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Clin Med- P > pneumonia > Flashcards

pneumonia Flashcards

1
Q

what is pneumonia?

A

inflammation of alveoli or interstitium of lung cause my microorganism (bacteria, viral, fungal)

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2
Q

how is pneumonia classified and what are the 4 types we went over?

A 
by source of infection
major groups: - CAP: community acquired 
-HAP: hospital acquired 
minor groups: -HIV associated (immunocompromised) 
-Flu associated MRSA pneumonia
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3
Q

how long must you have been at the hospital for it to be classified as HAP?

A

48 hrs after admission

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4
Q

3 risk factors for CAP

A

extremes of age, alcoholism (KLEB CL), other medical conditions (i.e. DM)

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5
Q

3 types of CAP

A

bacterial (worse symptoms, 85% of cases) viral (milder symptoms) fungal (only in immunocompromised people)

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6
Q

3 typical bacterial organisms that cause CAP. Typical makes up ___% of CAP

A

Strep Pneumo, H flu, M catarrhalis; 85%

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7
Q

which bacterial organisms for CAP are penicillin sensitive and penicillin resistant

A

Strep pneumo- some sensitive and resistant
H flu- some sensitive and some resistant to ampicillin (txt w/ Beta Lactamase inhib)
M cattarrhalis- all strains resistant

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8
Q

3 atypical bacterial organisms that cause CAP

A

legionella, mycoplasma, C pnemoniae

-usually less acute symptoms w/ less productive cough

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9
Q

rare bacterial pathogens that cause CAP and what are they assosciated with?

A

klebsiella (w/ alcoholism)
staph aureus (w/ flu)
* recent reports of recent fatal CA-MRSA pneumonia

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10
Q

inoculation of pneumonia means?

A

microaspiration (oral secretion with bacteria travels down the throat to the lungs)

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11
Q

clinical presentation of pneumoniae, how are these different if its viral?

A

symptoms come on rapidly, early onset COUGH (if productive it is purulent), PLEURISY (localized chest pain w/ breathing), maybe SOB and dec. pulse ox
*viral: same symptoms but more mild

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12
Q

respiratory rate w/ pneumonia

A

commonly increased

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13
Q

Lung PE for pneumonae

A
  • bronchial breath sounds in periphery (consolidation, fluid filled causes transmitted sounds to travel)
  • dull to percussion (effusion)
  • crackles (pus in alveoli)
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14
Q

Dx for simple pneumonia (no hospital admission)

A

chest x ray (gold standard) : guidelines recommend seeing consolidation (pus in airways- alveoli)
***INFILTRATES NOT PNEUMO

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15
Q

txt for pneumoniae: abx?

A

tripack > Zpack

azithromycin: 1 pill/day for 3 days

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16
Q

if Dx with CAP and considering hospitalization, what two further tests will you run?

A

deep cough sputum culture before giving abx and gram stain

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17
Q

additional tests for CAP and hospitalizing… to evaluate severity.. (3)

A

1) . pulse ox (if not as sick), ABG (if very sick)
2) . procalcitonin to evaluate severity (elevated w/ sepsis)
3) . pneumonia severity index

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18
Q

6 signs that pt should be admitted with CAP

A

neutropenia, multilobar infection, 50+yo and other med. problems, altered mental status, low BP

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19
Q

if CAP and hospitalized, what drugs (in general) are you giving?

A

IV Abx, multi-drug therapy
non ICU: floxacin or macrolide (mycin) AND b lactam
ICU: b lactam AND mycin or floxacin

20
Q

4 requirements to give oral abx and discharge

A

able to take PO, WBC decreasing, afebrile, improving cough and SOB

21
Q

when txt considered failed?

A

if not better in 72 hours: this might mean you gave the wrong drug, the bug was resistant or there are other complications (i.e. empyema)

22
Q

what is empyema?

A

complication of pneumonia: collection of pus in pleural cavity (abx cant reach these) (might need thoracentesis and drainage)

23
Q

symptoms get better before _____ gets better

A

chest xray (for longterm followup); can take 4-8 weeks to return to normal

24
Q

klebsiella pneumoniae has what as a risk factor?

A

alcoholism

25
Q

“walking pneumonia” usually refers to what?

A

viral pneumonia (more mild symptoms, no consolidation just crackles, few or no infiltrates)

26
Q

mortality for HAP; which pt population usually gets this?

A

high: 20-50%; most often vent pts

27
Q

HAP is usually from what source?

A

bacterial, multiple drug resistant pathogens

28
Q

clinical presentation for HAP

A

change in CLINICAL STATUS: those in hospital should be improving NOT declining

29
Q

important Dx test for HAP

A

sputum culture
blood cultures (helpful if positive)
*but dx is often unclear

30
Q

w/ HAP, there is a risk with _____

A

treating empirically- overtreating

start with broad spectrum then narrow based on culture results (involve ID)

31
Q

when did we see flu assosciated pnumonaie and who did it effect?

A

young healthy people

2008: very severe mortality from flu–>MRSA–>pneumonia
2014: –> strep pneumoniae

32
Q

index of suspicion of post-flu pneumonia is elevated by…

A

Hx of skin infection, recent flu, multilobar disease, lack of txt response, no flu vaccine

33
Q

SARS and MERS cause by what virus?

A

mutated coronavirus - very high mortality

34
Q

what is the most common opportunistic infection in HIV?

A

pneumocystitis jiroveci

35
Q

low CD4 counts mean what?

A

low immune system (HIV pts have this)

36
Q

many AIDs pts receive prophylactic azithromycin if CD4 count is under 100 to avoid what kind of pneumonia?

A

mycobacterium (fungal)

37
Q

most common types of fungal pneumonia? (3)

A

If healthy person, self limited *histoplasmosis- midwest from bird droppings
occidiomycosis- southwest

38
Q

old people have less or more pulmonary symptoms of infection

A

less- dont mount immune response as well. Be wary of old people whose vitals are bad- this means the infection must be really bad
-confusion, falling down

39
Q

major clinical presentation in elderly with pneumonia**

A

tachypnea

40
Q

what is BOOP?

A

bronchial obliterans organizing pneumoniae : bilateral bronchial and alveolar fibrous plugging PLUS alveolitis
–> looks like pneumonia but isnt infectious

41
Q

etiology of BOOP

A

immune hypersensitivity and resulting fibrosis

42
Q

txt for BOOP

A

steroids - but hard to taper off b/c signs recur once you start lowering
**NOT ABX

43
Q

CAP outpatient ABX therapy: previously healthy person vs someone with ABX therapy in the past 3 months

A

healthy- azithromycin or doxy

previous ABX use- floxacin OR mycin plus b lactam (cillin)

44
Q

symptoms and treatment of klebsiella

A

s/s: high fever, chills, productive cough with CURRANT JELLY SPUTUM
tx: inpatient, broad spectrum IV ABX

45
Q

two most common ATYPICAL CAP organisms?

A

M pneumo and C pneumo

46
Q

symptoms for atypical CAP (compared to typical bugs)

A

low grade fever, nonproductive cough, negative culture, self limiting in young healthy adults

47
Q

how long do you typically treat CAP vs HAP for?

A

CAP- 5 days of ABX
HAP- 7 days ABX
**longer if comorbidities present

Clin Med- P (124 decks)

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