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PANCE/EOC > Pulm #3 > Flashcards

Pulm #3 Flashcards

(48 cards)

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1
Q

MCC of typical Pneumonia

A

Strep Pneumo

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2
Q

Causes of atypical PNA

A
  • Mycoplasma PNA

- Legionella PNA

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3
Q

Symptoms of Typical PNA

A
  • Tachypnea
  • Signs of consolidation: bronchial breath sounds, dullness to percussion, increased tactile fremitus, ego phony, inspiratory crackles/rales
  • Fever, productive cough, pleuritic chest pain, dyspnea, rigors
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4
Q

Symptoms of Atypical PNA

A
  • Fever, dry nonproductive cough, myalgias, malaise, nausea, vomiting, diarrhea
  • Pulmonary exam often normal
  • May have crackles and rales
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5
Q

Regarding Strep Pneumo PNA, what kind of sputum is associated with it?

A

Blood-tinged rusty sputum

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6
Q

On a gram-stain for Strep Pneumo, what is seen?

A

Gram-positive diplococci

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7
Q

Regarding H. Influenzae PNA (second MCC of CAP), what are the risk factors for this type?

A
  • Extremes of age (young and old)
  • Immunocompromised (DM, HIV, chemo)
  • Underlying pulmonary disease (COPD, asthma, CF)
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8
Q

Staph Aureus PNA is associated with

A

A superimposed infection after a viral infection or hospital acquired pneumonia

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9
Q

What does a gram-stain for Staph A PNA show?

A

Gram-positive cocci in clusters

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10
Q

Klebsiella PNA is a severe illness in who?

A

Chronic alcoholism, sick patients, and patients with chronic illnesses (DM)

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11
Q

What kind of sputum is seem in patients with Klebsiella PNA?

A

-Purple-colored (currant jelly) sputum

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12
Q

For Klebsiella PNA, what is seen on CXR?

A

Cavitary lesions (especially right upper lobe) with bulging fissures

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13
Q

MCC of atypical PNA

A

Mycoplasma Pneumoniae

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14
Q

Risk factors for mycoplasma PNA

A

-Young and healthy (college students, military recruits)

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15
Q

Symptoms of Mycoplasma PNA

A
  • Pharyngitis and URI symptoms (headache, fever, malaise)
  • Persistent dry nonproductive cough
  • Bullous myringitis (rare): fluid filled blisters in TM
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16
Q

What does a CXR for mycoplasma PNA show?

A

-Reticulonodular pattern most common (diffuse, patchy or interstitial infiltrates)

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17
Q

What is the test of choice for mycoplasma PNA?

A

-PCR: cold agglutinins

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18
Q

Treatment for Mycoplasma PNA

A
  • Macrolides (Azithromycin) or Doxycycline

- Lacks a cell wall so resistant to beta-lactams

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19
Q

Legionella PNA is transmitted through

A

Outbreaks related to contaminated water sources (air conditioners, potable water, cooling towers)
-No person to person transmission

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20
Q

Symptoms of Legionella PNA

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A
  • GI symptoms prominent: watery diarrhea, nausea, vomiting
  • Hyponatremia and increased LFT’s
  • Neurologic symptoms: headache, confusion, AMS
21
Q

Preferred diagnostic for Legionella PNA

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A

-PCR or urine antigen

22
Q

Treatment for Legionella PNA

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A

-Macrolides or Levofloxacin, Moxifloxacin

23
Q

What is the time frame regarding CAP and HAP

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A

CAP: develops PNA within 48 hours of initial hospital admission or outside of the hospital

HAP: > 48 hours after hospital admission

24
Q

Outpatient treatment for CAP

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A
  • Macrolide or Doxycycline first line

- Fluoroquinolones only used if comorbid conditions or recent ABX use

25
Inpatient treatment of CAP
-Ceftriaxone or Ampicillin/Sulbactam OR -Levofloxacin, Moxifloxacin
26
HAP treatment
-Piperacillin/Tazobactam, Ceftazidime, Cefepime; Aminoglycosides (Amikacin, Gentamicin, Tobramycin); or Levofloxacin/Moxifloxacin
27
With HAP: - Add _____ or _____ if Legionella suspected - Add _____ or _____ if MRSA suspected
- Levofloxacin or Azithromycin | - Vancomycin or Linezolid
28
What is the CURB-65 criteria regarding admission for PNA?
Admit if at least 2 points, each is worth 1 point - Confusion - Uremia (> 7 mg/dL) - Respiratory rate > 30 - BP low (SBP < 90 or DBP < 60) - Age > 65
29
Aspiration PNA is MCC by
Anaerobes (Peptostreptococcus, Fusobacterium)
30
Aspiration PNA is MC found in
The right lower lobe due to vertical angle of right mainstem bronchus
31
Treatment for aspiration PNA
-Ampicillin-Sulbactam or Amoxicillin-Clavulanate
32
Histoplasmosis PNA is transmitted through
Inhalation of soil containing bird and bat droppings in the Mississippi and Ohio River valleys (also seen with demolition and spelunkers)
33
Most specific test for Histoplasmosis PNA
-Cultures
34
Treatment for mild-moderate disease in Histoplasmosis PNA
-Intraconazole 1st line
35
Pneumonia Vaccine Schedule
- Prevnar 13 to kids < 20 years old | - Prevnar 13 then Pneumovax 23 to people > 65
36
MCC of acute bronchiolitis
-RSV
37
Risk Factors for bronchiolitis
- Infants 2 months to 2 years - Exposure to cigarette smoke - Prematurity - Crowded conditions (day care)
38
Symptoms of acute bronchiolitis
-Viral prodrome followed by respiratory distress
39
Management for bronchiolitis
-Supportive: humidified oxygen, IVF, nebulized saline, cool mist humidifier, antipyretics
40
How to prevent bronchiolitis in high risk patients
- Palivizumab during first year of life for children < 29 weeks, symptomatic lung disease, immunodeficiency - Handwashing is preventative
41
Byssinosis is caused by
Cotton exposure in those employed in the textile industry
42
Symptoms of Byssinosis
- Dyspnea, wheezing, cough, chest tightness | - Symptoms get worse at beginning of week and improve later in the week (Monday fever)
43
Silicosis is pulmonary disease caused by
inhalation of silicon dioxide
44
Silicosis greatly increases the risk for
TB
45
Risk Factors for silicosis
- Coal mining - Quarry work with granite - Slate, quartz - pottery makers - Sandblasting - Masonry
46
What do chest radiographs for silicosis show?
- Multiple small opacities in upper lobes | - Eggshell calcifications of hilar and mediastinal nodes
47
What is the diagnostic gold standard for silicosis?
Lung biopsy
48
Mainstay of treatment for silicosis?
Removal from exposure

PANCE/EOC (63 decks)

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