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Junior - Pulm Mod 1 COPY > 6 - Pneumonia And TB > Flashcards

6 - Pneumonia And TB Flashcards

1
Q

Types of pneumonia

A

CAP

Nosocomial

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2
Q

What are the 3 types of nosocomial pneumonia?

A
  1. Hospital acquired
  2. Health care associated
  3. Ventilator associated
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3
Q

What are the pathways of pneumonia spread?

A

2 major:

  • Inhalation: via droplets
  • Aspiration: via oropharyngeal secretions

1 minor:
- blood borne pathogens

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4
Q

What is the MC type of pneumonia pathogens?

A

Bacterial&raquo_space; Viral

Usually S. Pneumoniae

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5
Q

Common bacterial pneumonia pathogens (list)

A 
S. Pneumoniae (MC)
S. Aureus
H. Influenzae
Klebsiella pneumonia
Pseudomonas sp
Legionella sp
Chlamydia pneumonia
Mycoplasma pneumoniae
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6
Q

How do patients get s. Aureus in their lungs to cause pneumonia?

A

Usually after influenza infection or hematogenous spread

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7
Q

Who usually gets h. Influenzae pneumonia?

A

COPD patients

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8
Q

Who usually gets klebsiella pneumonia?

A

Alcoholics

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9
Q

What is the definition of CAP?

A

Occurring outside hospital
Ambulatory patients
Not in nursing home
w/in 48hrs of admission

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10
Q

Prevalence of pneumonia?

A

4-5 million in US per year

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11
Q

Is pneumonia a big problem?

A

Yes 25% of cases require hospitalization

It is the most deadly infectious disease in the U.S.

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12
Q

What are the risk factors for CAP?

A 
Increasing age
ETOH
Tobacco use
Comorbitites (asthma, COPD, etc)
Immunosuppression
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13
Q

What are some normal defenses that prevent CAP in most healthy people?

A

Cough reflex
Immunity
Mucociliary clearance

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14
Q

Do viruses cause CAP?

A

Yes but not usually (1/3)

Influenza
RSV
Adenovirus
Parainfluenza

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15
Q

SS of CAP?

A

Acute onset of: fever, cough (+/- sputum) and dyspnea

Maybe:

  • sweats
  • chills
  • chest discomfort
  • rigors
  • pleurisy
  • hemoptysis
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16
Q

What is usually seen on PE for CAP?

A

Acutely ill appearing

  • fever
  • tachypnea
  • tachycardia
  • desaturation of arterial O2
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17
Q

What will the chest exam show with CAP?

A

Inspiratory crackles, bronchial breath sounds

Dullness on percussion/egophony if lobar or effusion present

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18
Q

Can chest exam diagnose CAP?

A

No its only 50% sensitive

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19
Q

What usually causes atypical pneumonia?

A

Mycoplasma pneumonia

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20
Q

S/S of atypical pneumonia?

A 
Gradual onset
Dry cough
HA
Malaise
N/V

May not appear sick

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21
Q

CXR for atypical pneumonia?

A

Usually worse than pt apperiance

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22
Q

Should i culture my CAP pt?

A

No, empiric tx usually works

Maybe if hx of travel

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23
Q

What will pulmonary opacity on CXR or CT?

A 
Patchy airspace disease
Lobar consolidation w air bronchiogram
Diffuse alveolar/interstitial opacities
Pleural effusion
Cavitations
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24
Q

How long will it take pneumonia to clear on CXR?

A

6+ weeks

- image “lags” behind clinical improvment

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25
Q

When do pneumonia pts need to return to the clinic?

A

Not necessary if clinical response is present

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26
Q

Who needs a follow up x ray?

A

High risk pts need another CXR at 7-10 weeks

Sometimes we find malignancy post tx

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27
Q

What special exams can be done for CAP?

A

Thoracentesis
Bronchoscopy
Procalcitonin

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28
Q

If i suspect P. Jirovecii or M. Tuberculosis what is the best way to get a sample?

A

Bronchoscopy

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29
Q

What do procalcitonin levels tell me?

A

It is released in response to bacterial toxins and inhibited by viral infections

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30
Q

How quickly should i initiate tx for CAP?

A

Dont delay > 6hrs

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31
Q

Which CAP etiologies generally dont need hospitalization?

A

S. Pneumo
Mycoplasma pneumo
Chlamydia pneumo
Influenza

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32
Q

My patient has not had abx w/in 90 days, what abx do they need?

A

Macrolide (clarithromycin or azithromycin)

Or

Docycycline

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33
Q

My patient has one or more of the following:

had abx in last 90 days age is >65,
comorbidity
Immunosuppressed
Works in daycare

What meds does he need?

A

Respiratory FQ
-moxi/gemi/levofloxacin

Or

Macrolicde + beta-lactam (amox-clavulante)

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34
Q

Which CAP etiologies usually get hospitalized?

A 
S. Pneumo
Mycoplasma pneumo
Chlamydia pneumo
H. Influenzae
Legionella sp
Viral
Aspiration pneumonia
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35
Q

Do CAP pts need IV abx?

A

They are often used but not superior to oral

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36
Q

Inpatient abx for CAP?

A

First line:

Respiratory FQ
Or

Marcolide (azithromycin or clarithromycin)
+
Cefotaxime or ceftriaxone or ampicillin

37
Q

What are the MC CAP etiologies that get admitted to ICU?

A 
S. Pneumo
H. Influenzae
Legionella 
Enterobacteriaceae
S. Aureus
Pseudomonas sp
38
Q

Abx for ICU treatment?

A

Respiratory FQ or azithromycin
+
Cefotaxime or ceftriaxone or ampicillin
(Antipseudomona beta-lactams)

39
Q

What is the pneumonia vaccine called?

A

Polyvalent pneumococcal vaccine

40
Q

What are PSI and CURB-65?

A

Methods to determine when to admit pts

PSI - Pneumonia severity index

Curb-65 - simpler estimate

41
Q

What does CURB-65 stand for?

A 
C - confusion
U - urea >20mg/dL
R - respiratory rate >30
B - BP <90 systolic / <60 diastolic
65 - 65 yrs or older

Each is worth 1 point

42
Q

CURB 65 points scale?

A

0-1: low death (3%)
2: moderate risk (9%)
3-5: high risk (15-40%)
- hospital

4-5 pts gets ICU

43
Q

Do you treat nosocomial pneumonias the same as CAP?

A

Nope hospital flora is super strong

44
Q

What is HAP?

A

Hospital acquired pneumona

> 48hrs after admission

45
Q

What is HCAP?

A

Healthcare associate pneumonia

- non-hospitalalized pt w/ extensive healthcare contacts

46
Q

What is VAP?

A

Ventilator associated pneumonia

Developed >48hrs after intubation

47
Q

What are some factors that contribute to the pathogenis of nosocomial pneumonias?

A

Things that change the respiratory tract flora:

Intubation
Dirty hands
Aerosols
Abx-resistance
Malnutrition
Increased age
Change in consciousness
Swallowing disorder
Underlying disease
48
Q

How fast does respiratory tract flora change?

A

75% colonization in the first 48hrs of hospitalization

49
Q

What is normally protective from changes in respiratory tract flora?

A

Gastric acid

- many hospitalized pts are on pH lowering meds

50
Q

What are the MC nosocomial pneumonia pathogens?

A 
S. Aureus (MRSA and MSSA)
Pseudomonas aeruginosa
Gram neg rods
- enterobacter
- klebsiella
- e coli
51
Q

What are the common s/s of nosocomial pneumonia?

A

Nonspecific, 2+ of:

  • fever
  • leukocytosis
  • purulent sputum
52
Q

DDX for hospital acquired pneumonia?

A 
CHF
Ateletasis
Aspiration
ARDS
PE
Med rxn
53
Q

What labs should i order for nosocomial pneumonias?

A 
Blood cultures x 2
CBC w differential 
CMP
ABG/SpO2
Thoracentesis/pleural fluid
54
Q

Do people aspirate oropharyngeal secretions?

A

Its normal to aspirate small amounts during sleep

Amount goes up with anaerobic respiratory infections

55
Q

Who is at an increased risk for aspiration?

A 
ETOH
Seizures, 
Anesthesia
Tracheal/NG tubes
Central nervous system dz
Dirty mouth people
56
Q

What is different about anaerobic pneumonia?

A

They like to make abscesses which leads to:
Fever
Wt loss
Malaise

foul smelling purulent sputum

57
Q

What lab is required for anaerobic pneumonia

A

They need an aspirate, thorocentesis, bronchoscopy culture

Remember its anaerobic so you need to go get it

58
Q

What will anaerobic pneumonia look like on images?

A

Lung abscess
Necrotizing pneumonia
Empyema

59
Q

What is a lung abscess?

A

Thick walled solitary cavity w surrounding consolidation

Same as outside lungs but inside…

60
Q

What is necrotizing pneumonia?

A

Multiple areas of cavitation w surrounding consolidation

61
Q

What is empyema?

A

Purulent pleural fluid

Hard to treat b/c they are little pockets

62
Q

Tx for anaerobic pneumonia?

A

Clindamycin
Amox-clav
Amox/PCN + metronidazol

Empyema and abscess may require incision and drainage

63
Q

TB

A

Tuberculosis - nuff said

Jk there are a bunch more cards coming

64
Q

TB is one of the worlds most widespread and deadly illnesses but what about the US?

A

It is the 2nd MC infectious cause of death in adults

65
Q

What bacteria causes TB?

A

mycobacterium tuberculosis and 1/3 of the world has it

66
Q

How is TB spread?

A

Person inhales airborne droplet nuclei of TB

Tubercle bacilli reaches the alveoli

Bacilli ingested by alveolar macrophages

Then the magic happens

67
Q

What are the possible outcomes of the TB inhalation?

A
  1. Immediate clearance (not likely)
  2. Primary disease: infection escapes alveolar macrophage and wrecks shit
  3. Latent infection: TB is contained, cant spread and dont have active disease
  4. Reactivation disease: latent period ends and primary happens
68
Q

What does primary tuberculosis and Miley cyris have in common?

A

“They came in like a wrecking ball!!!”

69
Q

What can cause latent TB infection to become active?

A

HIV/AIDS
ESRD, DM, Lymphoma
Corticosteroids
Smoking

(Gaspar triangle)

70
Q

What is it called when TB becomes hematogenously disseminated active TB?

A

Miliary TB

71
Q

S/S of active TB?

A 
Slowly progressive constitutional sxs
Chronic cough (MC)
Dypsnea (rare)
72
Q

What will a PE find for TB?

A

Chronically ill and malnourished pt

Non-specific chest exam
- apical crackles are possible

73
Q

What are some labs to diagnose M. Tuberculosis

A

3 consecutive a.m. sputum spp.
Blood cultures
Needle bx of pleura (culture)

74
Q

What will a CXR tell me about TB?

A

It cannot distinguish from primary, latent or reactivated disease

But it does show the disease is there

75
Q

What can CXR of TB be mistaken for?

A

Lower lobe disease may masquerade as a malignancy or pneumonia

76
Q

How do we test for TB?

A

PPD (purified protein derivative)

77% sensitive
97% specific

77
Q

What can cause a false negative for PPD?

A 
Poor technique
Current infection
Advanced age
Corticosteroids
Malnutrition
78
Q

What is the TB blood test called?

A

Interferon gamma release assay (quantiFERON gold/Tspot)

79
Q

Is interferon gamma release assay a good test?

A

Advantages: fewer false pos and no f/u required

Disadvantages: the monies

80
Q

We get a pos test. Now what?

A

Report to local and state public health

81
Q

What is tx for active TB?

A

Isoniazid (INH)
Rifampin
Pyrazinamide
Ethambutol

X 9 months

82
Q

What is the tx for resistant active TB?

A

18-24 months of 3+ drug regimen

Direct observed treatment

83
Q

What is direct observed treatment?

A

Nonadhearance is often why tx fales so we want keep a closer eye on them

84
Q

Baseline labs for active TB?

A 
CBC
CMP
Visual acuity/color test
Audiogram
Serum uric acid
85
Q

PPD allowable size before its considered pos?

A

5+ mm = high risk/sick pts

10+ mm = hospital workers/jail staff/homeless

15+ mm = healthy normal people

86
Q

What are the treatment regimens for latent TB?

A

INH x 9 months (preferred)
Rifampin + Pyrazinamide x 2 mo
Rifampin x 4 mo

87
Q

What is the one thing i hate more than lying?

A

Skim milk. Which is water thats lying about being milk

88
Q

Differentiating symptom between pneumonia and tb?

A

Dyspnea

Pneumonia has it

Tb often doesn’t

Junior - Pulm Mod 1 COPY (6 decks)

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