Pneumonia (SultanAli)

Question 1

How is pneumonia characterized?

Answer 1

1. fever/chills
2. respiratory signs and symptoms
   (cough, dyspnea, hemoptysis, pleuritic pain, expectoration)
3. at least one opacity on CXR
4. possible flu-like symptoms

Question 2

T/F: lung infection has the greatest global burden of all diseases

Answer 2

T

Question 3

____ is the #8 leading cause of death in the US

Answer 3

community acquired pneumonia

Question 4

Who is most commonly infected with pneumonia?

Answer 4

very young and the elderly (bimodal disease)

Question 5

What are the risk factors for comm acquired pneumonia?

Answer 5

1. age (very young and very old)
2. personal habits (etoh/smoking)
3. comorbidities
4. immunodeficiency (neutropenia, asplenia)
5. occupational (soldiers, animal exposure)
6. geographic

(*do we need to learn the specifics?)

Question 6

Marijuana use increases the risk of infection by what organism?

Answer 6

Aspergillus

Question 7

Common causes of CAP in patients who do NOT require hospitalization:

Answer 7

Streptococcus
Pneumoniae
Mycoplasm
Chlamydia
Haemophilus

(Severe Pneumonia Makes me Cough Hard)

Question 8

Common causes of severe CAP

Answer 8

Strep pneumoniae
enteric g- bacilli
Staph aureus
Legionella
Mycoplasma pneumoniae
Respiratory viruses
Pseudomonas aeruginosa

Question 9

Routes to the lung:

what are the two most common?

Answer 9

*aspiration
*inhalation
hematogenous
contiguous spread
reactivation (more common in immunocompr)

Question 10

Hospital acquired pneumonia usually results from what route to the lung?

Answer 10

inhalation

Question 11

By what routes does TB infect?

Answer 11

inhalation

reactivation in immunocompromised indv

Question 12

What three factors determine if exposure will result in pneumonia?

Answer 12

1. host defenses
2. agent virulence
3. inoculum load

Question 13

What are common oral flora?

Answer 13

anaerobes
gram + cocci
alpha-hemolytic strep
Moraxella sp.

Question 14

What flora are common sub-epiglottis?

Answer 14

none–it’s sterile

Question 15

What type of infections are related to:
hospitalizations?
antibiotics?
dental/gum disease?

Answer 15

g-
superinfections
anaerobes

Question 16

What are mechanical host defense mechanisms?

Answer 16

gag/sneeze
cough reflex
mucus/cilliary

Question 17

How do macrophages function in host defense?

Answer 17

1. initial defense against pathogens–prevent in alveoli
2. eliminate intracellular organisms (Legionella)
3. “clean-up”
4. APC

Question 18

What cellular immune cells protect against:

1. TB
2. bacteria
3. fungi

Answer 18

1. T cell lymphocytes
2. B cell lymphocytes
3. T cell lymphocytes

Question 19

Level of hypoxia correlates with:

Answer 19

severity of disease

Question 20

How does pneumonia cause hypoxia?

Answer 20

shunt**

Question 21

What cytokines are produced by inflammation?

What does this cause?

Answer 21

TNF, IL1, IL6, PAF

cellular damage > capillary leakage

Question 22

Exudate and pus in the lungs causes:

Answer 22

impaired gas exchange

Question 23

Pneumonia = infection of:

Answer 23

lung parenchyma

Question 24

What three symptoms, when present, correlate to a pneumonia likelihood ratio of 5?

Answer 24

fever + tachypnea + tachycardia

Question 25

Chest exam findings that = pneumonia: (7)

Answer 25

1. dullness to percussion
2. increased fremitus
3. egophony
4. crackles
5. pleural friction rub
6. rales (in sitting position)
7. bronchial breath sounds (louder and harsher than vesicular breath sounds)

Question 26

What is the function of quantifying characteristics of patients with pneumonia (pneumonia severity index)?

Answer 26

determine risk of mortality in order to drive decisions for management (admit, ICU, discharge, etc)

Question 27

What are the pneumonia severity index criteria?

Answer 27

consciousness
BUN
resp rate
BP 65

Question 28

CAP results in __% requiring ICU admission; among those patients, there is a ___% mortality rate

Answer 28

2

35

Question 29

How is pneumonia confirmed?

Answer 29

CXR