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Flashcards in PNA / Influenza Deck (59):
1

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

2

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

True

3

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

Microaspiration

4

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

5

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

S. Pneumoniae

H. Influenzae

S. Aureus

Group A Streptococci

Moraxella Catarrhalils

Anaerobes

Aerobic Gram-negative Bacteria

6

What are the bugs in atypical pneumonia? (4)

Legionella spp

M. pneumoniae

C. pneumoniae

C. psittaci

7

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

8

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

9

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.

10

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.

11

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

12

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

13

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

14

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

15

What are systemic symptoms of pneumonia?

High fever and chills

16

What are skin symptoms of pneumonia?

Clamminess and blueness

17

What are lung symptoms of infections pneumonia? (4)

Cough with sputum or phlegm

Shortness of breath

Pleuritic chest pain

Hemoptysis

18

What are musculoskeletal symptoms of infectious pneumonia?

Fatigue and aches, joint pain

19

What are gastric symptoms of infections pneumonia?

Nausea and vomiting

20

What are central symptoms of infectious pneumonia?

Headaches, loss of appetite, mood swings

21

What are the cardiovascular symptoms for infectious pneumonia?

Low blood pressure and high heart rate

22

How might elderly patients present with pneumonia?

Confusion, fatigue

23

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)

24

How does pneumonia show on CBC?

Leukocytosis (increased WBC)

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

25

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.

26

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.

27

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.

28

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

S. pneumonia and legionella

29

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

False

30

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

CT.

 

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

31

What is an empyema?

An empyema is a collection or gathering of pus within a naturally existing anatomical cavity

32

Is this lobar or multifocal pattern of pneumonia?

Q image thumb

Lobar

33

Is this lobar or multifocal distribution of pneumonia?

Q image thumb

Multifocal.

Infiltrate is bilateral in multiple lobes. The curved line on the right lung is a clear depiction of the fissure between the right middle and right upper lobes.

34

What is seen here?

Q image thumb

This is an example of cavitation. You can see a horizontal line that depicts the air-fluid level. There is a big abcess and you can see the fluid leveling out.

35

What pattern of distribution is this? What should you be concerned about?

Q image thumb

Miliary distribution. This should make you think about hematogenous disease (presence of bacteria in the blood). It looks like seeds spread around.

36

What's the pattern of pneumonia here? What should you think about?

Q image thumb

Interstitial pneumonia. Lines follow bronchovascular bundles. This makes you think about scarring and idiopathic interstitial pneumonia.

37

Miliary pattern of disease makes you think of what 2 things?

Hematogenous disease (presence of bacteria in the blood) and tuberculosis

38

What's the mnemonic for remembering alveolar filling processes?

Poor funny boy can't piss for crap

Pus, fluid, blood, cells/cancer, protein, fat, calcium

 

This will help you build your differential

39

What is community acquired pneumonia?

Pneumonia begins outside of the hospital and is diagnosed in less than 48 hours after hospital admission. The patient is not a resident in a long-term facility for more than 14 days before the onset of symptoms.

40

Which organisms are most common for causing community acquired pneumonia?

Streptococcus pneumonia (30-60% CAP), atypical organisms (10-20% of CAP)

 

Also...

H. influenzae

Moraxella

Staph A.

41

What is outpatient treatment for community acquired pneumonia?

Macrolides (azithromycin, clarithromycin, erythromycin, etc) or Doxycycline

Respiratory Fluoroquinolone (levofloxacin)

42

What is inpatient treatment for community acquired pneumonia?

Non ICU

Respiratory fluoroquinolone (levofloxacin) or

Beta-lactam and Macrolide (ceftriaxone + azithromycin)

ICU

Beta-lactam and Macrolide (ceftriaxone + azithromycin) or

Beta-lactam and respiratory fluoroquinolone 

Consider Anti-MRSA Therapy (vancomycin) (if you see cavitary pneumonia or if the patient had just gotten over the flu--anything that would make you wonder if it's a staph infection)

43

What is hospital (nosocomial) acquired pneumonia?

Pneumonia that occurs more than 48 hours after hospital admission

44

What is ventilatory associated pneumonia?

Pneumonia that happens more than 48-72 hours after an endotracheal tube intubation

45

What is healthcare associated pneumonia?

Pneumonia in a non-hospitalized patient with extensive healthcare contact

-IV therapy, wound care, IV chemotherapy within the last 30 days

- Resident of a nursing home or Long-term acute care facility

- Hospitalized in acute care hospital for more than 2 days within the prior 90 days

- Attendance at hospital or hemodialysis clinic within the past 30 days

46

True or False: Pneumonia infections can be polymicrobial, especially with healthcare and hospital associated pneumonia

True

47

True or False: Hospital and healthcare associated pneumonia infections are more likely to be multi-drug resistant.

True. (e.g. Pseudomonas aeruginosa)

48

Name 5 gram-negative multi-drug resistant pathogens and 1 gram-positive multi-drug resistant pathogen

Gram-negative MDR pathogens

1. Serratia

2. Pseudomonas aeruginosa (more common)

3. Acinetobacter

4. Citrobacter

5. Enterobacter or Escherichia Coli

Gram-positive MDR pathogens

1. Methicillin-Resistant Staphylococcus Aureus (MRSA)

49

How do you treat hospital/healthcare/ventilator associated pneumonia?

A image thumb
50

When treating hospital/ventilator/healthcare associated pneumonia, why is it important to de-escalate therapy based on culture data and clinical response in 48-72 hours?

You're using a lot of broad spectrum antibiotics which can generate resistence and put people at risk for C. Diff.

51

What is the duration of therapy for the different kinds of pneumonia?

Outpatient community acquired pneumonia - 5 days

Inpatient community acquired pneumonia - 7 days

Health care associated pneumonia - 7 days

Ventilator associated pneumonia - 8 days

Longer duration therapy for pseudomonas and MRSA (about 14 days)

52

When do influenza outbreaks typically occur, how long does it last, and about how much of the population is affected?

Winter, 2-3 months, 10-20% of general population

53

Influenza viruses undergo periodic changes in the antigenic characteristics of their _____. Name them.

Envelope glycoproteins. Hemagglutinin (H#) and Neurominidase (N#)

54

Major changes in influenza envelope glycoproteins are called _____ ______ while minor changes in the glycoprotines are called _____ ______.

antigenic shifts, antigenic drifts

55

What are symptoms of respiratory virus infections?

Symptoms can be variable in severity and presentation but generally these are the symptoms:

Fever, runny nose, sore throat, lethargy, loss of appetite, diarrhea, coughing, wheezing, nausea, vomiting.

56

Influenza mortality is associated typically with which age groups?

Elderly or young

57

What are complications of influenza infection? (4)

Primary influenza pneumonia

Secondary bacterial pneumonia

Myositis and rhabdomyolysis

CNS involvement

58

Which lab tests can diagnoze influenza?

Rapid antigen tests

Immunofluorescence

PCR*

Viral culture - 48 hour culture

Serologic testing

59

What are two treatments for influenza? What does treatment do?

Neuraminidase Inhibitors (active against influenza A and B)

- Oseltamivir and Zanamivir are most common

Adamantanes - Active only against influenza A (rarely, if ever used)

- Amantadine and Rimantidine

 

Treatment can shorten the duration and severity of symptoms. Greatest benefit is if the treatment is given within the first 24-30 hours.