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STEP2: Pneumonia Flashcards

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1
Q

What is pneumonia?

A

A respiratory infection characterized by inflammation of the alveolar space and/or the interstitial tissue of the lungs.

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2
Q

What is the leading infectious cause of death in industrialized nations?

A

Pneumonia.

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3
Q

How is pneumonia most commonly transmitted?

A

Via aspiration of airborne pathogens (primarily bacteria, but also viruses and fungi) or aspiration of stomach contents.

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4
Q

What are the two classifications of pneumonia based on clinical features?

A

Typical pneumonia and atypical pneumonia.

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5
Q

What are the common symptoms of typical pneumonia?

A
  • Sudden onset of malaise
  • Fever
  • Productive cough
  • Crackles and bronchial breath sounds on auscultation.
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6
Q

What are the common symptoms of atypical pneumonia?

A
  • Gradual onset of unproductive cough
  • Dyspnea
  • Extrapulmonary manifestations
  • Unremarkable auscultation.
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7
Q

What diagnostic tests are commonly used for pneumonia?

A
  • Blood tests for inflammatory parameters
  • Pathogen detection in blood, urine, or sputum samples.
  • Chest x-ray.
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8
Q

What does a chest x-ray show in typical pneumonia?

A

Opacity restricted to one lobe.

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9
Q

What does a chest x-ray show in atypical pneumonia?

A

Diffuse, often subtle infiltrates.

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10
Q

What is the most common pathogen causing community-acquired typical pneumonia?

A

Streptococcus pneumoniae.

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11
Q

What is the most common atypical pneumonia pathogen in the ambulatory setting?

A

Mycoplasma pneumoniae.

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12
Q

What are common pathogens for hospital-acquired pneumonia?

A
  • Pseudomonas aeruginosa
  • Enterobacteriaceae
  • Acinetobacter spp.
  • Staphylococci.
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13
Q

What mnemonic helps remember atypical pneumonia bacterial causes?

A

Atypically, Legions of Clams Mind their P’s and Q’s.

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14
Q

What are the stages of lobar pneumonia?

A
  • Congestion (day 1-2)
  • Red hepatization (day 3-4)
  • Gray hepatization (day 5-7)
  • Resolution (day 8 to week 4).
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15
Q

What characterizes bronchopneumonia?

A

Acute inflammatory infiltrates that fill the bronchioles and adjacent alveoli.

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16
Q

What are the risk factors for pneumonia?

A
  • Old age
  • Chronic diseases
  • Preexisting cardiopulmonary conditions
  • Immunosuppression
  • Alcoholism
  • Smoking.
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17
Q

What is community-acquired pneumonia (CAP)?

A

Pneumonia acquired outside of a healthcare establishment.

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18
Q

What is hospital-acquired pneumonia (HAP)?

A

Pneumonia onset > 48 hours after a patient is admitted to a hospital without evidence of disease at the time of admission.

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19
Q

What is ventilator-associated pneumonia (VAP)?

A

Pneumonia occurring in patients on mechanical ventilation in hospitals.

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20
Q

What are the general principles for diagnosing pneumonia?

A

Diagnosis is based on new pulmonary infiltrates on chest imaging in patients with respiratory symptoms and systemic inflammatory response.

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21
Q

What laboratory study indicates a bacterial infection in pneumonia?

A

Serum procalcitonin (PCT) levels ≥ 0.25 mcg/L.

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22
Q

True or False: Atypical pneumonia often has distinct classical symptoms.

A

False.

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23
Q

Fill in the blank: Pneumonia in immunocompromised patients is often caused by _______.

Study These Flashcards
A

Encapsulated bacteria.

24
Q

What is cryptogenic organizing pneumonia?

Study These Flashcards
A

A noninfectious pneumonia of unknown etiology characterized by the involvement of the bronchioles, alveoli, and surrounding tissue.

25
What should not be solely relied upon to guide decisions on antibiotic therapy?
Inflammatory markers (e.g., CRP, procalcitonin) ## Footnote These markers may not accurately reflect the need for antibiotics.
26
What microbiological studies should be obtained in all patients with severe CAP?
Blood cultures (2 sets), Sputum culture and Gram stain, Influenza and COVID-19 testing, Pneumococcal urinary antigen, Legionella pneumophila urinary antigen ## Footnote These tests help identify the causative pathogens.
27
In nonsevere CAP, what tests should be obtained during periods of community transmission?
Influenza and COVID-19 testing, Legionella pneumophila urinary antigen ## Footnote These tests are crucial when there is a risk of high transmission.
28
What imaging is indicated for all patients suspected of having pneumonia?
Chest x-ray (posteroanterior and lateral) ## Footnote This helps confirm the diagnosis of pneumonia.
29
What does lobar pneumonia appear as on chest x-ray?
Opacity of one or more pulmonary lobes, Presence of air bronchograms ## Footnote These findings are characteristic of lobar pneumonia.
30
What indicates bronchopneumonia on a chest x-ray?
Poorly defined patchy infiltrates scattered throughout the lungs, Presence of air bronchograms ## Footnote These features help differentiate bronchopneumonia from other types.
31
What are the x-ray findings for atypical or interstitial pneumonia?
Diffuse reticular opacity, Absent (or minimal) consolidation ## Footnote Atypical pneumonia often presents differently than typical pneumonia.
32
What confirms the diagnosis of pneumonia in a patient with classic signs?
A new pulmonary infiltrate on chest x-ray ## Footnote This is a critical diagnostic criterion.
33
What factors are considered in the pneumonia severity index (PSI)?
Patient age, Comorbidities, Lab results ## Footnote PSI helps classify patients into risk classes.
34
What is the CURB-65 score used for?
To evaluate the risk of mortality and guide hospitalization decisions ## Footnote It includes clinical parameters to assess severity.
35
What CURB-65 score indicates that a patient may be treated as an outpatient?
CURB-65 score 0 or 1 ## Footnote A low score suggests lower severity.
36
What is the recommended empiric antibiotic regimen for previously healthy patients without comorbidities?
Monotherapy with Amoxicillin, Doxycycline, or a macrolide (if pneumococcal resistance < 25%) ## Footnote This regimen targets common pathogens.
37
What combination therapy is recommended for nonsevere CAP in inpatient settings?
An antipneumococcal β-lactam (e.g., Ampicillin-sulbactam) PLUS a macrolide or respiratory fluoroquinolone ## Footnote This approach covers a broader range of potential pathogens.
38
What is the duration of treatment for outpatient CAP?
3 to 5 days of therapy ## Footnote This duration is typically sufficient for uncomplicated cases.
39
What pathogens cause Mycoplasma pneumonia?
Common in school-aged children and adolescents, Outbreaks occur in schools, colleges, and military facilities ## Footnote It is a significant cause of atypical pneumonia.
40
What is aspiration pneumonia?
Pneumonia that occurs as a result of oropharyngeal secretions and/or gastric contents aspiration ## Footnote It can lead to serious complications based on the volume of aspirated material.
41
What are the clinical features of aspiration pneumonitis?
Immediate symptoms: bronchospasms ## Footnote These symptoms can arise shortly after aspiration.
42
What is the primary treatment for Mycoplasma pneumonia?
A macrolide, doxycycline, or fluoroquinolone ## Footnote Beta-lactam antibiotics are ineffective against Mycoplasma.
43
What are the risk factors for aspiration pneumonia?
* Altered consciousness (e.g., alcohol, sedation) * Gastroesophageal reflux disease * Use of a nasogastric feeding tube ## Footnote These factors increase the likelihood of aspiration events.
44
What are the risk factors for aspiration?
* Altered consciousness: alcohol, sedation, general anesthesia, stroke * Apoplexy and neurodegenerative conditions * Gastroesophageal reflux disease * Esophageal motility disorders * Congenital defects (e.g., tracheoesophageal fistula) * Use of a nasogastric feeding tube ## Footnote These factors predispose individuals to reduced epiglottic gag reflex and dysphagia.
45
What are the immediate symptoms of aspiration pneumonitis?
* Bronchospasms * Dyspnea * Wheezing and/or crackles * Hypoxemia ## Footnote Late symptoms include fever, shortness of breath, and cough.
46
What are the late symptoms of aspiration pneumonia?
* Fever * Shortness of breath * Cough with foul-smelling sputum ## Footnote Immediate symptoms are often none.
47
What is the diagnostic approach for pulmonary aspiration?
Clinical diagnosis supported by characteristic laboratory and imaging findings ## Footnote Laboratory and microbiological studies are the same as for pneumonia.
48
In which position is aspiration most likely to affect the superior segment of the right lower lobe?
Supine position ## Footnote This is the most common site of aspiration in this position.
49
What is the typical treatment for aspiration pneumonia?
Antibiotic therapy following standard pneumonia treatment regimens ## Footnote Aspiration pneumonitis typically requires only supportive care.
50
What are some complications of pulmonary aspiration?
* Acute respiratory failure * Acute respiratory distress syndrome (ARDS) * Abscess ## Footnote This list is not exhaustive.
51
What are some prevention strategies for aspiration?
* Treatment of underlying causes * Aspiration precautions for at-risk patients * Regular oral care * Elevation of the head of the bed * Dysphagia-modified diet * One-on-one observation with meals * Suctioning equipment at bedside ## Footnote These measures can help reduce the risk of aspiration.
52
What is community-acquired pneumonia (CAP) responsible for in pregnancy?
Approximately 5% of antepartum admissions for nonobstetric complications ## Footnote Physiological changes during pregnancy may increase the risk for severe disease.
53
What is the CURB-65 score used for?
To evaluate the mortality risk associated with pneumonia ## Footnote Score 0: ∼ 1%, Score 1–2: ∼ 10%, Score 3: ∼ 14%, Score 4: ∼ 40%.
54
Which vaccinations are recommended for pneumonia prevention?
* Pneumococcal vaccination * Influenza vaccination * COVID-19 vaccination ## Footnote Smoking cessation is also recommended.
55
Fill in the blank: The typical management for outpatient community-acquired pneumonia is only in patients with _______.
[mild disease and no comorbidities]
56
True or False: The approach to antibiotic therapy during pregnancy is the same as that for the general adult population.
True ## Footnote Excluding potentially teratogenic medications like clarithromycin, fluoroquinolones, and tetracyclines.

STEP 2 (42 decks)

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