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Medicine > Pneumonia, Pleural Effusion And Emphysema > Flashcards

Pneumonia, Pleural Effusion And Emphysema Flashcards

1
Q

What is pneumonia

A

Infection of the lung parenchyma caused by bacteria, viruses, fungi or rarely protozoa

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2
Q

What is the leading cause of ID rested morbidity and mortality

A

Pneumonia

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3
Q

Which bacteria which cause pneumonia are the leading cause of death from pneumonia

A

Streptococcus pneumoniae
Legionella pneumophila

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4
Q

What is pneumonitis

A

Inflammation of the lungs from a variety of non-infectious causes such as chemicals, radiation and autoimmune processes

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5
Q

Pneumonia may be classified based on

A

The setting of the acquisition of the infection
Mechanism of acquisition
Clinical presentation
Infecting pathogen
Radiographic pattern of the infiltrate
Immune status of the patient

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6
Q

What is the main reason for classification of pneumonia

A

To help predict etiology and guide diagnostic and initial empirical therapeutic interventions

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7
Q

Which setting of acquisition of pneumonia occurs prior contact to the health care system in the outpatient setting or within 48 hours of hospitalization

A

CAP

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8
Q

Which type of pneumonia occurs 48 hours after hospitalization with no signs of pulmonary infection on admission

A

HAP

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9
Q

Which type of pneumonia develops 48 hours or more on mechanical ventilation

A

VAP

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10
Q

Which type of pneumonia occurs in non-hospitalized patients with extensive health care contact

A

HCAP

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11
Q

What are the two common mechanisms of acquisition of pneumonia

A

Ventilator use
Aspiration

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12
Q

Which type of pneumoniae has a less abrupt course with constitutional and mild upper respiratory tract symptoms preceding the onset of a non-productive cough

A

Atypical pneumoniae

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13
Q

Which type of pneumonia is associated with an acute respiratory illness characterized by productive cough, pleuritic chest pain, fever and dyspnea

A

Typical pneumonia

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14
Q

What condition is interstitial pneumonia associated with

A

Reticulonodular opacities

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15
Q

What condition tends to have multifocal opacities

A

Bronchopneumonia

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16
Q

Absolute neutrophil count which suggests a patient is immunocompromised

A

Neutrophil count < 1000/mcL or 1.0x10^9/L

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17
Q

What is the pathogenesis of pneumonia

A

There is invasion and overgrowth of pathogenic organisms in the king parenchyma
The host defenses work to prevent proliferation of microorganisms in the lungs
A combination of defective host defenses, virulence of pathogen, high pathogen inoculum and patient’s overall health results in development of pneumonia
The Inflammatory response against the microorganisms causes the clinical manifestations of pneumonia

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18
Q

What are some risk factors for CAP

A

Alcoholism and smoking
Age greater than 65
Recent viral upper respiratory tract infection
Underlying pulmonary disease (COPD, bronchiectasis, lung cancer)
Proton pump inhibitor therapy for the last 30 days
Smoke
Sedating medications
Immunosuppression
Severity of underlying illness
Presence of invasive respiratory devices
Stress ulcer prophylaxis

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19
Q

List some bacteria which cause typical pneumonia

A

Streptococcus pneumoniae
Staphylococcus aureus
Klebsiella pneumoniae
Haemophilus influenzae and Moraxella catarrhalis
Pseudomonas aeruginosa

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20
Q

What is the most common pathogen for causing pneumonia

A

Streptococcus pneumoniae

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21
Q

Which bacteria can be seen in alcoholics and heavy smokers, and in association with aspiration and could lead to aggressive necrotising lobar pneumonia

A

Klebsiella pneumoniae

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22
Q

Which bacteria could cause pneumonia in the elderly and patients with COPD

A

Haemophilus influenzae and Moraxella catarrhalis

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23
Q

Which bacteria is an uncommon cause of CAP in healthy adults but may occur following an influenza infection. It could also cause a severe necrotizing pneumonia that often requires ICU admission

A

Staphylococcus aureus

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24
Q

What is a rare pathogen in CAP except in patients with structural lung disease such as cystic fibrosis and bronchiectasis

A

Pseudomonas aeruginosa

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25
Q

What is the most common pathogen for atypical pneumonia

A

Mycoplasma pneumoniae

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26
Q

What is the result of aspiration of oropharyngeal contents

A

Anaerobic organisms

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27
Q

Mention some other bacteria that cause atypical pneumonia

A

Legionella spp
Coxiella burnetii (Q fever)
Chlamydophila pneumoniae

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28
Q

Aspiration pneumonia tends to be polymicrobial and may consist of some anaerobic species
True or false

A

True

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29
Q

Give some examples of anaerobic species that cause aspiration pneumonia

A

Klebsiella
Peptostreptococcus
Bacteroides
Fusobacterium
Prevotella

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30
Q

What is the most common viral cause of pneumonia in patients at the extremes of age, with multiple comorbidities, and pregnant women

A

Influenza A and B

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31
Q

Which virus causes pneumonia only in immunocompromised patients

A

Cytomegalovirus

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32
Q

Which viral pathogens can cause pneumonia

A

RSV
VZV
EBV
Coronavirus
Parainfluenza virus
Adenovirus

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33
Q

Fungal pathogens are rarely a cause for which type of pneumonia

A

CAP

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34
Q

Which bacteria is commonly associated with prolonged mechanical ventilation

A

Acinetobacter baumannii

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35
Q

Pneumonia is common in HIV patients
True or false

A

True

36
Q

Deactivation of which viruses can cause pneumonia in the IC host

A

HSV
VZV
CMV

37
Q

Toxoplasma gondii and Strongyloides stercoralis may rarely cause pneumonia in the IC host
True or false

A

True

38
Q

What are some symptoms of CAP

A

Combination of cough with or without sputum production
Fever, pleuritic chest pain
Shortness of breath
Respiratory distress
Etc

39
Q

Elderly and immunocompromised patients may present with subtle and non-respiratory symptoms such as

A

Lethargy or delirium
Poor oral intake
Decompensation of other comorbid medical conditions

40
Q

What are some clinical manifestations of atypical CAP

A

It is characterized by a more insidious onset, a dry cough and constitutional and extrapulmonary symptoms such as headache, low-grade fever, malaise, myalgias, sore throat, etc
Extra pulmonary symptoms are often more prominent than respiratory symptoms
Chest radiograph tends to appear much worse than the clinical or auscultatory findings

41
Q

Signs of CAP

A

Many patients appear acutely ill
Common physical findings include fever or hypothermia, tachypnea, tachycardia, and arterial oxygen desaturation
Dullness to percussion may be observed if lobar consolidation or a parapneumonic pleural effusion is present
Chest auscultation often reveals inspiratory crackles and bronchial breath sounds
The clinical evaluation is less than 50% sensitive compared to chest imaging for the

42
Q

VAP may also manifest as an increased need for mechanical ventilator support and/or pulmonary suction requirements
True or false

A

True

43
Q

What is the most consistent presenting symptom for bacterial pneumonia

A

Cough productive of sputum

44
Q

A red-colored sputum in pneumonia is characteristic of which bacteria

A

Streptococcus pneumoniae

45
Q

A green-colored sputum in pneumonia is characteristic of which bacteria

A

Pseudomonas
Haemophilus
Pneumococcal species

46
Q

A red currant jelly sputum In pneumonia is characteristic of which bacteria

A

Klebsiella species

47
Q

A foul smelling sputum in pneumonia is characteristic of which type of infection

A

Anaerobic infection

48
Q

The presence of rigors may suggest which type of pneumonia

A

Pneumococcal pneumonia more often than pneumonia caused by other bacterial pathogens

49
Q

What are some aspiration risks

A

Alcoholism
Altered mental status
Dysphagia
Seizure disorder
GERD

50
Q

Exposure to contaminated air conditioning or water systems can cause pneumonia. What bacteria is responsible for this

A

Legionella spp

51
Q

Exposure to overcrowded instititions can cause pneumonia. What bacteria is responsible for this

A

S. pneumoniae
Mycobacteria
Mycoplasma
Chlamydophilia

52
Q

Exposure to cattle, cats, sheep and goats can cause pneumonia . What organism is responsible for this

A

C. burnetii

53
Q

Exposure to cattle hide can cause pneumonia. What organism is responsible for this

A

B. anthracis

54
Q

Exposure to turkeys, chicken, duck or other birds can cause pneumonia. What organism is responsible for this

A

C. psittachi

55
Q

Exposure to rabbits and rodents can cause pneumonia. What organism is responsible for this

A

F. tularensis
Y. pestis

56
Q

What are some investigations for pneumonia

A

FBC (Leukocytosis with predominantly neutrophilia may be observed in any bacterial infection. Leukopenia may be an ominous clinical sign of impending sepsis)
Blood culture (should be obtained before the administration of antibiotics. Positive in 40% in cases)
Sputum gram stain and culture (should be performed before taking antibiotics)
Serum chemistry panel (Blood urea, electrolytes and creatinine)
Arterial blood gas determination (hypoxia and respiratory acidosis might be present)
Inflammatory biomakers (ESR, C-reactive protein, Procalcitonin)
Chest X-ray
Ziehl-Neelsen stain for acid fast bacilli
Silver stain for Pneumocystis jiroveci and fungal pathogens
Antigen tests (Can be performed on urine, nasal aspirate, sputum, lower respiratory tract specimens and serum for various pathogens including L pneumophila, S pneumoniae, Pneumocystis jirovecii, Cryptococcus neoformans, Histoplasma capsulatum etc. PCR testing for M pneumoniae, Chlamydophila spp, common respiratory viruses. Immunohistochemistry can be performed on BAL specimen to detect viral infections such as CMV, VZV, or HSV. Histology from a transbronchial biopsy is useful for detecting endemic fungal and mycobacterial pathogens)

57
Q

What is the the gold standard for diagnosis of pneumonia

A

The presence of an infiltrate in a chest x-ray

58
Q

A normal x-ray does not exclude the diagnosis of pneumonia because X-rays may be normal, early in the course of disease
True or false

A

True

59
Q

Always consider the possibility of this infection, because delayed treatment significantly increases mortality. What bacteria is being referred to

A

Legionella

60
Q

The episode of aspiration is usually not witnessed, thus a diagnosis is inferred when patient at risk of aspiration develops radiographic infiltrate in characteristic locations
True or false

A

True

61
Q

What are the non-infectious differential diagnosis for pneumonia

A

Pulmonary edema
Pulmonary embolism
Lung carcinoma
Hypersensitivity pneumonitis
Connective tissue disease involving the lung

62
Q

What are some infectious differential diagnosis of pneumonia

A

Acute bronchitis
Exacerbation of COPD
TB
Lung abscess

63
Q

Differentiate pulmonary edema diagnosis from pneumonia

A

There is bilateral infiltration with central predominance and abnormal ECG is suggestive in pulmonary edema

64
Q

Differentiate pulmonary embolism diagnosis from pneumonia

A

Pulmonary embolism rarely presents with productive coughs or infiltrations visible on chest x-ray

65
Q

A history of smoking, constitutional symptoms (e.g. significant weight loss), or chronic cough may be suggestive. What differential diagnosis of pneumonia is this

A

Lung carcinoma

66
Q

Most often, a prior diagnosis or symptoms of underlying disease is already present. Which differential diagnosis of pneumonia is this

A

Connective tissue disease involving the lung

67
Q

Diagnostic criteria including a compatible exposure history. What differential diagnosis for pneumonia is this

A

Hypersensitivity pneumonitis

68
Q

Once a diagnosis of CAP is made, the first management decision is to

A

Determine the site of care
(Is it safe to treat the patient at home or does the patient require admission to the medical ward or intensive care unit?)

69
Q

What are the two widely used clinical prediction rules available to guide admission and triage decisions

A

Pneumonia Severity Index (PSI-Preferred tool)
Curb-65 (Alternative tool)

70
Q

Curb-65 assesses 5 independent predictors of increased mortality. What are these

A

Confusion
Urea
Respiratory rate
Blood pressure
Age greater than 65

71
Q

What is the use of the CURB-65 scoring system

A

It is used to help identify patients that may be candidates for outpatient treatment or require admission

72
Q

In the Curb-65 system, one point is given in each of the predictors. What parameters of the predictors calls for points. List for each parameter (confusion, urea, respiratory rate, blood pressure, age greater than 65)

A

Confusion - altered mental state
Urea - BUN levels > 7mmol/L
RR - RR > 30bpm
BP - Systolic pressure < 90mmHg or diastolic pressure < 60mmHg
Age - 65 years or more

73
Q

What does score of 0-1 mean in the Curb system

A

Outpatient treatment

74
Q

What does score of 2 mean in the Curb system

A

Admission to medical ward

75
Q

What does score of 3 or higher mean in the Curb-65 system

A

Admission to ICU

76
Q

Which Curb-65 score range carries a low risk of mortality and which score range Carrie’s a high risk of mortality

A

0-1 - low risk of mortality
2-5 - high risk of mortality

77
Q

What is the mainstay of treatment of bacterial pneumonia

A

Antibiotic therapy

78
Q

List some supportive treatments for pneumonia

A

Supplemental oxygen with pulse oximetry monitoring
Ventilators support if supplemental oxygen is not sufficient or patient cannot maintain the increased work of breathing
Fluid resuscitation with intravenous crystalloids in patients with hypotension and/or tachycardia
Analgesia and antipyretics
Correction of electrolyte abnormalities
Chest physiotherapy to assist in drainage of secretions
Good nutrition and early mobilization of patients

79
Q

What are some preventative measures for CAP

A

Pneumococcal vaccines
Administration of influenza vaccine decrease the risk of viral influenza which decreases the risk of viral influenza which decreases the risk of bacterial superinfection

80
Q

What is pleural effusion

A

It refers to the accumulation of fluid between the layers of the parietal and visceral pleura. It is the manifestation of a disease rather than a disease in itself

81
Q

What are the classifications of pleural effusion

A

Transudative and exudative

82
Q

What is emphysema

A

Pus in the pleural space. It is typically a complication of pneumonia

83
Q

Emphysema may also arise from

A

Penetrating chest trauma
Esophageal rupture
Complication from lung surgery
Inoculation of the pleural cavity after thoracentesis or chest tube placement
Extension of a subdiaphragmatic or paravertebral abscess

84
Q

What is the pathophysiology of pleural effusion

A

Pleural effusions represent a disturbance between pleural fluid production and lymphatic resorption.
Pleural fluid is a product of Starling forces within the capillary bed of the parietal pleura and is absorbed by lymph vessels in the diaphragmatic and mediastinal surfaces of the parietal pleura
The entire volume of pleural fluid normally turns over within 1 hour.
The lymphatic vessels can handle flow of up to approximately 20 times more than the normal production rate → lymphatic resorption has a large reserve capacity

85
Q

The normal mean rate of production and absorption of the pleural fluid is

A

0.2 mL/kg/hour

Medicine (38 decks)

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