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Clinical Pulm > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

what are the 4 categories of Pneumonia

A

Community acquired pneumonia (CAP)
-aspiration pneumonia

Hospital acquired pneumonia (HAP)
-nosocomial

Ventilator associated Pneumonia (VAP)

Healthcare associate pneumonia (HCAP)

  • nursing homes, dialysis centers, clinics, admission within the last 3 months
  • usually multidrug resistant
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2
Q

what is most common cause of CAP

A

Streptococcus pneumoniae

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3
Q

what are common typical pneumonia of CAP

A

s pneumoniae, haemophilus influenzae

staph aureus

klebsiella and pseudomonas aeruginosa

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4
Q

what are common atypical pneumonia causes of CAP

A

Mycoplasma pneumoniae

Chlamydia pneumoniae

Legionella

also respiratory viruses such as influenza, adenovirus, RSV

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5
Q

what are some General RIsk factors of CAP

A

alcoholism, asthma, immunosuppression, and an age over 70

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6
Q

common fungi causes of CAP

A

Histoplasm, coccidioides

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7
Q

common virus causes of CAP

A

influenza, RSV, corona virus

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8
Q

common protozoa causes of CAP

A

toxoplasma gondii, plasmodium

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9
Q

how to diagnosis pneumonia

A

Chest x ray

Bronchoscopy

tissue biopsy

lab:

  • sputum gram stain and culture
  • blood culture
  • CBC
  • PCR
  • procalcitonin
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10
Q

when treating pneumonia what you must also be aware of when treating?

A

Co-morbidities because it changes what antibiotic to use

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11
Q

Risk factors for Pseudomonas and MRSA

A
  • Prior isolation of either organism on culture

- recent hospitilization and receipt pf parenteral antibiotics within the last 90 days

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12
Q

Risk factors for Pseudomonas in CAP

A
  • compromised immune system
  • recent prior antibiotic use
  • structural lung abnormalities
  • repeated exacerbations of COPD and use of antibiotics/glucocorticoid
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13
Q

risk factors for pseudomonas in HAP

A
  • age, length, mechanical ventilation, antibiotics, and admission at ICU
  • trauma
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14
Q

what is more significant about HAP vs CAP

A

much more severe typically

chance for broadened scope of organisms causing infection is greater

More complicated choices of treatment

May require a specialty consult

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15
Q

when treating HAP and VAP what are some risks are we worried about

A

Increased mortality

MDR pathogens and MRSA

MDR pathogens without MRSA

MRSA alone

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16
Q

Definition of HAP

A

infection acquired after at least 48 hours of hospitilization

prior term was nosocomial infection

17
Q

Definition of VAP and clues of VAP

A

Ventilator associated pneumonia

type of HAP develops more than 48 hours after endotracheal intubation

CLues:

  • difficult to wean off ventillator
  • persistent lack of improvement overall
  • new infiltrates on chest x ray
  • new fevers
  • new changes in baseline data: CBC, CMP
18
Q

Some primary regimens with low risk of MRSA

A
  • Cefepime
  • Piperacillin-tazobactam
  • Meropenem
  • Levofloxacin
  • Vancomycin (always add if known prior MRSA)
  • Ciprofloxacin
  • Linezolid
  • Aztronam
19
Q

what are some pathogens that could lead to aspirated pneumonia

A

agents from the oral cavity and pharynx

  • anaerobes
  • gram positive cocci
  • gram negative bacteria
  • strep anginosis group
20
Q

when to use Thoracentesis?

A

all effusions with > 1cm layering in decubitus view

if suspected effusion related to HF
-thoracentesis needs done if effusions are asymmetrical, fever, chest pain or failure to resolve

If felt to be related to infection

21
Q

What is Lights Criteria?

A

criteria that makes the solution exudate:

  • high pleural fluid/serum protein ratio > 5
  • pleural fluid lactate dehydrogenase greater than two thirds of the laboratory normal upper limit for serum LDH
  • Pleural/serum LDH ratio> 0.6

For exudative effusions, pleural fluid should also be tested for pH, glucose, white blood cell count with differential, microbiologic studies and cytology

22
Q

What is the definition of Acute respiratory distress syndrome?

A

Develops rapidly and includes:

  • sever dyspnea
  • diffuse pulmonary infiltrates
  • hypoxemia

Respiratory failure typically seen

23
Q

Key diagnostic criteria for ARDS

A
  • diffuse bilateral pulmonary infiltrates on CXR
  • PaO2 (arterial partial pressure of oxygen in mmHg)/FIO2 (inspired O2 fraction) <300mmHg
  • absence of elevated left arterial pressure
  • acute onset within 1 week of a clinical insult or new or worsening respiratory symptoms
24
Q

PaO2:FiO2 ratio for Mild, moderate, and severe ARDS

A

mild = >200 but less then <300 with ventilator PEEP or CPAP

moderate = >100 but less than <200 on ventilator PEEP>5cmH2O

Severe: <100 on ventilator that are PEEP >5

25
Q

what are the 3 phases of ARDS

A

Exudative

Proliferative

Fibrotic

26
Q

Exudative phase of ARDS:

A

Characterized by alveolar edema and neutrophil inflammation

hyaline membranes from diffuse alveolar damage

  • causes atelectasis
  • reduced lung compliance

Hypoxemia, tachypnea, progressive dyspnea develop and hypercarbia due to loss of alveolar exchange

  • bilateral opacities consistent with pulmonary edema
  • 7 days beginning 12-36 hrs after incident
27
Q

proliferative phase of ARDS

A

7-21 days after the incident

  • some develop progressive lung injury and evidence of pulmonary fibrosis
  • dyspnea and hypoxemia often persist during this phase
28
Q

Fibrotic phase of ARDS

A

majority recover within 3-4 weeks of initial injury but some experience progressive fibrosis leading to prolonged ventilatory support and oxygen

  • increased risk for of pneumothorax, reductions in lung compliance and increased pulmonary dead space are observed during this phase
  • pulmonary dead space
29
Q

how to properly use mechanical ventiatory support for ARDS

A

low tidal volumes that are combined with the use of positive end expiratory pressure (PEEP) at levels that strive to minimize alveolar collapse and achieve adequate oxygenation with the lowest required FiO2

helps limit alveolar distention

also place patient in prone position

30
Q

what are some ancillary therapies that patients with ARDS need?

A

should only receive IV fluids as needed

require sedation ad even paralytic agents

do not give glucocorticoids

31
Q

what protein means pandemic, and what protein means endemic for influenza

A

Hemagglutinins = pandemic

neuraminidase = endemic

32
Q

Extrapulmonary complications of Influenza

A

myositis

others:
-reyes syndrome, myo/pericarditis, CNS disease

33
Q

what are the treatments of Influenza

A

Neuraminidase inhibitors
(osetamivir, zanamivir, peramivir)
if started within 48 hours of infection can resolve infection 1-2 days earlier

34
Q

can SARS CoV lead to ARDS?

A

yes and patients can deterioate rapidly

important to identify the increased risk for illness severuty

35
Q

Risk factors of COVID

A 
CVD
DM
HTN
Chronic lung disease
Cancer
CKD
obesity
smoking

Clinical Pulm (5 decks)

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