Pneumonia Flashcards
(64 cards)
1
Q
What is the definition of pneumonia (PNA)?
A
- infection of the pulmonary parenchyma
2
Q
What are the types of PNA?
A
- community acquired (CAP)
- nosocomial/hospital acquired (HAP), healthcare associated (HCAP), ventilator associated (VAP)
- anaerobic PNA and lung abscess
- HIV related
- TB
3
Q
What is the pathophysiology of PNA?
A
- increased microbial pathogens at alveolar level
- host’s inability to fight off said pathogens
4
Q
How can microorganisms gain access to the lungs in PNA?
A
- MC: aspiration from oropharynx
- inhaled as contaminated droplets
- hematogenous spread
- extension from infected pleural or mediastinal space
5
Q
What is the physiologic result of PNA?
A
- alveolar capillary leak results in an infiltrate and rales
- alveolar filling results in hypoxemia
- leakage of erythrocytes can lead to hemoptysis
6
Q
What are the etiologies of CAP-typical?
A
- MC: S. pneumonia
- H. influenza
- S. aureus
- Klebsiella pneumonia
- P. aringinosa
7
Q
What is CAP-atypical resistant to?
A
- beta-lactams (PCN, amoxicillin)
8
Q
How does CAP-atypical present?
A
- zero to moderate sputum production
- no lobar consolidations
- only small increases in WBC
- few physical signs; patient looks better than symptoms/CXR suggest
9
Q
What type of PNA is restricted to small areas rather than a whole lobe?
A
- CAP-atypical
10
Q
What are the etiologies of CAP-atypical?
A
- MC: Mycoplasma pneumonia
- Chlamydia pneumonia
- Legionella spp
- Moraxella
- virus: flu, adenovirus, RSV
11
Q
What is the patient population likly to be infected by the MC etiology of CAP-atypical?
A
- younger
Mycoplasma pneumonia
12
Q
What is the patient population likely to be infected by C. pneumonia?
A
- outpatient
Chlamydia pneumonia
13
Q
What is the patient population likely to be infected by Legionella spp?
A
- inpatients
14
Q
What infection is associated with exposure to contaminated water droplets from cooling and ventilation systems?
A
- CAP-atypical Legionella
15
Q
What are CAP-typical S&S?
A
- 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
Q
What are CAP-atypical S&S?
A
- low grade fever
- relatively mild pulm symptoms
- myalgias & fatigue
17
Q
T/F: CAP S&S in elderly patients are often discrete/obvious.
A
- False, subtle/vague
18
Q
What are the common PE findings of CAP?
A
- fever
- tachypnea
- tachycardia
- hypoxia
- increased tactile fremitus
- egophony
- altered breath sounds
- dullness to percussion
19
Q
What testing would an outpatient CAP patient get?
A
- CXR
20
Q
What testing would an inpatient CAP patient get?
A
- POC diagnostic tests
- blood cultures
- ABG
- HIV testing
21
Q
T/F: Treatment for CAP must with held until blood cultures return.
A
- false
22
Q
What can be found on CXR for CAP patients?
A
- patchy airspace infiltrates
- lobar consolidation
- diffuse alveolar or interstitial infiltrates
- pleural effusion
23
Q
When is a CT scan indicated for CAP patients?
A
- in severe, unresolving cases of PNA or complicated cases
24
Q
What is the treatment for outpatient CAP?
A
- 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
