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Flashcards in Pneumonia Deck (72):
1

Cave exploring pneumonia = ?

Histoplasmosis

2

Bird associated pneumonia = ?

-C. Psittacosis
-Hypersensitivity pneumonitis

3

What are the three categories of pneumonia?

-Community acquired
-Atypical pneumonia
-Healthcare associated

4

IV therapy, wound care, or chemo in the last (__) days is suspicious for pneumonia

30 days

5

Hospitalization for over (__) days in the last (__) days is suspicious for healthcare associated pneumonia.

2

90

6

Treatment in a dialysis clinic in the last (__) days is suspicious for pneumonia

30

7

Who is the typical pneumonia patient?

Older black males

8

What is the all cause mortality for hospital acquired pneumonia

28%

9

What are the internal predisposing factors for developing pneumonia?

Hypoxemia
Acidosis
Pulmonary edema
Uremia

10

Why is it important to ask about altered level of consciousness with pneumonia?

Aspiration pneumonia

11

What is the most common infectious pneumonia? What is this associated with?

Strep. Pneumoniae
Smoking

12

How does smoking predispose to pneumonia?

Impairment of cilia

13

How does EtOH predispose to pneumonia?

Impairment of cilia/immune system

Aspiration

14

How does hypoxemia and acidosis predispose to pneumonia?

Lowered immune system

15

What are the three major genetic disorders that predispose to pneumonia?

CF
Kartagener's syndrome

16

Common use of what in older patients predisposes patients to pneumonia?

Denture use while sleeping

17

Typical or atypical cause of pneumonia: strep pneumonia

Typical

18

Typical or atypical cause of pneumonia: HiB

Typical

19

Typical or atypical cause of pneumonia: Staph Aureus

Typical

20

Typical or atypical cause of pneumonia: GAS

Typical

21

Typical or atypical cause of pneumonia: mycoplasma pneumonia

Atypical

22

Typical or atypical cause of pneumonia: legionella

Atypical

23

Typical or atypical cause of pneumonia: moraxella catarrhalis

Typical

24

Typical or atypical cause of pneumonia: gram negative bacteria

Typical

25

Typical or atypical cause of pneumonia: Chlamydia pneumoniae

Atypical

26

Typical or atypical cause of pneumonia: Chlamydia psittaci

Atypical

27

What are the four most common infectious agents found to cause pneumonia?

1. Strep pneumonia
2. viruses
3. Mycoplasma pneumoniae
4. Legionella

28

What are the bacteria that you should consider with pneumonia post influenza?

Staph aureus (MRSA)
Enterobacteriaceae
Pseudomonas

29

What are the risk factors of developing an pneumonia/abscesses secondary to aspiration?

Anaerobic bacteria

30

What is the causative agent of Q fever? In whom is this commonly found? Why?

Coxiella brunetti
Farmers and vets d/t exposure to animal placentas

31

What is associated with francisella tularensis?

Rabbits

32

What is the test that can be run to detect Legionella (besides a culture/PCR)?

Urine antigen test

33

What is the bacteria that causes hospital acquired pneumonia?

Staph Aureus

34

In whom is H. influenzae seen?

Older pts and those with underlying lung disease

35

In whom is M. Pneumoniae usually seen?

Epidemics in schools or military recruits

36

What makes chlamydophila pneumoniae hard to diagnose?

Lack of s/s with serological testing

Intracellular pathogen

37

What are the common associations with legionella?

Water sources (air conditioners, showers, etc)

38

What is the prognosis with Legionnaires disease (generally)?

Bad

39

What is the usual bacterial cause of empyema?

Anaerobic bacteria

40

What are the risk factors for getting an anaerobic pneumonia?

Aspiration risks

41

In whom are anaerobic bacteria less common?

Edentulous

42

True or false: gram negative bacilli are uncommon causes of CAP, with the exception of patients requiring ICU treatment

True

43

What are the two most common infectious agents of CAP in the ICU?

S. pneumoniae
Gram negative

44

CF patients pneumonia = ?

Pseudomonas

45

Klebsiella pneumonia = ?

alcoholics

46

What is the sensitivity of clinical diagnosis of pneumonia (CXR, ssx)?

50%

47

What are the usual ssx of typical pneumonia?

Productive cough
Fever
Pleuritic chest pain
Dyspnea

48

What is the CBC finding of typical pneumonia?

Leukocytosis with a L shift

49

How often do patients with pneumonia have crackles and signs of consolidation?

1/3

50

What is the gold standard for diagnosing pneumonia?

CXR

51

True or false: most patients who are dehydrated may have a false- negative CXR,

false-Only a small proportion is this true

52

Air fluid level on CXR with density below and lucency above = ?

Lung abscess

53

True or false: establishing the specific pathogen for CAP is essential in the treatment of pneumonia

False--usual empiric therapy is sufficient

54

What organisms should be cultured, if suspected?

Legionella
Flu or MERS
MRSA

55

Why is a culture useful for hospitalized or pts in a nursing home?

Can help with treatment of others close to pt

56

True or false: the majority of pneumonia cases admitted are treated empirically

True

57

When is a sputum culture recommended?

-ICU admission
-Failure of abx
-Cavitary changes
-Immunocompromised
-Alcoholism
-COPD
-Pleural effusion

58

More than how many epithelial cells per HPF are sputum cultures rejected?

more than 10 per HPF

59

What fraction of blood cultures are positive in hospitalized patients with strep pneumoniae?

7-16%

60

What bacterial infections do we have urinary antigen tests for? Are these valid after abx treatment?

Legionella
Strep pneumoniae

Still valid even after abx treatment

61

What is the diagnositc test needed for C. Pneumoniae?

PCR or serological testing

62

What is the treatment for CAP?

Macrolide or doxycycline

63

What is the treatment for pneumonia in patients with comorbidities? (2)

Oral fluoroquinolone (floxacins) or beta lactam plus a macrolide

64

What is the treatment for inpatient pneumonia?

Fluoroquinolone

or

anti-pseudomonal beta lactam + a macrolide

65

What is the ICU treatment for pneumonia?

Antipseudomonal + beta lactam

OR

Azithromycin

66

What is the ICU treatment for pneumonia if pt has a PCN allergy?

Quinolone plus aztreonam

67

What is the treatment for MRSA?

nafcillin or oxacillin

68

How long should abx treatment for CAP be?

5 days

69

What are the criteria for discontinuation of abx with CAP?

afebrile for 47-72 hours

70

When are corticosteroids indicated for CAP?

Seriously ill patients, especially those in the ICU

71

What are the risk factors for developing pneumonia secondary to an aerobic bacterial infection?

Alcohol use
Seizures
Stroke

72

Why are GAS infections less common in edentulous patients?

GAS grows in periodontal area