging
- dehydration
- morphine
- atropine
- Mycoplasma infections
- chronic bronchitis
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Term
| What anatomic changes facilitate pneumonia infection |
|
Definition
- emphysema
- bronchiestasis
- obstructive mass lesions
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Term
| Role of inflammatory cells in impairing host defense |
|
Definition
- release proteolytic enzymes
- alters bronchial epithelium
- alter ciliary clearance
- produce excess mucus
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Term
| What could blunt the cellular and humoral immune responses |
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Definition
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Term
| What could cause reduced granulocyte chemotaxis? |
|
Definition
- aging
- DM
- malnutrition
- hypothermia
- corticosteroids
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Term
| what could cause reduced neutrophil number (neutropenia) |
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Definition
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Term
| What could cause dysfunctional alveolra macrophages |
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Definition
- coricosteroids
- cytokines
- viral illnesses
- malnutrition
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Term
| What could cause diminshed Ab production or function |
|
Definition
- chronic lymphocytic leukemia
- multiple myeloma
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Term
| What type of Iatrogenic manipulations could influence spread of pneumonia? |
|
Definition
- endotracheal tubes
- nasogastric tubes
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Term
| How does tobacco cause pneumonia |
|
Definition
- disrupt mucociliary function
- distrupt macrophage activity
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Term
| How can alcohol influence spread of bacteria? |
|
Definition
- impair cough
- impair epiglottic reflexes
- colonize gram negative bacteria
- block TNF and neutrophil activation
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Term
| Role of aging in development of pneumonia |
|
Definition
- less effective mucociliary clearance and coughing
- changes in humoral and cell mediated immunity
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Term
| Causes of recurrent pneumonia |
|
Definition
- anatomic abnormality
- tumor
- compressed bronchus
- pum. sequestration
- foreign body
- bronchiectasis
- Ig deficiencies (CVID)
- depressed neutrophil function (CGD)
- cystic fibrosis
- abnormal ciliary activity
- immotile cilia syndrome
- Kartagener's syndrome
- Young's syndrome
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Term
| Symptoms upon taking history of pneumonia with typical pathogens |
|
Definition
- high fever
- chills
- productive cough
- dyspnea
- pleuritic chest pain
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Term
| Symptoms upon taking medical history with atypical pathogens |
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Definition
- low grade fever
- nonproductive cough
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Term
| Lobar pneumonia X ray findings |
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Definition
| focal pneumonia (bacterial cause) |
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Term
|
Definition
- epidemiology considerations
- age
- environment
- underlying conditions
- season
- blood cultures
- gram stain of sputum
- characteristic X ray appearance
- antigen tests (S. pneumonia, Legionella)
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Term
| Most common cause of community acquired pneumonia |
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Definition
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Term
| symptoms of Streptococcus pneumonia |
|
Definition
- shaking chills
- pleuritic chest pain
- rusty sputum
- suppurative complications
- sinusitis
- otitis media
- endocarditis
- meningitis
- parapneumonic effusion/empyema
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Term
| Pneumococcal vaccine (describe, who should get it, how often) |
|
Definition
- structure
- capsular polysaccharide from 23 serotypes
- who should git it
- age 65 and over
- chronic cardiac, pulm., renal disease
- DM
- alcoholics
- cirrhosis
- age
- splenic dysfunction
- HIV
- transplant patients
- military recrutis
- revaccinate after 5 years
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Term
| Hemophils influenza pneumonia (associated with what conditions?, symptoms) |
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Definition
- Char
- penicillin resistant due to beta lactamase production being common
- encapsulate strains more virulent
- associated w/:
- symptoms
- fevers
- chills
- cough w/purulent sputum
- pleural effusion
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Term
| Hib vaccine (type of vaccine, success) |
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Definition
- conjugate vaccine containing type b polysaccharide
- incidence of invasive disease remarkably reduced among children
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Term
| Klebsiella pneumoniae (associated with what, symptoms/signs, can lead to what type of pneumonia) |
|
Definition
- associated with:
- signs/symptoms
- sudden onset of prostration and toxemia
- fever
- chest pain
- dyspnea
- hemoptysis
- thick purulent sputum
- chronic necrotizing pneumonia
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Term
| Major causes of community acquired pneumonia |
|
Definition
- Streptococcus pneumonia
- Hemophils influenza
- Klebsiella pneumonia
- Staph aureus
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Term
| S. aureus (symptoms, MRSA pneumonia) |
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Definition
- symptoms
- fever
- multiple rigors
- dyspnea
- cough
- purulent sputum
- CaMRSA
- contains Panto-Valentine Leukocidin
- frequently see abscesses or lung cavities due to this enzyme
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Term
| S aureus (prim vs secondary pneumonia) |
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Definition
- primary
- follow viral infection esp. influenza or hospital acquired infection
- secondary
- hematogenous dissemination with multiple pulmonary nodules
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Term
| Bacterial causes of atypical pneumonia |
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Definition
- Legionella
- Mycoplamsa
- Chlamydophila
- Psittacosis
- Tularemia
- Q fever
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Term
| Common symptoms of atypical pneumona |
|
Definition
| cough most prominant symptom with a fever often absent |
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Term
| Symptoms, diagnosis of Legionella pneumophilia |
|
Definition
- symptoms
- high fevers
- Gi symptoms
- multilobar, rapid progression
- diagnosis by:
- serology
- culture of bronchial specimens (on charcoal yeast extract)
- PCR
- urinary Legionella Ag test, but only for serogroup 1 (but this is 90% of all Legionella pneumonias)
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Term
| Myocplasma pneumoniae (prevalence, symptoms, diagnosis) |
|
Definition
- most common of lower RT infection in young adults
- symptoms
- sore throat
- nonproductive cough
- headaches are prominent symptoms
- bullous myringitis (in children)
- extrapulm. manifestation
- rash
- DIC
- hemolysis
- meningoencephalitis
- myocarditis
- hepatitis
- diagnosis
- X rays often worse than clinical findings
- made clinically and confiremd by serology (cold agglutininis) or culture
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Term
| Chylamydophilia pneumoniae (demographic most effective, prominent symptoms) |
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Definition
- mainly effects college students
- hoarseness prominent
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Term
| Chlamydophilia psittaci (psittacosis) is associated with what in the patient history |
|
Definition
- associated with bird exposure
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Term
| Coxiella burnetti (Q fever) associated with exposure to what and what complications? |
|
Definition
- associated with exposure to sheep, goats, cattle
- complications
- endocarditis
- hepatitis
- osteomyelitis
- meningitis
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|
Term
| Franciella tularensis (tularemia) associated with what in the patient history |
|
Definition
- exposure to infected tissue of rabis or bite from infected tick
- requires Cys-enriched media for growth
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Term
| Pathology of aspiration/anaerobic pneumonia along with predisposing conditions |
|
Definition
- at risk in patients with
- impaired gag/cough reflex
- CNS disease
- alcohol accompanied by severe periodontal disease
- tonsillectomy
- tooth extraction
- esophageal dysfunction
- altered consciousness
- alcohol, anesthesia, drug OD
- leads to chemical pneumonitis, bronchial obstruction, and bacterial aspiration
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Term
| Nosocomial pneumonia pathogenesis and risk factors |
|
Definition
- colonization of oropharynx with pathogenic organism followed by aspiration
- risk factors
- age over 70
- severe underlying disease
- malnutrition
- comorbid conditions
- acidosis
- ventilator support
- sedatives
- narcotics
- steroids
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Term
| microbiology and treatment of nosocomial pneumonia |
|
Definition
- microbiology
- majority due to aerobic gram negative bacteria (Klebsiella, Enterobacter, Serratia, Pseudomonas)
- S aureus increasingly common
- treatment
- antibiotics should included anti-pseudomonal therapy
- therapy directed against aerobic gram negative bacilli and MRSA
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Term
|
Definition
|
|
Term
| Microbiology of emyemas and comp. of fluid within them |
|
Definition
- microbiology- mainly anaerobics
- Pleural fluid comp.
- low pH
- low glucose
- high LDH
- positive gram stain
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Term
|
Definition
- never let the sun go down on parapneumonic effusion
- requires chest tube if
- organisms on gram stain
- culture positive
- pH < 7.2
- glucose <20
- four weeks of antibiotics directed at pathogen cultured
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