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FAMILY MEDICINE > Pneumonia > Flashcards

Flashcards in Pneumonia Deck (31):
1

Difference between pneumonia and pneumonitis

pneumonia - INFECTION of lung parenchyma by bacteria, viruses, fungi, and parasites

pneumonitis - INFLAMMATION of lungs from NON-INFECTIOUS causes such as autoimmune, chemicals, blood, or radiation

2

Most common mechanism triggering pneumonia

upper airway colonization by pathogenic organisms that are then aspirated

3

most common viral causes of community acquired pneumonia (CAP)

influenza A and B, parainfluenza, adeno, RSV

4

most common bacterial causes of CAP

s pneumo (most common), h influenza (often seen with underlying COPD), moraxella catarrhalis

5

rust colored sputum, fever, shaking chills, lobar infiltrate on chest xray...

PNEUMOCOCCAL PNEUMONIA

6

bacterial causes of atypical pneumonia

mycoplasma pneumoniae, chlamydia pneumoniae, legionella + different viruses

most common in adolescents and adults, whereas typical is more common in very old and young

7

How do atypical organisms present on xray

bilateral diffuse infiltrates rather than focal lobar infiltrates (seen in typical)

8

Risk factors for health acquired pneumonia

hospitalization within 90 days, home infusion therapy, dialysis, living at nursing home

9

Causative organisms for health acquired pneumonia

everything that causes CAP + gram negative aerobes (pseudomonas, klebsiella, acinetobacter) and gram positive cocci (staph aureus). MRSA getting more common

10

symptoms of pneumonia

productive cough, fever, pleuritic chest pain, dyspnea

11

pneumonia that is abrupt onset or abruptly worsening

pneumococcal pneumonia

12

pneumonia + diarrhea, hyponatremia, elevated liver enzymes, and/or older patients

legionella

13

common cause of post influenza pneumonia

staph aureus

14

physical exam findings of pneumonia

tachycardia, tachypnea, fever, hypotension, low o2 sat
rhonchi/rales on lung exam
egophony (focal lung consolidation)
dullness to percussion (pulmonary effusion)

15

What confirms dx of pneumonia and should be done in all patients suspicious of pneumonia?

CHEST X RAY (WILL SEE INFILTRATES)
but absence of infiltrate does not rule out pneumonia

16

bilateral "ground glass" infiltrate

pneumocystis jiroveci often seen in AIDS patients

17

apical consolidation on xray

TB

18

Where is pneumonia caused by aspiration of GI contents seen?

RLL because of branching bronchial tree

19

Other testing indicated in pneumonia

CBC, chem panel, blood/sputum culture (low sensitivity)

20

What test can confirm legionella

urine antigen testing

21

How to tell if patient with pneumonia can be managed inpatient vs outpatient

use a prediction scoring system!

CURB-65 (CAP)
pneumonia severity index (PSI/PORT score)

low risk = classes 1, 2 can be treated outpatient
high risk = classes 3-5 inpatient

22

Risky lab findings in pneumonia

low pH, low sodium, low Hct, low o2 sat, high glucose, high BUN, pleural effusion on xray

23

empiric treatment of CAP in healthy persons for outpatient

macrolide (clarithro/azithromycin) or doxy

24

Treatment for patient with comorbidities like DM or heart/lung disease

flurouinolones (levofloxacin, moxifloxacin) or combo of b-lactam (high dose amox, augmentin) plus macrolide

25

When should patient being treated outpatient return for follow up?

3-4 days, since no clinical improvement in 5-7 days can indicate bronchogenic carcinoma which can present with typical pneumonia

26

how to treat pseudomonas pneumonia

pipercilin tazobactam (ZOSYN) plus fluroquinolone

27

how to treat MRSA pneumonia

vanc

28

How long does treatment usually last in CAP vs heatlh care acquired

depends on severity of symptoms

CAP 5-10 days (or 3 days afebrile)
HAP - two-3 weeks

29

complications of pneumonia

bacteremia, parapneumonic pleural effusion, empyema, (may need to do thoracentesis of too much fluid)

30

Who should get pneumococcal vaccine?

everyone over 65, adults with chronic cardiopulm diseases, cigarette smokers, immunocompromised

use 23 polysaccharide vaccine in adults 65 an dolder in addition to 13-valent conjugate vaccine.

31

What other vaccine can you get to reduce risk of pneumonia

influenza! (prevents secondary pneumonia)