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Flashcards in PNA / Influenza Deck (59)
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What is pneumonia?

A disease of the lungs that is characterized by inflammation of the parenchyma of the lung (alveoli) and accumulation of abnormal alveolar filling with fluid of lung tissue. Most commonly caused by infection


True or False: Lower airways of the lungs usually remain organism-free due to pulmonary host defense mechanisms



What is the most common way that material and microbes enter the lower respiratory tract?



What are the 6 mechanisms of infections pneumonia?

- Inhalation of infections particles

- Inhalation of oropharyngeal or gastric contents

- Hematogenous spread (blood stream infection e.g. endocarditis)

- Infections from adjacent or contiguous structures

- Direct inoculation

- Reactivation


What are the bugs in "typical" pneumonia? (7)

S. Pneumoniae

H. Influenzae

S. Aureus

Group A Streptococci

Moraxella Catarrhalils


Aerobic Gram-negative Bacteria


What are the bugs in atypical pneumonia? (4)

Legionella spp

M. pneumoniae

C. pneumoniae

C. psittaci


What are some clinical history factors that can change a person's immune response and their ability to manage infections?

HIV, immunosuppression, alcohol/drug abuse.


These change your differntial for which bacteria may be involved


Why is age important when assessing for pneumonia?

Elderly patients have less of a classic presentation and findings may be subtle. They also go from relatively healthy to critically ill much faster


How can mineral oil usage be a concern for pneumonia?

Patients that use a lot of mineral oil or vasaline can inhale particles and develop pneumonia.


How is occupational history/allergic history important when looking for pneumonia?

It is important to consider these things to decide what else is on your differential. These are important to think about particularly if you're treating someone for pneumonia and they aren't getting better.


What underlying cardiopulmonary diseases are important to keep in mind when assessing for pneumonia?

COPD and congenital or acquired pulmonary diseases.

Chronic infections (e.g. patients with CF), can develop bronchiectasis which can change the kind of microbes that can end up in the lower lung tract. This will change how you treat the infection


What are co-morbidities for pneumonia? (4)

- Aspiration risk (alcohol, oral hygiene, dysphagia, GETA)

- IV Drug use

- Pregnancy (later trimesters, women have decreased esophageal junction tone and are more likely to aspirate)

- Diseases associated with immunosuppression


What drug clinical history should you watch out for when assessing a patient for pneumonia?

- Allergy drugs

- IV drug abuse

- Drug induced lung diseases

- immunosuppressive agents


When assessing for pneumonia, it is important to think about healthcare risk factors. What are these? (3)

- Community

- Nursing Home

- Recent Hospital discharge


community acquired vs healthcare associated will help you determine treatment


What are systemic symptoms of pneumonia?

High fever and chills


What are skin symptoms of pneumonia?

Clamminess and blueness


What are lung symptoms of infections pneumonia? (4)

Cough with sputum or phlegm

Shortness of breath

Pleuritic chest pain



What are musculoskeletal symptoms of infectious pneumonia?

Fatigue and aches, joint pain


What are gastric symptoms of infections pneumonia?

Nausea and vomiting


What are central symptoms of infectious pneumonia?

Headaches, loss of appetite, mood swings


What are the cardiovascular symptoms for infectious pneumonia?

Low blood pressure and high heart rate


How might elderly patients present with pneumonia?

Confusion, fatigue


What kind of physical examination findings do you find with pneumonia?

Fever (80%, may be absent in elderly)

Tachypnea (45-70%)

Audible crackles

Evidence of consolidation (bronchial breath sounds, egophany, dullness to percussion)


How does pneumonia show on CBC?

Leukocytosis (increased WBC)

or if a patient is very sick Leukopenia (decreased WBC) - poor prognosis


What do you look for in a basic chemistry panel for pneumonia?

You want to check renal function and electrolytes to get a sense of if the problem is just in the lungs or if there is systemic involvement.


How are blood and sputum cultures used for assessing for pneumonia?

While blood and sputum cultures test positive infrequently (in less than 20% of patient for blood and 10% for sputum), it can help in treating healthcare related pneumonia and identifying resistant strains.


How is respiratory PCR used in diagnosing pneumonia?

This is a newer development that is helping to identify the infectious organism. Before, these results took days but new technologies are reducing the time to hours so we can use this to help in treatment.


Urine tests can be used to identify which two pneumonia organisms?

S. pneumonia and legionella


True or False: Radiographic features alone can differentiate etiology of pneumonia



What is better for imaging pneumonia--CXR or CT?



CXR is a good starting point but CT can see more.