1
Q
what family are influenza viruses a part of
A
orthomyxoviridae
2
Q
genera of influenza viruses
A
influenzavirus A
influenzavirus B
influenzavirus C
3
Q
Type A viruses
A
infect people and animals
4
Q
Type B and C viruses
A
only infect humans
5
Q
influenza structure
A
segmented negative ssRNA (8 different ssRNAs)
best example of reassortment
all 8 RNA segments enclosed in helical capsids
envelope with hemagglutinin (HA) and neuraminidase (NA) also very small amounts of M2 that is an ion channel to regulate pH
6
Q
hemagglutinin
A
responsible for entry of virus into cells
binds Nacetylneuraminic acid (sialic acid)
no role in disease
7
Q
neuraminidase
A
liquifies mucous in respiratory tract
removes Nacetyneuraminic acid from viral cellular proteins in affected cells
target of new anti flu drugs
8
Q
nomenclature
A
subtypes distinguished by differences in HA and NA molecules
this is because of anitgenic drift
only H1N1, H2N2, H3N2 circulate in humans
9
Q
antigenic shift
A
one subtype is found exclusively for several decades until its suddenly replaced by a different subtype
might occur when animal is infected with two different subtypes
only occurs in type A
10
Q
antigenic drift
A
in both types A and B
small changes in amino acid sequence of HA and NA due to mutation (no proofreading)
HA has 4 antigenic sites for antibodies and this causes gradual changes of amino acids at these sites
11
Q
seasonal flu
A
influenza A = annual epidemics around the world
spreads rapidly bc short incubation period
elderly and children most at risk
most common January-March
12
Q
flu pathogenesis
A
spread through inhalation of respiratory droplets
infect ciliated columnar epithelial cells
incubation 1-4 days
abrupt onset fever
symptoms last about 1 week
cell damage initiates an acute inflammatory response
virus interferes with respiratory tract clearing bc destroys ciliated and mucous secreting cells
more severe if primary viral pneumonia or secondary bacterial pneumonia occur
13
Q
elderly at risk for what
A
risk of complications
14
Q
children at risk for what
A
otitis media and bacterial infections
less than 3 may have GI symptoms
15
Q
flu diagnosis
A
based on clinical signs
rapid tests available
if its blue its flu zstat flu test
16
Q
flu treatment
A
symptomatic care (rest, fluids, antipyretics)
17
Q
antiviral treatment
A
neurominidase inhibitors - block active site of NA so blocks release of new virus
amantadine and rimantadine - block M2 channel, dont give pregnant women
flu vaccine - trivalent inactive contains both circulating type A viruses and one type B
live attenuated vaccine - reassortment with cold adapted strain of flu, better immune response, between 2-50
quadrivalent - protect against 4 different flu viruses
high dose vaccines for those 65 and older
18
Q
pneumocystis jirovecii
A
75% US children asymptomatic carriers
immunocompetent individuals very rare
85% AIDs pts develop
transmission via respiratory route
attaches and kills type 1 pneumocytes, serum leaks into alveoli, silver stain reveals holes in exudate, ground glass appearance on Xray
usually have elevated LDH
tx - TMP/SMX
19
Q
bronchopneumonia
A
patchy
20
Q
lobar pneumonia
A
entire lobe consolidation
typically bacterial infection (strep pneumonia, haemophilus influenza, klebsiella pneumonia, legionella pneumonia)
sudden onset of fever, chills, difficulty breathing
stages (congestion, red hepatization, gray hepatization, resolution)
21
Q
streptococcus pneumonia
A
most common community acquired
cultures often negative
22
Q
haemophilus influenza
A
most common bacterial cause of acute COPD exacerbation
also in cystic fibrosis or bronchiectasis
23
Q
moraxella catarrhalis
A
second most common cause of COPD exacerbation
can cause otitis media
24
Q
staph aureus
A
often follow viral respiratory illness
high risk of complications
important cause of hospital acquired
25
legionella pneumophilia
flourishes in atificial acquatic environments
often in patients with predisposing conditions
26
klebsiella pneumonia
most common gram negative bacterial pneumonia
thick gelatinous sputum
often malnourished or debilitated individuals
27
pseudomonas aeruginosa
occurs with cystic fibrosis and immunocompromised or neutropenic
associated with secondary coagulative necrosis of lung parenchyma
28
mycoplasma pneumonia
children and young adults
epidemics
29
early red hepatization
congested septal capillaries and numerous intraalveolar neutrophils
30
gray hepatization
early organization of intraalveolar exudate through pores of khon
31
advanced organizing pneumonia
exudates have been converted to fibromyxoid masses rich in macrophages and fibroblasts
32
laryngotracheobronchitis and bronchiolitis viral pneumonia
vocal cord swelling and abundant mucus production
plugging of small airways
can lead to fibrosis/obliterative bronchiolitis with permanent lung damage
33
viral pneumonia
congestion
interstitial reaction involving walls of alveoli
intraalveolar proteinaceous material and cellular exudate
34
coronavirus
many cause mild cold like infections
others highly pathogenic (SARS-CoV-2) - bind ACE2 protein in alveoli, often have acute lung injury or ARDS, many other manifestations
35
lung changes in coronavirus
edema, epithelial damage, capillaritis/endothelitis
exudative diffuse alveolar damage with hyalin membrane formation and pneumocyte hyperplasia
high viral load, lymphonia, massive secretion of proinflammatory cytokines
36
respiratory syncytial virus
enveloped single stranded RNA
major pathogen among young children
necrosis and sloughing of bronchial, bronchiolar, alveolar epithelium
lymphocyte inflammatory infiltrate
usually self limited, intubate when severe
37
aspiration pneumonia
aspiration of GI contents
aerobic and anaerobic organisms
chemical injury
can lead to lung abcess
38
necrotizing pneumonia/lung abcess
prominent necrosis of parenchyma and abcess formation
anaerobic bacteria common
abcess = local suppurative infection that produces necrosis of lung tissue
streptococci, s aureus, gram negative organisms
can be multiple
necrosis with central cavitation that can be filled with suppurative material
clubbing/weight loss, cough, foul smelling sputum
39
interstitial pneumonia
affects interstitial tissues (spaces around alveoli)
feathery infiltrates
inflammation and scarring of these tissues
shortness of breath, dry cough, fatigue
does not fill alveoli with fluid or pus
40
pneumonia treatment and prevention
handwashing
indiscriminate use fo antibiotics should be avoided
41
streptococcus pneumoniae (pneumococcal pneumonia)
gram positive diplococci
alpha hemolytic
not in lancefield classification system
antiphagocytic capsule
optochin sensitive
lencet shaped diplococci
lysed by bile
respiratory droplet transmission
sudden onset
usually lower or middle lobe
rust colored sputum
spontaneous crisis that often resolves without treatment 5-10 days after onset
42
strep pneumonia phases
congestion - pneumococci replicate in alveoli causing edema
red hepatization - infiltration and accumulation of RBCs, bacteria, and PMNs
gray hepatization - alveoli contain PMNs but no detectible pneumococci, fibrin nets form exudate
resolution - lesions heal without scarring, can spread to pleural cavity or pericardium, disseminates by lymphatics
43
strep pneumonia vaccine
50 and older
19-50 with certain medical conditions
previously recived PCV13 may recieve PPSV23 if 65 or older
less than 5
children older than 5 with chronic disease
44
pneumococcal conjugate vaccine (PCV13)
purified polysaccharide conjugated to a nontoxic variant of diptheria toxin
all children 2-59 3 doses at 2 month intervals
booster 12-15 months
greater than 65
45
pneumovax and pnuimune
purified polysaccharide antigens from 23 types
46
s. pneumoniae vaccine administration
>65 second vaccine if got vaccine >5 years ago and were less than 65 when got it
elderly with unknown vaccine status should get vaccine
antibody levels remain elevated for 5 years but fall to prevaccination levels within 10 years
47
pneumococcal conjugate vaccine (PCV23)`
prevent pneumococcal disease caused by 23 serotypes in vaccine
48
staph aureus
small yellow colonies on blood agar, beta hemolytic
coagulase positive (other staph species negative)
catalase positive
ferments mannitol on mannitol salt agar
49
staph aureus pneumonia
often occurs in sequela of influenza
opportunistic - impaired immune function
acute pneumonia
requires culture
productive, salmon colored sputum, rapid onset, higher rate of necrosis, nosocomial
50
klebsiella
found in GI tract, member of enterobacteriaceaee family but lack motility
gram negative rods
antiphagocytic capsule
often aspirate from own respiratory tract
often hospitalized or COPD, diabetes, or alcoholism
51
klebsiella pneumonia
severe lobar pneumonia
pleuritic pain, thick bloody sputum with thinner consistency and is bright red
may get abcess or severe lung necrosis
52
legionella
gram negative aerobic rod (facultative intercellular bacteria)
polar flagella
small numbers in fresh water
weakly oxidase positive, catalase positive, urease negative
require iron and L cysteine for growth
chlorine resistant
53
legionnaires disease
high fever, headache, muscle aches
acute purulent pneumonia 2-10 days after exposure
induce lysis and death of infected macrophages, release new organisms, infected macrophages release potent stimulators
early pleural effusion
lower lobe predominance
hyponatremia
detected in urine antigen test
54
pontiac fever
flu like illness
fever, headache, diarrhea, malaise
no pneumonia
remits spontaneously
55
mycoplasma pneumoniae
gram negative
lack cell wall
pleomorphic
facultative - glucaose and arginine source
tracheobonchitis to primary atypical pneumonia
ciliostasis = dry hacking cough
attachment mediated by P1 protein
cold hemagglutinins
lower lobes
56
coxiella
gram negative obligate intracellular parasites
inhale aerosols
highly infectious
q fever
57
Q fever
mild atypical pneumonia
2-6 weeks after exposure
high fever, chills, headache, myalgia, vomiting, diarrhea
can have hepatitis, liver tenderness
spontaneous recovery in 1-2 weeks
doxycycline
58
chronic Q fever
years after inital infection
may have endocarditis
fever, clubbing of fingers, splinter hemorrhages
doesnt respond to treatment
59
coronaviridae
spherical positive ssRNA
helical capsid
transmitted by respiratory droplets
high frequency of recombination
onset 10-14 days after exposure
pneumonia with bilateral infliltrates
mild respiratory illness to severe disease
implement infection control measures
testing with RTPCR and immunodetection
60
human respiratory syncytial virus (RSV)
no hemagglutinination or neuraminidase
cause bronchiolitis and pneumonia in children
infants often have to be hospitalized
nosocomial spread common
survive in droplets on skin or in environment
localized infection of ciliated mucosal epithelial cells and virus shed for 5 days
reactive bronchi
diagnosis with viral antigen detection
tx = supportive
61
chlamydophila
tropism for columnar epithelial cells of respiratory tract
parrot fever, community acquired pneumonia
psittacosis - generalized systemic symptoms with CNS envolvement, incubate 1-3 weeks
mild pneumonia or prolonged bronchitis
suggest association with atherosclerotic plaques
62
nocardia
gram positive filaments breaking up into rods, aerobic, partially acid fast
in soil and dust
exogenous transmission (airborne or traumatic implantation)
immunosuppression and cancer predisposed
nocardiosis - cavitary bronchopulmonary or multiple brain abcesses, skin lesions with cellulitis and draining
63
serratia marcescens
motile gram negative rod
blood red at room temp
pneumonia and sepsis with reticuloendothelial cancer receiving chemo
64
yersinia pestis
gram negative coccobacilli
lactose negative on macconkeys
bipolar safety pin staining
salvatic - zootic
urban - humans from fleas
demic - human to human
disseminated intravascular coagulation
can spread to lungs
bubonic, septicemic, pneumonic (hemorrhagic pneumonia with lower lobe consolidation)
65
bunyaviridae
segmented enveloped virus
encephalitis in four corners region
exposure to rodent excrement
66
hantavirus
inhalation of rodent feces - four corners region
prodrome fever and constitutional symptoms
progress to pulmonary syndrome with pulmonary edema and effusion leading to hypotension and shock
67
endymic mycoses
blastomycosis
coccidioidomycosis
histoplasmosis
paracoccidioidomycosis
68
blastomycosis
dead or decaying matter
southeastern or central states
ohio and mississippi river valley
inhale infectious particles causing asymptomatic, pulmonary, or extra pulmonary disseminated disease
69
blastomycosis pulmonary infection
mild flu like illness
severe - high fever, lobar infiltrates, cough
fulminant adult respiratory distress - high fever, diffuse infiltrates and respiratory failure
subacute or chronic - resemble tuberculosis or lung cancer, pulmonary mass or fibronodular infiltrates
70
blastomycosis pathology
sputum, bronchoalveolar lavage, or lung biopsy
broad based budding yeast
mycelial form not diagnostic must convert to yeast
immunodetection - exoantigen A
tx - amphotericin B
71
coccidioidomycosis
san joaquin valley fever
C. immitis in california
C. posadasii outside of california
southwestern US
inhale infectious particles (arthroconidia)
conversion to spherule in lung
72
coccidioidomycosis presentation
primary disease = asymptomatic in most, flu like illness, hypersensitivity
secondary disease = nodules, cavitary disease or progressive pulmonary disease
disseminated disease = chronic/fulminant
73
coccidioidomycosis pathology
sputum, exudate, or tissue
endosporulating spherule
agglutination and precipitin test, complement fixation
tx = primary supportive, secondary amphotericin B
74
histoplasmosis
soil, bat and avian habitats
ohio and mississippi river valleys (soil with nitrogen)
inhale microconidia aerosolized by disturbance of soil
75
histoplasmosis presentation
pulmonary infection - asymptomatic, self limited flu like, lymphadenopathy and pulmonary infiltrates
progressive pulmonary - chronic symptoms (apical cavities and fibrosis, progressive destruction secondary to immune response)
disseminated - chronic (loss of weight/fatigue, oral ulcers), subacute (fever, weight loss, malaise, ulcers, bone marrow involvement), acute (fulminant process in immunocompromised, septic shock like)
76
histoplasmosis pathology
sputum, tissue, bone marrow, CSF, blood
normally clustered intracellularly in macrophages
antigen and antibody detection
tx = amphotericin B
77
paracoccidioidomycosis
thermal dimorphic (suprobic and parasitic phase)
central and south america
inhalation or traumatic inoculation
78
paracoccidioidomycosis presentation
latent - reactivate when defense impaired
symptomatic - chronic pulmonary disease, respiratory issues, disease progression leads to persistent cough, purulent sputum, chest pain, dyspnea, fever, nodular lesions in lungs
79
paracoccidioidomycosis pathology
sputum, bronchoalveolar lavage, CSF, biopsy
multiple bids in a ring
immunodetection - exoantigen 1,2,3
tx = amphotericin B
80
opportunistic mycoses
exogenous or endogenous
risk factors - promotion of fungal colonization, immunosuppression, direct vascular access, exposure to pathogen
candidiasis
cryptococcus
aspergillosis
zygomycosis/mucormycosis
81
cryptococcosis
organ transplant or respiratory inhalation
yeast spores deposited in alveoli and phagotized (capsule has antiphagocytic properties)
pulmonary - asymptomatic, flu like, fulminant bilateral pneumonia
disseminated - meningitis, cryptococcoma, skin lesions
encapsulated budding yeast
latex agglutination
tx = amphotericin B + flucytosine, fluconazole in AIDS
82
aspergillosis
in air, soil, decaying matter
almost always immunosuppressed
allergic bronchopulmonary - hypersensitivity reaction
chronic necrotizing - subacute infection, cavitary pulmonary infiltrate
aspergilloma - fungus ball in preexisting cavity
invasive aspergillosis - rapidly progressive, fever, cough, dyspnea, pleuritic chest pain, hemoptysis
septate hyphae that branches at acute angles
grow in cycloheximide
tx = steroids, surgery, antifungals
83
hypoxemic respiratory failure
PaO2 < 60 mm Hg on 60% oxygen
alveolar capillary unit problem (V/Q mismatch, diffusion limitation, right to left shunting)
non alveolar capillary unit problems (alveolar hypoventilation, high altitude, low mixed venous O2)
84
hypercapnic respiratory failure
PaCO2 > 45 mm Hg and pH < 7.35
1. abnormalities of airway and alveoli with airflow obstruction and air trapping (open airway)
2. abnormalities of chest wall (correct mechanics)
3. abnormalities of CNS (reversal/pharm/pt)
4. neuromuscular conditions (treat underlying issue/pt)
85
noninvasive mechanical ventilation
BPAP = bilevel positive airway pressure
acute-on-chronic respiratory failure related to COPD exacerbations
preset positive pressure applied during inspiration and low pressure applied during expiration
fever complications than mechanical ventilation
86
conventional mechanical ventilation
cuffed endotracheal tube
optimize oxygen while avoiding ventialtor induced lung injury
different modes characterized by a trigger
87
respiratory acidosis acute change
change pH = 0.08 x (PaCO2 - 40) /10
88
respiratory acidosis chronic change
change pH = 0.03 x (PaCO2 - 40)/10
89
respiratory alkalosis acute change
change pH = 0.08 x (40 - PaCO2)/10
90
respiratory alkalosis chronic change
change pH = 0.03 x (40 - PaCO2)/10
91
oxygen transport to tissues (DO2)
DO2 = cardiac output x oxygen content of arterial blood (CaO2)
CaO2 = (1.34 x Hgb x SaO2) + (0.03 x PaO2)
DO2 = cardiac output x (1.34 x Hgb x SaO2)
92
alveolar arterial gradient
PAO2 = PIO2 - PACO2
PIO2 - (760 mm Hg - 47 mm Hg H2O) x 0.2093
PIO2 = 149 mm Hg at sea level and room temp
PACO2 = PaCO2/R (R=0.8)
so PAO2 = 149 - PaCO2/0.8
A-a = PAO2 - PaO2 (usually 5 to 15 in healthy)
age normal A-a = 0.3 x age
93
diffusion limitation
minimal effect on hypoxemia
interstitial lung disease, emphysema, alveolar hemorrhage
tx = oxygen
94
right to left shunting
hypoxemia due to perfusion of non ventilated alveoli
causes ARDS, severe pneumonia, pulmonary edema, intracardiac shunt
responds best to positive end expiratory pressure
95
acute lung injury and ARDS
FaO2/FiO2 less than 200 (less than 300 for ALI)
CXR with bilateral infiltrates compatible with pulmonary edema
acute
no cardiogenic pulmonary edema and PAWP < 18
diffuse alveolar damage
96
primary causes of ARDS
pneumonia, aspiration of gastric contents, pulmonary contusion, fat emboli, near drowning, inhalation injury, reperfusion pulmonary edema after transplant
severe sepsis, trauma, cardiopulmonary bypass, drug overdose, acute pancreatitis, blood product transfusions
97
ARDS treatment
correct underlying issue
mechanical ventilation through lung protective strategies
fluid management
nutrition
sedation and paralysis
DVT, ulcer, nosocomial pneumonia prophylaxis
98
complications of pneumonia
bronchiectasis
lung abscess
pleural effusion
99
empyema
collection of pus in pleural cavity
100
pleural effusion
accumulation of fluid in pleural space
exudate - inflammatory or malignant, high protein and LDH
transudate - alteration of hydrostatic or oncotic forces, low protein and LDH
101
causes of pleural effusions
infectious, neoplastic, congestive heart failure, cirrhosis
102
radiographic findings in pleural effusion
straight line or meniscus in effusion (fluid level)
fluid may shift when patient in lateral recumbant
CT will identify effusion
103
light criteria
distinguish between transudate and exudate
to be an exudate it must meet one of the following - protein/serum ratio > 0.5, LDH/serum ration >0.6m pleaural fluid LDH > 2/3 upper limit of normal for serum LDH
104
pleural effusion treatment
treat CHF wtih diuresis
treat malignancy or pulmonary embolism
thoracostomy and drainage for more aggressive
105
bronchiectasis
irreversible airway dilation
focal or diffuse
infectious or noninfectious origin
vicious cycle hypothesis - susceptible to infection and poor clearance cause microbial colonization or bronchial tree
may be immune mediated reaction damaging bronchial wall and parenchymal distortion bc fibrosis
persistent productive cough with thick tenacious sputum, crackles and wheezing, digital clubbing
tx - treat infections, hydration and mucolytics, 3+ occurances a year get suppressive antibiotics
106
lung abcess
necrosis and cavitation of lung
primary - aspiration, often polymicrobial, often posterior upper and superior lower lobes of right lung
secondary - underlying condition due to many organisms (most often gram negative rods)
CT for diagnosis
tx - antibiotics
107
mycobacterium
found in soil and water
facultative intracellular aerobic gram positive bacilli
acid fast
produces niacin
macrophage is host cell
cord factor - grows as rope like aggregate, inhibits fusion of macrophage with lysosome in phagosomes, stimulates granuloma formation, block PMN migration
sulfatides - block or reverse priming of monocytes, protects from intracellular killing
108
TB susceptibility
HLA predisposition
age and physiologic state
native americans, eskimos, asians, hispanics, blacks
109
TB infection
halmark is formation of granulomas around foci of infection
host immunity depends on antimycobacterial cell mediated immune (CMI) response
CMI requires release of cytokines
110
TB transmission
droplet aerosol discharge in air
entry usually lower respiratory
patients with cavitary pulmonary or laryngeal tuberculosis likely to spread disease
111
primary TB infection
pneumonic
mild flu like symptoms
inflammatory cellular exudates appear
dissemination from initial site by lymphatics and blood to seed other organs
children develop hilar lymphadenopathy
after several weeks the bacteria stop multiplying and you become TB positive
ghon complexes
112
secondary TB infection
usually reactivation
initial lesions have necrosis and localized bc CMI response
bacilli multiply only initially on necrotic area
localized early but spreads as bronchus erode or blood vessels erode
extension into adjacent tissues and allergic inflammation cause necrosis
disseminated form is milliary
weight loss, FUO, night sweats, cough longer than 3 weeks
113
TB test
delayed typer hypersensitivity
positive appears 3-4 weeks after infection and persists for years
indicates previous infection with TB
old tuberculin - autoclaved or boiled culture
purified protein derivative - grown in synthetic medium, autoclaved, filtered, precipitated
114
TB prevention
immunization with BCG vaccine - live vaccine, not used in US
115
atypical mycobacterium
mycobacterium avium intracellulare (MAC)
opportunistic pathogen
enter immunocompromised through GI
multiply in GALT for 4-5 months
chronic diarrhea
pulmonary, subacute lymphadenitis, disseminated
116
how do babies breathe
obligate nasal breathers until 2-6 months age
unless it is blocked then they breathe out of their mouth
117
children anatomical differences
airway smaller in diameter and shorter in length
tongue larger
larynx more anterior
epiglottis long, floppy, narrow
children < 10 narrowest portion of airway is below glottis
118
alveoli growth
full term infant has 25 million alveoli (adult has 300 million)
growth occurs in first 2 years mainly and finished by year 8
119
airway resistance
major factor is diameter
small changes can have big change in resistance
120
tachypnea for kids
< 2 months > 60 bpm
2-12 months > 50 bpm
1-12 years > 40 bpm
> 12 years > 30 bpm
121
laryngotracheaobronchitis (croup)
acute stridor in young, acute onset, barking cough, hoarseness, contractions
usually follows URI
3-7 days
caused by parainfluenza virus
mild tx - single dose dexamethasone IM or oral
moderate to severe tx - nebulized racemic epinephrine + oral or IM dexamethasome
if persistent when calm and resting hospitalize
122
epiglotitis
swelling or epiglottis
H influenzae common
physician skilled in airway management must accompany child at all times
tripod posture
123
bronchiolitis
inflammatory disease of lower respiratory tract with obstruction of small airways
RSV primary cause
extremely contageous, coughing aerosolizes it but hand carries it
ssRNA paramyxovirus
incubation 4-6 days (appears as URI in first 3 days)
low grade fever, irritability, very young may not have prodrome
prolonged expiratory phase, nasal flaring, retractions, hyperexpansion of lungs
CXR - hyperinflation, peribronchial cuffing, patchy atelectasis
tx - supportive
124
foreign body aspiration
usually < 3
rapid diagnosis and retrieval improves outcomes
cough, wheeze, unilateral breathe sounds, stridor
if remains in the lungs may get persistent cough, sputum production, recurrent unilateral pneumonia
125
tracheomalacia
floppy trache due to lack of structural integrity of tracheal wall
cartilage rings may not extend as far around
collapse pronounced during expiration
congenital or acquired from mechanical ventilation
aggravated by respiratory infections
expiratory noizes
126
aspergillosis
allergic manifestations in healthy individuals
serious sinusitis, pneumonia, and invasive disease in immunocompromised
alveolar macrophages exposed to antigens
septate filaments branching at acute angles
necrotizing pneumonia, invades blood vessels
127
mucormycosis
nonseptate hyphae with irregular width and right angle branching
lungs, nasal sinuses, GI areas
infect immunosuppressed
transmission is airborne
macrophages provide initial defense
availability of free iron increases probability of infection
128
cryptococcosis
inhalation of spores from pigeon droppings
small parenchymal granulomatous nodules
most serious in immunocompromised
narrow based budding with thick mucoid capsule
methenamine silver common stain
CNS involvement
129
coccidioidomycosis
delayed hypersensitivity reaction
southwest US
alveolar macrophages it blocks fusion of phagosome and lysosome which prevents it getting killes
thick walled nonbudding spherules often filled with endospores
granulopmatous, pyogenic, or mixed inflammatory response
130
blastomycosis
central and SE US
pulmonary, disseminated, or primary cutaneous
granulomas, thick double contoured cell wall with visible nuclei
focal lesion with central necrosis and purulent reaction
broad base budding
131
histoplasmosis
ohio and mississippi river
resemble TB with granulomas with caseous necrosis
silver stain
thin walled yeast
132
pneumocystis
P. jirovecii
opportunistic infection in HIV
cysts have cup shaped appearance
alveolar thickening with eosinophilic exudate in lumen of lung
humoral and cellular immune response
silver stain
133
flu contagiousness
may infect others begining 1 day before symptoms develop and up to 5-7 days after becoming sick
most contagious in first 3-4 days after illness began
134
flu prevention
wash hands, good hygeine, avoid sick contacts
flu vaccine
135
flu vaccines
inactivated - killed version (egg based) IM injection
recombinant - purified HA antigen, IM injection
live attenuated - weakened (nasal mist in each nostril, only 2-49 yrs)
high dose or adjuvanted - from inactivated or recombinant
trivalent for all in 2025-2026
generally recommended in all over 6 months
high risk - elderly, children < 5, long term care facilities, pregnant/postpartum, american indians, alaskan natives
136
child flu vaccine dosing
children 6 months to 8 years getting vaccinated for the first time or those who previously only got one dose need to get two doses 28 days apart
137
antiflu meds
oseltamivir and zanamivir
peramivir
baloxavir
side effects - upset stomach mainly, drug interactions, drug resistance
138
neuraminidase inhibitors
oseltamivir (tamiflu) - acute uncomplicated flu A and B, taken within 2 days of symptoms, cause nausea/anaphylaxis/neuropsych affects (>1 prophylaxis, >2 months treatment, pregnant women)
zanamivir - powder inhaled through mouth, first 12 hours of illness, no milk allergy or underlying respiratory disease, cause bronchospasm and allergic reactions (> 5 prophylaxis, > 7 treatment)
peramivir - IV within 2 days, no prophylaxis, treatment for > 6 months, cause serious skin reactions and neuropsych events
prevent influenza from leaving infected cell
reduce illness duration, severity, and risk of transmission
139
endonuclease inhibitor of polymerase acidic protein
baloxavir - stop gene transcription
5-12 with no medical conditions
all people over 12
not in pregnant
cause stomach upset, bronchitis, nasopharyngitis
140
M2 ion cahnnel inhibitors
amantadine - prophylaxis against flu A symptoms, tx of parkinsons, causes insomnia and seizure disorders, anticholinergic affects
rimantadine - prophylaxis for flu A, lower CNS toxicity and preferred over amantadine, anticholinergic/HCTZ/triamterene interactions
block M2 proton ion which interferes with uncoating of viral RNA which prevents viral replication
only affective against flu A
given within 24 hours after onset of symtpoms
high levels of resistance so not recommended for treatment or prophylaxis
141
pertussis (whooping cough)
gram negative coccobacilli
tx - azithromycin/clarithromycin/erythromycin (macrolides) OR TMP/SMX
prophylaxis - TDAP vaccine
142
macrolides "mycin"
bind 50s ribosomal subunit to inhibit protein synthesis
cytochrome P450 A inhibitor, can cause QT prolongation and torsades de pointes
143
SMX/TMP
sulfonamides completely inhibit incorporation of PABA into dihydropteroic acid
trimethoprim is an inhibitor of dihydrofolate reductase blocking synthesis
used in MRSA, gram negative bacilli, listeriosis
contraindicated - newborn and last 2 months of pregnancy
side effects - SJS, nephrotoxicity, hemolytic anemia, hepatitis, kernicterus
144
RSV tx
ribavirin - triazine riboside analog, inhibits viral RNA polymerase and protein synthesis NOT RECOMMENDED
supportive care - SABA and/or ICS or oral glucocorticoids
vaccine - 60 or older
145
pneumonia treatment administration route
outpatient - oral
inpatient - IV
typically 10-14 days
146
typical pneumonia
strep pneumo
h influenzae
moracella catarrhalis
staph aureus
rapid onset, severe symtpoms, productive cough, dense consolidation on XRAY
147
atypical pneumonia
mycoplasma pneumoniae
chlamydophila pneumoniae
legionella
slower onset, patchy interstitial pattern on XRAY
148
determining outpatient or inpatient
use CURB 65
C - confusion
U - BUN > 19 mg/dl
R - RR > 30
B - BP < 90/60
65 - age
1 or less = outpatient
> 1 = inpatient
149
when to admit to ICU
severe COPD
post influenza
suspected gram negative bacilli
risk of penicillin G resistant S. pneumoniae
150
outpatient community acquired pneumonia therapy
no comorbidities - amoxicillin +/- macrolide or doxycycline
with comorbidities - amoxicillin/clavulinate + macrolide or doxycycline
151
inpatient community acquired pneumonia therapy
not ICU - antipneumococcal B lactam (ceftriaxone, cefotaxime, ceftaroline, ertapenem, amp/sulbactam) AND azithromycin
ICU - antipneumococcal B lactam + azithromycin + vancomycin or linezolid (change B lactam to antipseudomonal if pseudomonas is possible)
152
hospital acquired pneumonia treatment
antipseudomonal B lactam - pip/tazo, cefepime, ceftazidime, imipenem, meropenem
non antipseudomonal B lactam - levofloxacin, ciprofloxacin, amikacin, gentamicin, tobramycin
anti MRSA - vancomycin, linezolid
153
acinetobacter pneumonia treatment
ventilator associated
imipenem or meropenem
154
legionella pneumonia treatment
levofloxacin
or azithromycin
155
aspiration pneumonia treatment
outpatient - omicillin/clavulanate
hospitalized - ampicillin/sulbactam
hospital acquired - imipenem or meropenem or pip/tazo
156
histoplasmosis
itraconazole
amphotericin B if bad
157
blastomycosis
blast it with amphotericin B
158
coccidioimycosis
risk for complications fluconazole/itraconazole or amphotericin B if bad
159
paracoccidioidomycosis
amphotericin B
ketoconazole of TMP/SMX alt
160
aspergillosis tx
voriconazole
liposomal amphotericin B
161
TB therapy overview
intensive 2 month phase (RIPE)
continuation phase of 4-7 months (rifampin + isoniazid)
162
first line TB drugs
Rifampin - inhibit synthesis of RNA from DNA by inhibiting RNA pol, can cause hepatitis/flu like syndrome/allergic rxn, drug interactions with cytochrome drugs bc it ramps it up, red/orange body fluids
Isoniazid - prodrug that inhibits one or more enzymes needed for synthesis of mycolic acid needed for mycobacterial cell wall, rapid resistance if used alone (but is used alone for prophylaxis), can cause hepatitis and peripheral neuritis, is a CYP inhibitor
Pyrazinamide - disrupts mycobacterial cell membrane metabolism and transport functions, can cause hyperuricemia/hepatotoxicity
Ethambutol - inhibits arabinosyl transferase which inhibits cell wall construction, can cause optic neuritis/hypersensitivity, doesnt cause liver damage
163
alternative TB drugs
ethionamide - similar to isoniazid, cause gastric irritation and neuro symtpoms
ciprofloxacin
rifabutin
amikacin
streptomycin
164
TB prophylaxis
isoniazid for 6-12 months or rifampin for 4 months if isoniazid resistant
165
lung cancer prevalence
second most common in men and women
most common cause of cancer mortality
breast/prostate then lung then colorectal
166
small cell and squamous cell mutations
loss of function
167
adenocarcinoma mutation
gain of function
168
paraneoplastic syndromes
common in small cell
cushing syndrome, hyponatremia, hypercalcemia, hypocalcemia, gynecomastia, carcinoid syndrome, lambert eaton, peripheral neuropathy, DVT/thromboembolism, clubbing of fingers
169
pulmonary hamartoma
composed of cartilage, smooth muscle and entrapped respiratory epithelium
170
precursor legions
atypical adenomatous hyperplasia (adenocarcinoma)
adenocarcinoma in situ aka bronchoalveolar carcinoma (adenocarcinoma)
squamous dysplasia and carcinoma in situ (squamous cell)
diffuse idiopathic neuroendocrine hyperplasia (carcinoids)
171
malignant lung tumors
small cell carcinoma
non small cell carcinomas = adenocarcinoma, squamous cell carcinoma, large cell carcinoma
neuroendocrine tumors (carcinoid)
lymphomas
sarcomas
metastatic carcinomas
172
squamous cell carcinoma
smoking related
central (pancoast tumor or superior vena cava syndrome)
squamous differentiation with intracellular bridges or keratinization
tx = sx, chemo, radiation
173
adenocarcinoma
most common overall
more in women
not strongly smoking related
peripheral
atypical glandular epithelium, TTF1, smaller tumor spread along alveolar septae
tx = sx, chemo, radiation
174
large cell carcinoma
undifferentiated, large nuclei, prominent nuclei, moderate cytoplasm
either undifferentiated squamous cell or adenocarcinoma
neuroendocrine forms occur
central or peripheral
175
small cell carcinoma
associated with smoking
central but can arise from bronchi or peripheral
aggressive with early metastasis, cant sx
paraneoplastic syndromes
neuroendocrine tumor
chemo, radiation
176
carcinoid
forms from cells that release hormones
dense core granules, produce ACTH, stain for serotonin, neuron specific enolase, chromogranin, synaptophysin
located in bronchi but can penetrate bronchial wall
does not metastasize
177
most common type of lung cancer
metastatic tumor
178
staging
t = size
n = node
m = metastasis
small cell = limited or extensive
179
interstitial lung disease
involves spaces and tissues around alveoli
diffuse parenchymal lung disease
inflammation and fibrosis OR granulomatous change
180
hypersensitivity pneumonitis
inflammatory syndrome of lung caused by repetitive inhalation of organic dusts
type 3 and 4 hypersensitivity
farmers lung - moldy hay, tx by removing source
byssinosis - cotton dust, chronic after 10 years of exposure
silo fillers disease - inhaling nitrogen dioxide, acute illness
berylliosis - beryllium in metal, similar to sarcoidosis, acute pneumonitis, tx w steroid
181
pneumoconioses
deposition of mineral dust in lungs
usually diagnosed w imaging
silicosis - sand, produce collagen, small rounded opacities, lead to respiratory failure, tx w lung lavage
asbestosis - asbestos, plumbing/electric/ships/insulation, damage epithelium and cause fibrosis, latency occurs, bibasilar crackles/pleural thickening/restricitve findings
coal workers (anthracosis) - coal dust, centrilobular emphysema or larger lesions of fibrosis, rapidly evolving round densities
182
mesothelioma
malignant tumor of pleura from asbestos exposure
pleural plaques and pleural effusion
183
foregut cysts
derived from premitive gut
abnormal ventral budding of the tracheobronchial tree
bronchogenic, esophageal, or enteric
cartilage glands in walls and lining of respiratory epithelium
often contain fluid
184
pulmonary sequestrations
mass in or near lungs composed of pulmonary tissue
vascular supply from aorta and its branches
extralobular or intralobular
tx - address complications, sx if symptomatic
185
pulmonary hypoplasia
defective development caused by abnormalities that compress lungs or impede normal development
tx - address underlying condition, support, echmo
186
atelectasis
incomplete expansion of lungs or collapse of previous inflated lungs
resorption - bc occlusion, mediastinum shift toward
compression - bc accumulated fluid/air/tumor, mediastinum shift away
contraction - with fibrosis
tx - treat underlying prob, supportive
187
chylopthorax
accumulation of lymph in pleural cavity bc obstruction of thoracic duct
tx - thoracentesis
188
metastatic pleural disease
most frequently from lung and breast
189
solitary fibrous tumor
soft tissue tumor that can arise in pleura
fibroblastic origin
inversion of chromosome 12 causing NAB2-STAT6 fusion gene
CD34 positive and keratin negative
190
mesothelioma
asbestos exposure
latent period
smoking does not increase incidence, but smoking and asbestos greatly increase incidence of carcinoma
chest pain, dyspnea, recurrent pleural effusions
ACOM
flashcards
Decks in class (23)
# Cards
-
Exam Block 2158
-
Molecular Medicine Block 3359
-
anatomy block 3105
-
anatomy block 4215
-
molecular medicine block 4174
-
Anatomy Block 5222
-
Molecular Medicine Exam Block 5299
-
Neuro Block 1123
-
Neuro Block 2102
-
Neuro Block 3198
-
MSK Exam 1206
-
MSK Exam 2344
-
Heme Lymph Exam 1324
-
Heme Lymph Exam 2491
-
Derm Exam 1295
-
Derm Exam 2140
-
Cardio Block 1307
-
Cardio Block 2261
-
cardio block 3272
-
Respiratory Exam 1299
-
Respiratory Exam 2208
-
Respiratory Exam 3190
-
Renal Exam 1216
