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CPR Exam 2 > Clinical Med Part 2 (Tyler) > Flashcards

Clinical Med Part 2 (Tyler) Flashcards

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1
Q

What is the overall mortality of pneumonia?

A
  • 10%
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2
Q

What microbes have the highest incidences of mortality?

A
  • Gram negative and S. aureus
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3
Q

What are some outpatient microbial causes of pneumonia?

A
  • S. pneumoniae
  • M. pneumoniae
  • H. influenzae
  • C. pneumoniae
  • Respiratory viruses
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4
Q

What are some non-ICU microbial causes of pneumonia?

A
  • S. pneumoniae
  • M. pneumoniae
  • C. pneumoniae
  • H. influenzae
  • Legionella spp
  • Respiratory viruses
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5
Q

What are some ICU microbial causes of pneumonia?

A
  • S. pneumoniae
  • S. aureus
  • Legionella spp
  • Gram negative bacilli
  • H. influenzae
  • Respiratory viruses
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6
Q

What is the most common cause of community acquired pneumonia?

A
  • S. pneumoniae
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7
Q

What are some causes of typical pneumonia?

A
  • S. pneumoniae
  • H. influenzae
  • S. aureus
  • Klebsiella pneumoniae and P. aeruginosa
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8
Q

What are some causes of atypical pneumonia?

A
  • M. pneumoniae
  • C. pneumoniae
  • Legionella spp
  • Respiratory viruses
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9
Q

What are some general risk factors for community acquired pneumonia?

A
  • Alcoholism
  • Asthma
  • Immunosuppression
  • Institutionalization
  • Age over 70
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10
Q

What is a risk factor for pneumonia specifically in the elderly?

A
  • Lack of a cough/gag reflex due to muscle weakness
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11
Q

What are some risk factors for the pneumococcal pneumonia?

A
  • Dementia
  • Seizure disorders
  • Heart failure
  • Cerebrovascular disease
  • Alcoholism
  • Tobacco smoking
  • COPD
  • HIV infection
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12
Q

Who does enterobacteriaceae tend to infect?

A
  • Those that have recently been hospitalized and/or received antibiotic therapy or who have comorbidities like alcoholism, heart failure, or renal failure
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13
Q

Who has a problem with P, aeruginosa?

A
  • Patients with severe structural lung disease like bronchiectasis, cystic fibrosis, or severe COPD
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14
Q

What are some risk factors for Legionella?

A
  • Diabetes
  • Hematologic malignancy cancer
  • Severe renal disease
  • HIV infection
  • Smoking
  • Male gender
  • Recent hospital stay or cruise
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15
Q

What are some fungi that could cause pneumonia?

A
  • Histoplasma capsulatum

- Coccidioides immits

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16
Q

How is pneumonia diagnosed?

A
  • CXR
  • Point of care ultrasound (POCUS)
  • Bronchoscopy
  • Tissue biopsy
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17
Q

What labs are used to help in the diagnosis of pneumonia?

A
  • Sputum gram stain and culture
  • Blood culture
  • CBC
  • PCR and antigen studies
  • Procalcitonin
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18
Q

What is the general appearance of someone with pneumonia?

A
  • Fever
  • Hypothermia
  • Malaise
  • Most appear ill
  • Alert to obtundent
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19
Q

What does the respiratory exam look like with pneumonia?

A
  • Adventitious sounds
  • Tachypnea
  • Hypoxia
  • Chest movement
  • Cough
  • Inspiratory crackles
  • Bronchial breath sounds
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20
Q

What does a cardiac exam look like with pneumonia?

A
  • Tachycardia
  • Hypo- or hypertension
  • Exacerbations of heart failure
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21
Q

What is the treatment of pneumonia?

A
  • Based on history
  • Use the ATSA/IDSA guidelines for management and treatment of CAP
  • Use CURB-65 to help determine level of morbidity
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22
Q

What are the risk factors for Pseudomonas with CAP?

A
  • Compromised immune system
  • Recent prior antibiotic use
  • Structural lung abnormalities (cystic fibrosis or bronchiectasis)
  • Repeated exacerbations of COPD requiring frequent glucocorticoid and/or antibiotic use
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23
Q

What are some risk factors for Pseudomonas with HAP?

A
  • Increased age
  • Length of mechanical ventilation
  • Antibiotics at admission
  • Transfer from a medical unit or ICU
  • Admission to a ward with high rate of Pseudomonas
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24
Q

What is hospital acquired pneumonia?

A
  • Infection acquired after at least 48 hours of hospitalization
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25
What is the treatment for HAP?
- There is a higher morbidity and mortality rate than CAP | - Need for a treatment for broadened scope of organisms is greater
26
What are some considerations in HAP and VAP?
- Increased mortality - MDR pathogens and MRSA - MDR pathogens without MRSA - MRSA alone
27
What is healthcare associated pneumonia?
- Used to identify patients at risk for infection with MDR pathogens - Classification has been very sensitive and lead to inappropriate antibiotic use
28
What is ventilator associated pneumonia?
- Type of HAP that develops more than 48 hours after endotracheal intubation
29
What are some clues to VAP?
- Difficult to wean off ventilator - Persistent lack of improvement overall - New infiltrates on CXR - New fevers - New changes in baseline data: CBC, CMP, etc
30
What is aspiration pneumonia?
- Most pneumonia arises following the aspiration of microorganisms from the oral cavity or nasopharynx
31
What are some risk factors for aspiration pneumonia?
- Neurologic disorders - Reduced consciousness - Esophageal disorders - Vomiting - Witnessed aspiration
32
Who is aspiration pneumonia suspected in?
- A lethargic, obtundent, or unconscious patient, esp those who have been vomiting - Stroke patients with swallowing dysfunction - Elderly - Patients with multiple sclerosis and bulbar symptoms
33
What are the most likely considered pathogens in aspiration pneumonia?
- Agents from oral cavity and pharynx - Primarily anaerobes - Gram positive cocci - Gram negative bacteria - S. anginosus group
34
What are some clinical findings of aspiration pneumonia?
- Indolent symptoms - Predisposing condition for aspiration - Absence of rigors - Failure to recover likely pulmonary pathogens with cultures of expectorated sputum - Sputum that has a putrid odor, which is diagnostic of anaerobic infection
35
What imaging is seen in someone with aspiration pneumonia?
- CXR showing involvement of dependent portions of lung or segments obstructed by malignancy, stricture, or foreign body - CXR or CT showing pulmonary necrosis with lung abscess or empyema
36
What is the treatment for aspiration pneumonia?
- Clindamycin (primarily outpatient) - Ceftriaxone and metronidazole - Ampicillin-sulbactam - Imipenem- tazobactam - Ertapenem
37
What is a pleural effusion?
- Excess fluid accumulation in the pleural space
38
What causes a transudate?
- Systemic influences on pleural fluid formation and resorption - Left ventricular failure, cirrhosis - Nephrotic syndrome - Myxedema - Peritoneal dialysis
39
What causes an exudate?
- Local influences on pleural fluid formation or resorption - Bacterial pneumonia - Malignancy - Viral infection - PE - TB - Fungal or parasitic infections
40
What are the two most common causes of pleural effusion?
- Heart failure | - Pneumonia
41
How is the diagnosis for pleural effusion made?
- Plain film radiographs - CT chest - Ultrasound - Often an area of egophony just superior to the effusion
42
When is a thoracentesis done?
- If effusions are asymmetrical, fever, chest pain, or failure to resolve
43
What are some complications with a thoracentensis?
- Pneumothorax - Hemothorax - Re-expansion pulmonary edema - Spleen/liver laceration
44
What is the Light's criteria used for?
- Used to tell of exudates fulfill at least one of the criteria
45
What is the Light's criteria?
- Protein pleural fluid/serum protein ratio (>0.5) - Pleural fluid LDH greater than two-thirds of the laboratory normal - Pleural/serum LDH ratio >0.6
46
Do transudative effusions typically meet the Light's criteria?
- No
47
What else should be tested for exudative effusions?
- pH - Glucose - WBC count with diff - Microbiologic studies - Cytology
48
What is the definition of ARDS?
- Acute respiratory distress that includes: - Severe dyspnea - Diffuse pulmonary infiltrates - Hypoxemia
49
What is a key diagnostic for ARDS?
- Diffuse bilateral pulmonary infiltrates on CXR - PaO2/FiO2 <300 mmHg - Absence of elevated left atrial pressure - Acute onset within 1 week of a clinical insult or new or worsening respiratory symptoms
50
What is the PaO2/FiO2 ratio?
- Common measure of oxygenation and is most often employed in ventilated patients
51
What do values under 300 mmHg represent in the PaO2/FiO2?
- Abnormal gas exchange
52
What are the risk factors for ARDS?
- Sepsis - Pneumonia - Trauma - Multiple blood transfusions - Gastric acid aspiration - Drug overdose - Older age - Chronic alcohol abuse - Metabolic acidosis - Pancreatitis
53
What is the exudative phase of ARDS?
- Characterized by alveolar edema and neutrophil infiltration - Diffuse alveolar damage - Atelectasis and reduced lung compliance - Hypoxemia, tachypnea, progressive dyspnea, and hypercarbia - CXR reveals bilateral opacities consistent with pulmonary edema
54
What is the proliferative phase of ARDS?
- Lasts from 7 to 21 days after inciting insult | - Some develop progressive lung injury and have evidence of pulmonary fibrosis
55
What is the fibrotic phase of ARDS?
- Most recover within 3-4 weeks but some experience fibrosis | - INcreased risk of pneumothorax, reductions in lung compliance, and increased pulmonary dead space
56
What is the treatment for ARDS?
- Treatment of underlying medical condition that caused lung injury - Minimizing iatrogenic complications - Prophylaxis to prevent venous thromboembolism and GI hemorrhage - Prompt treatment of nosocomial infections - Adequate nutritional support
57
How can we minimize the alveolar collapse and achieve adequate oxygenation?
- Put patient into prone | - Low tidal volumes and positive end expiratory pressure
58
What are some ancillary therapies with ARDS?
- Patients have pulmonary vascular permeability leading to interstitial and alveolar edema - Receive IV fluids only as needed - Most patients require sedation and even paralytic agents - Avoid the use of glucocorticoids
59
What are the clinical manifestations of the influenza virus?
- Sudden onset respiratory illness (symptoms in 48-72 hours of exposure) - Rhinorrhea - Sore throat - Conjunctivitis - Cough
60
What does the physical exam show of the influenza virus?
- Non-localizing rales, rhonchi, and wheezing
61
How is influenza distinguished from other respiratory illnesses?
- Greater degree of accompanying fever, fatigue, myalgia, and malaise
62
Who are influenza complications more common in?
- Young children <5 - Elderly - Pregnant women in second or third trimester - Patients with chronic disorders
63
What are some respiratory complications with influenza?
- Pneumonia
64
What are some extrapulmonary complications with influenza?
- Myositis (influenza B) - Reye's syndrome - myo/pericarditis - CNS disease
65
What is found in laboratory testing for influenza?
- RT-PCR of respiratory samples is most sensitive for detecting influenza - Rapid tests can yield results quicker but are as sensitive
66
What is the treatment for influenza?
- Neuraminidase inhibitor for influenza A and B | - If started within 48 hours of infection, symptoms can resolve 1-2 days sooner
67
What are the risk factors for COVID?
- CV disease - Diabetes - HTN - Chronic lung disease - Cancer - Chronic kidney disease - Obesity - Smoking

CPR Exam 2 (12 decks)

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