Pneumonia Flashcards Preview

Clin Med I - Pulmonary > Pneumonia > Flashcards

Flashcards in Pneumonia Deck (64):
1

What is the definition of pneumonia (PNA)?

- infection of the pulmonary parenchyma

2

What are the types of PNA?

- community acquired (CAP)
- nosocomial/hospital acquired (HAP), healthcare associated (HCAP), ventilator associated (VAP)
- anaerobic PNA and lung abscess
- HIV related
- TB

3

What is the pathophysiology of PNA?

- increased microbial pathogens at alveolar level
- host's inability to fight off said pathogens

4

How can microorganisms gain access to the lungs in PNA?

- MC: aspiration from oropharynx
- inhaled as contaminated droplets
- hematogenous spread
- extension from infected pleural or mediastinal space

5

What is the physiologic result of PNA?

- alveolar capillary leak results in an infiltrate and rales
- alveolar filling results in hypoxemia
- leakage of erythrocytes can lead to hemoptysis

6

What are the etiologies of CAP-typical?

- *MC: S. pneumonia*
- H. influenza
- S. aureus
- Klebsiella pneumonia
- P. aringinosa

7

What is CAP-atypical resistant to?

- beta-lactams (PCN, amoxicillin)

8

How does CAP-atypical present?

- zero to moderate sputum production
- no lobar consolidations
- only small increases in WBC
- few physical signs; patient looks better than symptoms/CXR suggest

9

What type of PNA is restricted to small areas rather than a whole lobe?

- CAP-atypical

10

What are the etiologies of CAP-atypical?

- *MC: Mycoplasma pneumonia*
- Chlamydia pneumonia
- Legionella spp
- Moraxella
- virus: flu, adenovirus, RSV

11

What is the patient population likly to be infected by the MC etiology of CAP-atypical?

- *younger*
(Mycoplasma pneumonia)

12

What is the patient population likely to be infected by C. pneumonia?

- outpatient
(Chlamydia pneumonia)

13

What is the patient population likely to be infected by Legionella spp?

- inpatients

14

What infection is associated with exposure to contaminated water droplets from cooling and ventilation systems?

- CAP-atypical Legionella

15

What are CAP-typical S&S?

- acute or subacute onset of cough w/ or w/o production
- dyspnea
- fever, chills, sweats
- chest pain
- hemoptysis
- GI complaints
- fatigue
- HA
- myalgias
- kids present with belly pain

16

What are CAP-atypical S&S?

- low grade fever
- relatively mild pulm symptoms
- myalgias & fatigue

17

T/F: CAP S&S in elderly patients are often discrete/obvious.

- False, subtle/vague

18

What are the common PE findings of CAP?

- fever
- tachypnea
- tachycardia
- hypoxia
- increased tactile fremitus
- egophony
- altered breath sounds
- dullness to percussion

19

What testing would an outpatient CAP patient get?

- CXR

20

What testing would an inpatient CAP patient get?

- POC diagnostic tests
- blood cultures
- ABG
- HIV testing

21

T/F: Treatment for CAP must with held until blood cultures return.

- false

22

What can be found on CXR for CAP patients?

- patchy airspace infiltrates
- lobar consolidation
- diffuse alveolar or interstitial infiltrates
- pleural effusion

23

When is a CT scan indicated for CAP patients?

- in severe, unresolving cases of PNA or complicated cases

24

What is the treatment for outpatient CAP?

- healthy w/o abx in last 3 mo: macrolide
- comorbidities or abx w/in 3 mo: fluoroquinolones OR b-lactam + macrolide

25

How can CAP be prevented?

- flu and pneumo vaccine

26

What is the outpatient f/u in CAP?

- 2-3d w/o improvement or sooner if sx worsen
- fever resolves in 2-4d

27

When is a repeat CXR taken for CAP?

- smokers
- elderly

28

What is the inpatient f/u in CAP?

- repeat CXR in 4-6w

29

What should be ? if relapse or recurrence of CAP, particularly in same segment of lung?

- underlying neoplasm

30

Define HAP

- sx after hospitalization for 48 hours

31

Define VAP

- PNA that has developed more than 48 hours following endotracheal intubation and mechanical ventilation

32

What are the common etiologies of HCAP/HAP/VAP?

- S. pneumo
- S. aureus
- P. aeruginosa: MC in ICU
- Klebsiella
- E. coli
- Enterobacter
- VRE

33

What are the S&S of HCAP/HAP?

- similar to CAP but may be nonspecific
- 2+ clinical findings in the setting of a new or progressiv pulm opacity on CXR

34

What test should be done for HCAP/HAP/VAP?

- gram stain & sputum culture
- blood cultures from 2 sites
- ABG/pulse ox
- CXR

35

What is the tx of HCAP/HAP/VAP?

- start empirical and modify with culture results

36

What is the cause of anaerobic PNA & lung abscess?

- aspiration into dependent lung zones

37

What is a dependent lung zone?

- based on body position at time of aspiration

38

Describe the onset of anaerobic PNA & lung abscess?

- insidious

39

What is the clinical presentation of anaerobic PNA & lung abscess?

- fever
- wt loss
- malaise
- cough w/ FOUL-SMELLING PURULENT SPUTUM
- poor dentition

40

What diagnostic tests should be done for anaerobic PNA & lung abscess?

- sputum culture
- CXR

41

What is the treatment for anaerobic PNA & lung abscess?

- abx
- drainage

42

_______ disease is one of the most frequent complications of _______.

- pulmonary
- HIV

43

What are the 3 MC AIDS defining illnesses?

- recurrent bacterial pneumonia
- TB
- Pneumocystis jiroveci

44

How does HIV related pneumonia present?

- nonspecific symptoms
- fever, cough, SOB
- unexplained wt loss
- hypoxia

45

What diagnostics should be done in HIV related PNA?

- sputum samples
- CXR
- CT scan

46

What will be seen on CXR in HIV related PNA?

- ground glass appearance

47

What is the tx for HIV related PNA?

- Bactrim (TMP/SMX)
- steroids when hypoxic

48

How long should tx be for HIV related PNA?

- 21d

49

What should follow HIV related PNA initial tx?

- prophylaxis with Bactrim or dapsone in all pts with CD4<200 or hx of PCP

50

What causes Tuberculosis?

- Mycobacterium tuberculosis

51

How is TB transmitted?

- airborne droplets

52

What are the risk factors for TB?

- HIV +
- foreign born
- disadvantaged populations

53

What are the stages of TB?

- primary
- primary progressive
- latent
- secondary/reactivation

54

Define primary TB

- clinically & radiographically silent
- granulomas form around organism to limit multiplication

55

How does TB present?

- slow, progressive, constitutional symptoms
- chronic cough
- patient appears ill & malnourished

56

What testing should be done for TB?

- culture
- CXR

57

What will be seen on CXR of primary TB?

- small, homogeneous infiltrates
- paratracheal LN enlargement
- Ghon & Ranke complexes

58

What is a Ghon complex?

- calcified primary focus

59

Whar is a Ranke complex?

- calcified primary focus & hilar LN

60

What is used to determine if someone has even been infected with TB?

- PPD/Mantoux test

61

What must be seen on a + TB test?

- transverse induration

62

What are the 4 major drugs used as 1st line tx for TB?

- Isoniazid
- rifampin
- pyrazinamide
- ethambutol

63

What is the tx regimen in HIV (-) TB(+)?

- 2mo of all 4 drugs
-4 mo of isoniazid & rifampin

64

What is the tx regiment in HIV and TB (+)?

- similar to HIV (-) but longer
- direct observation therapy to increase pt compliance