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03a: Pneumonia Flashcards

1
Q

Including lobar pneumonia, what are other forms that pneumonic process can take?

A
  1. Interstitial
  2. Necrotizing (small cavities under 2 cm)
  3. Lung abscesses (cavities over 2 cm)
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2
Q

List the three key clinical features seen in patient with classic pneumonia.

A
  1. Fever
  2. Cough (with/without sputum)
  3. Dyspnea

May have pleuritic chest pain

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3
Q

List the physical exam signs you would find in classic pneumonia (lobar consolidation).

A
  1. Dullness to percussion
  2. Increased fremitus
  3. Crackles and bronchial breath sounds
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4
Q

Which clinical features would make you suspect atypical pneumonia as opposed to classical pneumonia?

A

Dry cough and prominence of extra-pulmonary symptoms (HA, myalgia, N/V, diarrhea)

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5
Q

(X)% of healthy adults aspirate pathogens that cause pnuemonia in their sleep. Aspiration occurs more frequently in which patients?

A

X = 50

Pts with impaired consciousness, neuromuscular disorders, or oropharynx/swallowing disorders

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6
Q

Pneumonia patients in “outpatient group 1” are under age (X), have no history of (Y) disease or risk factors for (Z) infection.

A 
X = 60
Y = Cardiopulmonary
Z = gram-neg
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7
Q

24 y.o. med student with no past med history presents with pneumonia symptoms. Which pathogens most likely on your differential?

A

Outpatient Group 1:

  1. S. pneumo
  2. Mycoplasma pneumo
  3. Chlamydia pneumo
  4. Viral (Rhinovirus, Influenza, Parainfluenza)
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8
Q

Pneumonia: Outpatient group 1 first-line agents/drugs.

A

Macrolides or doxycycline

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9
Q

T/F: Pneumonia patients responding to antibiotics will show radiologic resolution before clinical improvement.

A

False - clinical improvement 2-4 days but radiologic resolution takes 4-6 weeks

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10
Q

50 y.o. patient with COPD presenting with pneumonia symptoms. Which pathogens most likely on your differential?

A

Outpatient Group 2:

  1. S. pneumo
  2. H. flu
  3. Viral
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11
Q

Pneumonia: Outpatient group 2 first-line agents/drugs.

A
  1. Resp fluoroquinolone
    OR
  2. Beta-lactam with Macrolide
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12
Q

T/F: Bacteremia occurs in 20-30% of S. pneumo CAP.

A

True

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13
Q

List the criteria used to decide if pneumonia patient should be admitted to hospital.

A

CURB-65

C: Confusion
U: Uremia (BUN over 20)
R: RR over 30/min
B: Low Blood P

Age 65 or older

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14
Q

T/F: All nursing home residents presenting with pneumonia symptoms should be admitted to hospital, regardless of age.

A

True

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15
Q

T/F: Health-Care Associated Pneumonia is in hospitalized patients or in patients with extensive health-care contact (such as nursing home).

A

Partly true, but NOT in hospitalized patients

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16
Q

Ventilator associated pneumonia occurs (X) hours after (Y) procedure.

A 
X = 48-72 
Y = intubation
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17
Q

List the criteria that, if even one is present, patient should be admitted to ICU.

A
  1. Septic shock

2. Resp failure requiring ventilation/intubation

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18
Q

T/F: Microbiologic diagnosis/ID for pneumonia is only established in about 50% of cases.

A

True - treatment recommendations often empiric (based on likely pathogens)

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19
Q

T/F: Parapneumonic effusion and empyema are common in pneumococcal pneumonia.

A

False - effusion common, but empyema rare (2%)

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20
Q

Hemorrhagic bullous myringitis, infection of (X), present in 5% of pneumonia patients with (Y) as pathogen.

A 
X = tympanic membrane (and nearby ear canal)
Y = mycoplasma pneumo
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21
Q

Neutrophil (immune) impairment: which infectious pathogens (general) are you most worried about?

A

Extracellular bacteria and fungi

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22
Q

T-Lymphocyte (immune) impairment: which infectious pathogens (general) are you most worried about?

A

Intracellular bacteria, fungi, parasites, viruses

23
Q

Splenectomy and (X)-cell immune impairment: which infectious pathogens (general) are you most worried about?

A

X = B

Spleen and B cell response are critical for adaptive immunity and killing of encapsulated bacteria

24
Q

Why might cancer patient have transient neutropenia?

A

Chemo-induced bone marrow suppression

25
Q

Patient with rheumatic disease is on anti-TNF immunosuppressant and presents with pneumonia symptoms. Which infectious pathogen are you worried is he particularly at high risk for?

26
Q

Lung transplant: 50% of patients develop (X) pneumonitis.

27
Q

List the two key parts of the general diagnostic workup for pneumonia.

A
  1. Pulse oximetry

2. CXR

28
Q

T/F: Specific workup for etiology of pneumonia typically done in low-risk cases (since the tests take time).

A

False - indicated for highest mortality cases and/or if specific risk factor present

29
Q

Why are serologic titers not very useful clinically for an infection (like pneumonia)?

A

Need to be compared with convalescent titers 2-3 months post infection

30
Q

Patient presents with pneumonia and symptoms severe enough that you admit her (inpatient, non-ICU). List the potential pathogens highest on your list.

A
  1. S. pneumo
  2. H. flu
  3. Viruses
  4. Atypicals, anaerobes
31
Q

Patient presents with pneumonia and symptoms severe enough that you admit her (inpatient, non-ICU). List the drugs used to treat this class of patients.

A
  1. Ceftriaxone AND

2. Macrolide or resp fluoroquinolone

32
Q

Increased risk of H. flu in which two patient populations?

A

Smokers and COPD

33
Q

Patient presents with pneumonia and symptoms symptoms of sepsis, so you admit him to ICU. List the potential pathogens highest on your list.

A
  1. S. pneumo
  2. Legionella
  3. MRSA
  4. Gram negs
34
Q

Hospital Acquired Pneumonia (HAP) is pneumonia that was not present or incubating at time of admission, but occurs (X) hours or more after admission.

35
Q

Patient was briefly hospitalized for a week 2 months ago post-surgery and is now presenting with pneumonia symptoms. Under which category of pneumonia would this fall?

A

Healthcare associated pneumo (HCAP)

36
Q

HAP, VAP, and HCAP (pneumonias): which pathogens are common in these patients?

A
  1. Gram negs
  2. S. aureus, Strep

Increased risk for MDR organisms

37
Q

HAP, VAP, and HCAP (pneumonias): which treatment regimens would you start right away?

A

Empiric for:

1. MRSA (Vanco or Linezolid) 2. Pseudomonas (Piperacillin and quinolone)

38
Q

MOST lung abscesses that result from pneumonia are caused by (X). Which other organisms can cause these abscesses?

A

Aspiration of:
X = anaerobes

S. aureus, Gram neg, Nocardia, Actinomyces

39
Q

Patient was treated for pneumonia a month ago and returns to ER with productive cough and hemoptysis. You notice he has poor dental health and immediately suspect (X). Which other symptoms would you be looking for to confirm this?

A

X = lung abscess

  1. Putrid (gross smelling) sputum
  2. Fever/night sweats
  3. Weight loss (and maybe anemia)
40
Q

Uncomplicated parapneumonic effusion: (exudate/transudate) that is (acidic/basic) and glucose is (high/low/normal).

A

Exudate;
Neither (no acidosis)
Normal

41
Q

Complicated parapneumonic effusion: (exudate/transudate) that is (acidic/basic) and glucose is (high/low/normal). Very high levels of (X) are also characteristic of these effusions.

A

Exudate;
Acidic; low glucose

X = LDH

42
Q

T/F: All parapneumonic effusions require drainage.

A

False - not uncomplicated effusions

43
Q

List the available pneumococcal vaccines, which generate Ab that target (X).

A

X = capsular polysaccharide

  1. Pneumovax (23 serotypes that cause 85-90% infections)
  2. Prevnar 13 (most common 13 serotypes to cause disease)
44
Q

T/F: Pneumococcal vaccines produce Ab response that lasts up to 10 years.

45
Q

T/F: Everyone should be receiving pneumococcal vaccines.

46
Q

Which patients should be receiving pneumococcal vaccine?

A
  1. Over 65 OR

2. Chronic illnesses (COPD, CHF, FM, EtOH abuse, cirrhosis, asplenia)

47
Q

Patient with PCP treated with Bactrim. Which other therapy is indicated for this infection if (X) symptom is present?

A

Prednisone if:
X = hypoxemia

PaO2 under 70 mmHg OR
A-a gradient over 35

48
Q

Dullness to percussion and no breath sounds over lung suggestive of (X). But if you heard bronchial sounds, (Y) is more likely.

A 
X = pleural effusion 
Y = consolidation
49
Q

What’s on your differential for transudative pleural effusion?

A
  1. CHF
  2. Nephrotic syndrome
  3. Cirrhosis
50
Q

What’s on your differential for exudative pleural effusion?

A
  1. Cancer
  2. TB
  3. Pneumonia
  4. PE
  5. CVD
51
Q

Patient has pleural effusion, so you do thoracentesis. Which labs do you request to assess the fluid?

A

Pleural fluid: LDH, cholesterol, cell count/differential, total protein, gram stain/culture

Serum: LDH and total protein

52
Q

Following thoracentesis, which calculations must be done to assess if fluid is transudate/exudate?

A
  1. Pleural protein/serum protein
  2. Pleural LDH/serum LDH
  3. Pleural LDH/upper limit of normal serum LDH
53
Q

List the criteria that (if any one of them is met) characterizes pleural fluid as exudate.

A
  1. Pleural/serum total protein over 0.5
  2. Pleural/serum LDH over 0.6
  3. Pleural LDH more than 2/3 of upper normal limit for serum LDH

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