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Respiratory > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

Cave exploring pneumonia = ?

A

Histoplasmosis

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2
Q

Bird associated pneumonia = ?

A
  • C. Psittacosis

- Hypersensitivity pneumonitis

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3
Q

What are the three categories of pneumonia?

A
  • Community acquired
  • Atypical pneumonia
  • Healthcare associated
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4
Q

IV therapy, wound care, or chemo in the last (__) days is suspicious for pneumonia

A

30 days

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5
Q

Hospitalization for over (__) days in the last (__) days is suspicious for healthcare associated pneumonia.

A

2

90

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6
Q

Treatment in a dialysis clinic in the last (__) days is suspicious for pneumonia

A

30

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7
Q

Who is the typical pneumonia patient?

A

Older black males

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8
Q

What is the all cause mortality for hospital acquired pneumonia

A

28%

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9
Q

What are the internal predisposing factors for developing pneumonia?

A

Hypoxemia
Acidosis
Pulmonary edema
Uremia

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10
Q

Why is it important to ask about altered level of consciousness with pneumonia?

A

Aspiration pneumonia

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11
Q

What is the most common infectious pneumonia? What is this associated with?

A

Strep. Pneumoniae

Smoking

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12
Q

How does smoking predispose to pneumonia?

A

Impairment of cilia

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13
Q

How does EtOH predispose to pneumonia?

A

Impairment of cilia/immune system

Aspiration

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14
Q

How does hypoxemia and acidosis predispose to pneumonia?

A

Lowered immune system

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15
Q

What are the three major genetic disorders that predispose to pneumonia?

A

CF

Kartagener’s syndrome

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16
Q

Common use of what in older patients predisposes patients to pneumonia?

A

Denture use while sleeping

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17
Q

Typical or atypical cause of pneumonia: strep pneumonia

A

Typical

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18
Q

Typical or atypical cause of pneumonia: HiB

A

Typical

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19
Q

Typical or atypical cause of pneumonia: Staph Aureus

A

Typical

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20
Q

Typical or atypical cause of pneumonia: GAS

A

Typical

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21
Q

Typical or atypical cause of pneumonia: mycoplasma pneumonia

A

Atypical

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22
Q

Typical or atypical cause of pneumonia: legionella

A

Atypical

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23
Q

Typical or atypical cause of pneumonia: moraxella catarrhalis

A

Typical

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24
Q

Typical or atypical cause of pneumonia: gram negative bacteria

A

Typical

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25
Q

Typical or atypical cause of pneumonia: Chlamydia pneumoniae

A

Atypical

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26
Q

Typical or atypical cause of pneumonia: Chlamydia psittaci

A

Atypical

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27
Q

What are the four most common infectious agents found to cause pneumonia?

A
  1. Strep pneumonia
  2. viruses
  3. Mycoplasma pneumoniae
  4. Legionella
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28
Q

What are the bacteria that you should consider with pneumonia post influenza?

A 
Staph aureus (MRSA)
Enterobacteriaceae
Pseudomonas
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29
Q

What are the risk factors of developing an pneumonia/abscesses secondary to aspiration?

A

Anaerobic bacteria

30
Q

What is the causative agent of Q fever? In whom is this commonly found? Why?

A

Coxiella brunetti

Farmers and vets d/t exposure to animal placentas

31
Q

What is associated with francisella tularensis?

A

Rabbits

32
Q

What is the test that can be run to detect Legionella (besides a culture/PCR)?

A

Urine antigen test

33
Q

What is the bacteria that causes hospital acquired pneumonia?

A

Staph Aureus

34
Q

In whom is H. influenzae seen?

A

Older pts and those with underlying lung disease

35
Q

In whom is M. Pneumoniae usually seen?

A

Epidemics in schools or military recruits

36
Q

What makes chlamydophila pneumoniae hard to diagnose?

A

Lack of s/s with serological testing

Intracellular pathogen

37
Q

What are the common associations with legionella?

A

Water sources (air conditioners, showers, etc)

38
Q

What is the prognosis with Legionnaires disease (generally)?

A

Bad

39
Q

What is the usual bacterial cause of empyema?

A

Anaerobic bacteria

40
Q

What are the risk factors for getting an anaerobic pneumonia?

A

Aspiration risks

41
Q

In whom are anaerobic bacteria less common?

A

Edentulous

42
Q

True or false: gram negative bacilli are uncommon causes of CAP, with the exception of patients requiring ICU treatment

A

True

43
Q

What are the two most common infectious agents of CAP in the ICU?

A

S. pneumoniae

Gram negative

44
Q

CF patients pneumonia = ?

A

Pseudomonas

45
Q

Klebsiella pneumonia = ?

A

alcoholics

46
Q

What is the sensitivity of clinical diagnosis of pneumonia (CXR, ssx)?

A

50%

47
Q

What are the usual ssx of typical pneumonia?

A

Productive cough
Fever
Pleuritic chest pain
Dyspnea

48
Q

What is the CBC finding of typical pneumonia?

A

Leukocytosis with a L shift

49
Q

How often do patients with pneumonia have crackles and signs of consolidation?

A

1/3

50
Q

What is the gold standard for diagnosing pneumonia?

A

CXR

51
Q

True or false: most patients who are dehydrated may have a false- negative CXR,

A

false-Only a small proportion is this true

52
Q

Air fluid level on CXR with density below and lucency above = ?

A

Lung abscess

53
Q

True or false: establishing the specific pathogen for CAP is essential in the treatment of pneumonia

A

False–usual empiric therapy is sufficient

54
Q

What organisms should be cultured, if suspected?

A

Legionella
Flu or MERS
MRSA

55
Q

Why is a culture useful for hospitalized or pts in a nursing home?

A

Can help with treatment of others close to pt

56
Q

True or false: the majority of pneumonia cases admitted are treated empirically

A

True

57
Q

When is a sputum culture recommended?

A
  • ICU admission
  • Failure of abx
  • Cavitary changes
  • Immunocompromised
  • Alcoholism
  • COPD
  • Pleural effusion
58
Q

More than how many epithelial cells per HPF are sputum cultures rejected?

A

more than 10 per HPF

59
Q

What fraction of blood cultures are positive in hospitalized patients with strep pneumoniae?

A

7-16%

60
Q

What bacterial infections do we have urinary antigen tests for? Are these valid after abx treatment?

A

Legionella
Strep pneumoniae

Still valid even after abx treatment

61
Q

What is the diagnositc test needed for C. Pneumoniae?

A

PCR or serological testing

62
Q

What is the treatment for CAP?

A

Macrolide or doxycycline

63
Q

What is the treatment for pneumonia in patients with comorbidities? (2)

A

Oral fluoroquinolone (floxacins) or beta lactam plus a macrolide

64
Q

What is the treatment for inpatient pneumonia?

A

Fluoroquinolone

or

anti-pseudomonal beta lactam + a macrolide

65
Q

What is the ICU treatment for pneumonia?

A

Antipseudomonal + beta lactam

OR

Azithromycin

66
Q

What is the ICU treatment for pneumonia if pt has a PCN allergy?

A

Quinolone plus aztreonam

67
Q

What is the treatment for MRSA?

A

nafcillin or oxacillin

68
Q

How long should abx treatment for CAP be?

A

5 days

69
Q

What are the criteria for discontinuation of abx with CAP?

A

afebrile for 47-72 hours

70
Q

When are corticosteroids indicated for CAP?

A

Seriously ill patients, especially those in the ICU

71
Q

What are the risk factors for developing pneumonia secondary to an aerobic bacterial infection?

A

Alcohol use
Seizures
Stroke

72
Q

Why are GAS infections less common in edentulous patients?

A

GAS grows in periodontal area

Respiratory (34 decks)

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