4 - CAP

Question 1

definition of pneumonia? spectrum of pathology?

Answer 1

inflammation of lung, usually of infectious etiology. bronchitis, bronchiolitis, bronchopneumonia, pneumonia aka pneumonia.

Question 2

classification of pneumonia

Answer 2

can be typical or atypical. lobar, segmental, sub segmental, or interstitial. community, hospital or health care acquired.

Question 3

pneumonia: what happens?

Answer 3

lung parenchyma inflammation/injury +/- filling of alveolar spaces with inflammatory gunk aka consoldiation

Question 4

pathogenesis of pneumonia

Answer 4

upper airways constantly exposed to pathogens: can get micro or macro aspiration = they enter the lower resp tract. could also have hematogenous spread.

Question 5

lower airways are usually ____? development of CAP means?

Answer 5

sterile: indicates a defect in host defenses, exposure to an overwhelming inoculum or a particularly virulent microorganism

Question 6

symptoms and signs

Answer 6

fever, dyspnea, cough, sputum, pleuritic chest pain, mental status changes, toxic appearance, high resp rate/heart rate, maybe resp. failure or septic shock.

Question 7

physical exam findings

Answer 7

asymmetric mvt of chest wall, dullness to percussion, increased tactile fremitus, bronchial breath sounds on auscultation, crackles, wheezes, egophony, whispering pectoriloquay

Question 8

diagnosis of pneumonia?

Answer 8

chest radiograph essential: do PA and lateral views, if there is pleural effusion then do lateral decubitus view. CT imaging has higher sensitivity, specificity though = gold standard.

Question 9

management of pneumonia?

Answer 9

cABC, O2 to keep SpO2 >90%. IV fluids. then work up: sputum, blood, urine, CXRs, and CT/bronchoscopy as needed. antibiotics (usually empiric selection)

Question 10

outpatient antibiotics?

Answer 10

macrolide (azithromycin, other “mycins”) OR doxycycline. if there are comorbidities: then fluoroquinoline (floxacins) or beta lactam + macrolide

Question 11

pts under 50 with CAPs should be? xrays?

Answer 11

screened for HIV infections and IgG deficiency. follow up chest xrays if smoker or over 40

Question 12

non resolving pneumonia: causes?

Answer 12

wrong antibiotic or drug. lung abcess. parapneumonic effusion - empyema. hydrostatic pulmonary edema. inflamamtory disorders. occult cancer. PE. etc.