Pneumonii

Question 1

Clasificare pneumonii

Answer 1

Pneumonia comunitara (PC)
Pneumionia nosocromiala
Pneumonia de aspirtatie
Pneumonia persoanelor imunosupresate 
Pneumonia asociata ventilatiei mecanice

Question 2

De ce e cauzata,in principal, pneumonia comuitara

Answer 2

Streptococcus Pneumoniae

Question 3

Factori de risc pentru pneumonia comunitara

Answer 3

Varsta <16 sau >65
Comorbiditati (HIV,DZ, BCR, malnutritie, infectii respiratorii virala recente)
Alte afectini respiratorii( BPOC, fibroza chistica, bronsiectazii)
Stil de viata( fumat, alcool, droguri iv)
Iatrogen -corticoterapia indelungata

Question 4

Tablou clinic pneumonie

Answer 4

Tuse uscata sau productiva
Dispnee
Febra
Durere toracica, de natura pleuritica
Manifestari extrapulmonare -mialgii ,altralgi si stare generala altereata(Mycoplasma)
-miocardita si pericardita (Mycoplasma)
-cefalee(Legionela)
-reactivitatre herpes simplex labial (pneumococcica)
-durere abdominala, diaree, varsaturi
-alte rash-uri ca eritemul polimorf si eritemul nodos (Mycoplasma)
-hepatita (Legionela)

Question 5

Scorul CURB-65

Answer 5

C :confusion prezenta
U: ureea >42 mg/dl(7 mmol/l)
R : respiratory rate >30 resp/min
B: blood presure TAS <90 TAD<60
65 -varsta >

Question 6

Alti markeri de gravitate pt pneumonie, eceptand CURB-65

Answer 6

Radiografie pulmonara cu mai mult de 1 lob afectat
PaO2>60mmHg
albumina serica <3,5 mg/dl
leucocite <4*10 sau >20*10
hemoculturi pozitive
absenta febrei la varstnici
alte comorbiditati

Question 7

Analize de sange in pneumonia cu Streptococc Pneumonie, Mycoplasma , Legionela.

Answer 7

Streptoccoc -leucocitoza >14*10 ( neutrofilie 90%)
-VSH >100 PCR>100
Mycoplasma- leucocite normale
Legionela- limfopenie cu leucocite normale
-hiponatremie , hipoalbuminemie, crestere transaminaze

Question 7

Analize de sange in pneumonia cu Streptococc Pneumonie, Mycoplasma , Legionela.

Answer 7

Streptoccoc -leucocitoza >14*10 ( neutrofilie 90%)
-VSH >100 PCR>100
Mycoplasma- leucocite normale
Legionela- limfopenie cu leucocite normale
-hiponatremie , hipoalbuminemie, crestere transaminaze

Question 8

Antibioterapie in pneumonie

Answer 8

Curb65 0: Amoxacilina 500mg-3zi sau Claritormicina 500mg-2zi sau Doxacinina 100 mg

Curb65 1-2:Amoxacilina 500-1000mg-3zi +Claritromicina 500mg 2zi
Alegie penicilina; Doxacilina 100mg/zi sau levofloxacin 500mg-2*zi sau moxifoxacin 400 mg/zi

Curb65 3-5: Co-Amoxiclav 1,2g-3zi + Claritromicina 500 mg/2zi i.v.
Alternativ la alergie Cefriaxona 2g/zi +Claritromicina 500mg/2*zi

Question 9

Cauze pneumonie lent rezorbative?

Answer 9

Tratament antimicrobian incomplet/incorect (rezistenta, doza inadecvata, malabsortie, non-aderenta)
Complicatii pneumonie (empiem, abces puilmonar)
Leziuni neoplazie, boli subiacente

Question 9

Cauze pneumonie lent rezorbative?

Answer 9

Tratament antimicrobian incomplet/incorect (rezistenta, doza inadecvata, malabsortie, non-aderenta)
Complicatii pneumonie (empiem, abces puilmonar)
Leziuni neoplazie, boli subiacente

Question 10

Complicatiile pneumoniei

Answer 10

Generale (insuficenta respiratori, sepsis)

Locale (empiem, abces pulmonar, revarsat pleural lichid, pneumonie in organizare)

Question 11

Pleurezia parapneumonica si empiemul

Ce procent de PC complica?

Answer 11

Complica 1/3-1/2 din pneumonii

Question 12

Abcesul pulmonar. Simptome

Paraclinic

Answer 12

Simptome : pneumonie persistenta sau agravata, catitate mare de sputa( miros fetid) ,febra oscilanta, alerarea starii generale si scadere ponderala
Paraclini : anemie normocitara si probe inflamatorii crescute