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Pulmonology > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

What anatomical structure divides the upper and lower airways?

A

Vocal cords?

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2
Q

Nosocomial or Hospital Acquired Pneumonia is defined as what…

A

A pneumonia occurring > 48 hours after hospital admission (Early onset is 2-4 days)
(Late onset is 5 or more)

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3
Q

What is an infection that occurs after 48 hours of endotracheal intubation known as?

A

Ventilator associated pneumonia (VAP)

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4
Q

What is the greatest at risk population for Pneumonia?

A

Age >65y.o (MALES and A.A.) (also <5y.o)
COPD’ers
Asthma, CHF, DM, Stroke, Malnutrition, etc.
Smoking, ETOH abuse, opioid abusers
Crowded living conditions
Recent abx therapy or abx resistance

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5
Q

What are some of the most common mechanisms of infection with Pneumonia?

A

(MC) Microaspiration
Hematogenous
Direct spread
Macroaspiration

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6
Q

What are the most common pathogenic organism which cause Pneumonia?

A

Strep. Pneumoniae
H. influenzae
Mycoplasma Pneumoniae
Viruses: Rhinovirus, parainfluenza, RSV

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7
Q

An atypical pneumonia is more common to present in what PT population?

A

Young adults or Immunocompromised (i.e. HIV)

Pneumocystis jirovici***

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8
Q

What are some of the most frequently encountered ATYPICAL PNEUMONIA bugs?

A

Legionella
Mycoplasma pneumoniae
Chlamydophila pneumoniae
C. psittaci

Walking Pneumonia: Mycoplasma pneumonia (MC)

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9
Q

A PT presents to your clinic with a slower onset, with less severe symptoms of pneumonia… This would lead you to think it is what kind of pneumonia?

A

ATYPICAL (Slower, less severe)

TYPICAL (FAST ONSET, SEVERE)

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10
Q

What is the common clinical presentation of Pneumonia?

A 
Productive yellow or rusty sputum
Cough
Fever and malaise; N and V
Chills
Inc. HR and RR
Lowered BP
Dyspnea
Decreased breath sounds
Pleuritic chest Px
Arthralgia
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11
Q

IVDA and pneumonia may co-occur with what microorganism?

A

S. aureus

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12
Q

Diabetes and pneumonia may co-occur with what microorganisms?

A

S. aureus

S. pneumoniae

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13
Q

Alcoholism and pneumonia may co-occur with what responsible microorganisms?

A

S. pneumoniae
Klebsiella pneumoniae
S. aureus

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14
Q

Arthralgia, confusion, and GI symptoms (NVD) are commonly associated with which type of pneumonia?

A

ATYPICAL

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15
Q

How can you differentiate between the different causes of pneumonia? I.e. Bacterial, viral, etc.

A

Bacterial Pneumonia: Green, yellow or blood streaked sputum

Mycoplasma / Viral Pneumonia:
Clear, to no sputum at all

Klebsiella (alcoholic/aspiration) Pneumonia:
Red, jelly-like sputum

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16
Q

What would be some clinical findings on physical exam which would lead you to a Pneumonia diagnosis?

A 
INCREASED TACTILE FREMITUS (consolidation within the lungs amplifies the sound)
Dullness to percussion
Crackles/Rales
BRONCHIAL BREATH SOUNDS
HYPOtension
Positive Egophony/Bronchophony
17
Q

A CXR series is ordered for a patient with suspected pneumonia. What would you expect to see on PA and lateral views?

A

Typical: Lobar consolidation

Atypical: Bilateral infiltrates (interstitial pneumonia)

18
Q

What initial Lab Tests would you order for a PT with suspected pneumonia?

A

Leukocyte Ct. (elevated in bacterial but normal to low in atypical)

Sputum Gram Stain; C and S

Blood Cultures x 2

Urine Antigens (LEGIONELLA)

19
Q

What does the CURB-65 criteria consist of for pneumonia determination if hospitalization is indicated?

A 
Confusion
Uremia (BUN >20)
Respiratory (RR > 30)
BP Systolic (<90 mmHg)
>65 y.o.

2 or more gets you admitted (3-5 ICU baby)

20
Q

What would an empiric treatment for OUTPATIENT therapy typically consist of?

A

MACROLIDES (azithro, clarithro, erythro) or doxy

OR

FLUORQUINOLONES if comorbidities present or recent abx

21
Q

What would an empiric treatment be for INPATIENT therapy typically consist of?

A

FLUORQUINOLONE IV
OR
B lactam + Macrolide

ICU PTs: B lactam + azithro + fluoroquinolone

22
Q

What is the typical duration of abx therapy which is needed for pneumonia?

A

S. pneumoniae? 7 to 10 days

Mycoplasma pneumoniae or Chlamydia pneumoniae? 10 to 14 days

23
Q

What vaccines are recommended for anyone over 65 or under 5; or have comorbid conditions?

A

PCV13; kids
and
PPSV; adults

Pulmonology (17 decks)

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