Pneumonia (Peine)

Question 1

What factors influence disease penetrance

Answer 1

• host defenses (immune strength, genetics, past exposure)
• environmental factors during exposure
• pathogenic load

Question 2

List 4 pathophysiologies of pathogenicity

Answer 2

• aspiration (micro vs macro)
• hematogenous spread (blood)
• direct extension (spread from adjacent organs/structures)
• direct inoculation (non-sterile procedure, etc.)

Question 3

List some macro risks to aspiration

Answer 3

organisms gaining access to lower resp tract
- deep sleep/coma
- substance intox
- post-CVA dysphagia
- poor dentition

Question 4

List some mechanical host defenses against pneumonia

Answer 4

• hairs/turbinates
• gag/cough
• normal flora

Question 5

List the etiology/RF for community acquired pneumonia

Answer 5

Question 6

List the sxs of community acquired pneumonia

Answer 6

Question 7

List the pathognomonic sxs for pneumococcal pneumonia

Answer 7

(strep pneum): URI followed by bone shaking rigor, fever, cough, rust colored sputum

Question 8

List the pathognomonic sxs for mycoplasma pneumonia aka walking pneumonia

Answer 8

indolent onset, nonproductive cough, myalgias/arthralgias, maculopapular or SJS rash, bullous myringitis

Question 9

Describe the pathognomonic sxs for legionella pneumonia

Answer 9

insidious onset, dry cough, diarrhea, hyponatremia, confusion, rapidly progressive organ failure, exposure to fine mist

Question 10

Describe the pathognomonic sxs for klebsiella pneumonia

Answer 10

currant jelly sputum, assoc with heavy alc use

Question 11

describe the pathognomonic sxs for pneumocystis pneumonia

Answer 11

anorexia, weight loss, immunosuppression

Question 12

what is this

Answer 12

bullous myringitis from mycoplasma pneumonia

Question 13

Microbial association with alcohol overuse

Answer 13

klebsiella

Question 14

microbial association with CF

Answer 14

pseudomonas

Question 15

microbial association with milk

Answer 15

coxiella burnetti (Q fever)

Question 16

microbial association with rabbit exposure

Answer 16

fancisella tularensis (tularemia)

Question 17

microbial association with bird/bat droppings

Answer 17

histoplasmosis

Question 18

microbial association with recent travel to the SW US

Answer 18

coccidiosis (valley fever)

Question 19

microbial association with Mississippi/Ohio river valley

Answer 19

blastomycosis

Question 20

Describe the PE & diagnostic testing for community acquired pneumonia

Answer 20

Question 21

where is the pneumonia

Answer 21

right middle lobe

Question 22

Define a conjugate vaccine

Answer 22

type of vaccine that joins a protein to part of the bacteria to improve the protection the vaccine provides

Question 23

Define a polysaccharide vaccine

Answer 23

a type of vaccine that is made to look like the surface of certain bacteria in order to help the body build protection against that germ

Question 24

When is the PCV 20 vaccine recommended to prevent pneumococcal pneumonia

Answer 24

once for all people 65+

19-64 with certain medical conditions or who smoke cigarettes

Question 25

When should you get a flu vaccine and who can get it

Answer 25

• yearly
• starting at age 6 mos
• can get while pregnant

Question 26

in an ambulatory patient what tests do you order to confirm pneumonia

Answer 26

CXR

Question 27

For a pt who presents to the clinic and is dx with pneumonia, how do you determine if they need to be admitted to the hospital

Answer 27

CURB 65

Question 28

Describe the treatment for community acquired pneumonia

Answer 28

Question 29

Describe the scoring for CURB-65

Answer 29

• confusion
• BUN: abnormal
• RR 30+
• BP <90/<60
• age 65+

Question 30

Describe the etiology of hospital acquired pneumonia

Answer 30

Question 31

Describe the etiology of ventilator acquired pneumonia

Answer 31

Major cases occur in ICU, direct inoculation or aspiration from further up the tubing

Often multi-drug resistant pathogens

RF: mechanical ventilation, age 60+, pulmonary disease, coma, surgery, re-intubation, prolonged intubation

Question 32

Describe the diagnostic testing for hospital acquired/ventilator acquired pneumonia

Answer 32

sputum culture and consult ID