25.26. Pneumonia Flashcards
What is pneumonia?
Inflammation of the distal small airways, alveoli, and the interstitium associated with exudate accumulation in the alveolar space.
What is pneumonitis?
Pneumonia induced by irradiation or chemical agents.
What is interstitial pneumonia?
Inflammation affecting primarily the interstitium.
What is community-acquired pneumonia (CAP)?
A type of pneumonia that is acquired outside of a hospital or healthcare setting.
What are the typical pathogens that cause typical pneumonia?
Streptococcus pneumoniae, Hemophilus influenzae, and Staphylococcus aureus.
What are the atypical pathogens that cause atypical pneumonia?
Mycoplasma pneumoniae, Chlamydophila pneumoniae, and viruses.
What is hospital-acquired pneumonia (HAP)?
A type of pneumonia that is acquired in a hospital or healthcare setting.
What is ventilator-associated pneumonia (VAP)?
Pneumonia occurring in patients on mechanical ventilation breathing machines in hospitals, typically in the ICU.
What are the gram-negative pathogens that cause HAP?
Pseudomonas aeruginosa, Enterobacteriaceae (E.coli), and Acinetobacter spp.
What are the symptoms and clinical signs of pneumonia?
-Symptoms : Fever, cough, sputum, dyspnea, chest pain,
- Clinical signs : shortened sound with percussion, fine crepitation, rales, X-ray shadow.
What are the laboratory test results in pneumonia?
- Increased CRP, neutrophil granulocytes, ESR, LDH, GOT,
- increased procalcitonin in severe sepsis (may increase in lung cancer),
- decreased renal function.
What are the blood gas test results in pneumonia?
Hypoxemia, hypocapnia, and respiratory alkalosis.
What is the ECG finding in pneumonia?
Sinus tachycardia (fever).
What are the diagnostic methods for pneumonia?
-Clinical diagnosis based on history, physical examination, laboratory findings, and CXR finding.
- Consider microbiological studies and advanced diagnostics based on patient history, comorbidities, severity, and entity of pneumonia.
What are the methods to collect sputum from lower airways?
- Bronchofibroscopy,
- protected brush specimen,
- bronchoalveolar lavage.
Why do we need to do a urine test for pneumonia?
For streptococcus pneumoniae and Legionella pneumophila antigen detection.
What are the different findings observed in chest X-ray for different types of pneumonia?
- Lobar pneumonia shows opacity of one or more lobes with air bronchograms,
- bronchopneumonia shows poorly defined patchy infiltrates,
- atypical/interstitial pneumonia shows diffuse reticular opacity.
What are the different findings observed in chest CT for pneumonia?
Localized areas of consolidation (hyperdense), air bronchograms, and ground-glass opacities
What is the PORT score?
The PORT (pneumonia outcome research team) score is a clinical prediction rule used to calculate the probability of morbidity and mortality among patients with community-acquired pneumonia.
What is the classification of the PORT score?
The PORT score is classified into four categories:
- PORT I (at home, per os ABs),
- PORT II-III (at home, per os ABs, some will later need hospitalization),
- PORT III-IV (i.v. AB, hospitalization),
- PORT IV-V (i.v. AB, respirator).
Which viruses cause viral pneumonia in adults?
Influenza virus, COVID.
Which virus causes viral pneumonia in children?
Respiratory syncytial virus (RSV).
What are the typical manifestations of viral pneumonia?
Fever, dyspnea, cough.
What is influenza?
A highly contagious viral infection that typically occurs during winter months.
What causes influenza?
Influenza A, B, and C viruses.
What are the two proteins found on the surface of the influenza virus?
Hemagglutinin (H) and neuraminidase (N).
What is the usual presentation of symptomatic patients with influenza?
- Sudden onset of high fever,
- nonproductive cough (atypical pneumonia!!)
- headache,
- malaise.
What are the usual levels of inflammatory markers in patients with influenza?
They are usually normal or slightly elevated.
What is the diagnostic test used to confirm the diagnosis of influenza?
PCR testing.
What is the recommended management for patients with early or severe influenza?
Antiviral therapy with neuraminidase inhibitors such as oseltamivir or zanamivir.
What is primary influenza pneumonia?
It is caused by direct infection of the lung parenchyma by the influenza virus and is less common than pneumonia or secondary bacterial bronchitis.
What are some of the symptoms of primary influenza pneumonia?
Dyspnea, hypoxemia, cyanosis, and acute deterioration 2-5 days after onset of flu-like symptoms.
What are some of the blood test and radiographic findings in patients with primary influenza pneumonia?
Blood tests may show leukocytosis or leukopenia, and CXR may show perihilar congestion with diffuse/multifocal infiltrates.
What is the recommended management for primary influenza pneumonia?
Antiviral therapy for influenza with oseltamivir or zanamivir.
What is COVID-19?
COVID-19 is an infectious disease caused by the coronavirus SARS-CoV2.
What is the mechanism of entry of SARS-CoV2 into host cells?
The Spike protein of SARS-CoV2 facilitates entry by attaching to the ACE2 receptor of the host cell.
How is SARS-CoV2 transmitted?
SARS-CoV2 is transmitted via inhalation of droplets, aerosol particles, or mucous membrane contact with respiratory particles.
What are the clinical features of COVID-19?
Fever, cough, dyspnea, fatigue, loss of smell/taste, sore throat.
What are the diagnostic tests for COVID-19?
PCR test or antigen testing.
What is the mechanism of action of Ritonavir-boosted Nirmatrelvir?
Ritonavir inhibits packaging and assembly of viruses, while Nirmatrelvir inhibits the activity of protease.
What is the mechanism of action of Remdesivir?
It is a nucleotide analog that inhibits RNA synthesis.
What is the recommended route of administration for Ritonavir-boosted Nirmatrelvir?
Oral.
