Pneumonias

Question 1

Pneumonia Pathophys

Answer 1

• Inflam of lungs w/ consolidation or interstitial lung infiltrates

Question 2

Pneumonia Presentation

Answer 2

• Cough
• Fever
• Pleuritic CP (sharp on inspiration)
• Dyspnea
• Sputum
• Rales/crackles
• Tactile fremitus (increased if consolidation, decreased if effusion)

Question 3

Pneumonia Dx

Answer 3

• H&P
• CXR
• SPO2
• Labs
• Sputum or blood culture
• ABG

Question 4

Bacterial vs. Viral Pneumonia

Answer 4

• Bacterial: mucopurulent sputum

- Viral: scant watery sputum

Question 5

CAP Epi

Answer 5

• Seasonal

- Vaccine (Pneumovax)

Question 6

CAP Etiology

Answer 6

• Strep pneumo**, h.flu, moraxella catarrhalis

Question 7

CAP Pathophys

Answer 7

• Acute inf of pulm parenchyma

Question 8

CAP Dx

Answer 8

• CURB-65 (confusion, urea, RR, BP, age 65): scoring to determine tx (at home vs admit)

Question 9

CAP Tx

Answer 9

• Otherwise healthy outpt: macrolide or doxy
• Comorbid outpt: FQ or beta lactam+macrolide
• Inpt non-ICU: resp FQ, beta lactam+macrolide
• Inpt ICU: beta lactam+azithro or resp FQ

Question 10

HAP Etiology

Answer 10

• 48 hrs+ after admission
• If diagnosed >5 days after sx –> higher risk of multi drug resistance
• Pseudomonas**, e.coli, klebsiella, MRSA

Question 11

HAP Dx + Tx

Answer 11

• Sputum and blood culture –> tx w/ abx
• CXR
• CT
• Labs

Question 12

Ventilator Associated Pneumonia

Answer 12

• 48-72 hrs after endotracheal intubation

Question 13

Healthcare Associated Pneumonia

Answer 13

• Extensive healthcare contact

Question 14

Aspiration Pneumonia RF

Answer 14

• Elderly
• Alcoholics
• Swallowing dysfx

Question 15

Aspiration Pneumonia Etiology

Answer 15

• Oropharyngeal or gastric contents (anaerobic)

Question 16

Aspiration Pneumonia Presentation

Answer 16

• Usually lower lobe inf
• Higher risk of complications
• Hx is important

Question 17

Aspiration Pneumonia Tx

Answer 17

• Abx (esp clindamycin)

Question 18

Mycoplasma/Atypical Pneumonia RF

Answer 18

• Young adults

- Closed/contained settings

Question 19

Mycoplasma/Atypical Pneumonia Etiology

Answer 19

• Atypical bacteria (mycoplasma**, chlamydophila, legionella)

Question 20

Mycoplasma/Atypical Pneumonia Sx

Answer 20

• Persistent dry cough

- Vesicular rash

Question 21

Mycoplasma/Atypical Pneumonia Tx

Answer 21

• Outpt w/ macrolide or doxy

Question 22

Fungal Pneumonia RF

Answer 22

• Immunocompromised

Question 23

Fungal Pneumonia Etiology

Answer 23

• These fungi are endemic to certain areas of country
• Histoplasma and blastomyces (midwest)
• Coccidioides (south west)

Question 24

Fungal Pneumonia Pathophys

Answer 24

• Can become systemic in severe cases

Question 25

Fungal Pneumonia Tx

Answer 25

- Mild: itraconazole | - Severe: ampho B

Question 26

Pneumocystis Pneumonia (PCP) RF

Answer 26

- HIV (esp. AIDS), immunocompromised

Question 27

Pneumocystis Pneumonia (PCP) Sx

Answer 27

- Fatigue - Sweats/chills - Cough - SOB

Question 28

Pneumocystis Pneumonia (PCP) Dx

Answer 28

- Hx** - CXR - Elevated LDH - Low ABG

Question 29

Pneumocystis Pneumonia (PCP) Tx

Answer 29

- Antimicrobial (Bactrim) | - Steroids