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Senior - EMED 2 > 6 - Pneumonia > Flashcards

6 - Pneumonia Flashcards

1
Q

Pneumonia is:

A

An infection of the alveoli

Could be bacteria, virus, fungi, etc

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2
Q

Community-acquired pneumonia

A

Acute pulmonary infection in a patient who is NOT hospitalized or residing in a nursing home 14 days or more before presentation

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3
Q

Hospital-acquired pneumonia

A

New infection occurring 48 hrs or more after hospital admission

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4
Q

Ventilator-acquired pneumonia

A

New infection occurring 48 or more hours after starting mechanical ventilation

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5
Q

Healthcare-associated pneumonia:

A

Patients hospitalized for 2 or more days within the past 90 days

Nursing home / long term care residents

Patients receiving home IV antibiotic therapy

Dialysis patients

Patients receiving chronic wound care

Patients receiving chemotherapy

Immunocompromised patients

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6
Q

Productive cough?

A

Think bacterial

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7
Q

Nonproductive cough?

A

Think viral or atypical

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8
Q

MC organism for CAP?

A

Pneumococcus

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9
Q

Most patients with severe CAP who were otherwise healthy have:

A

S. Pneumoniae

Or

Legionella

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10
Q

What kind of patient may have pneumonia with more than one organism?

A

Nursing home patients
Drunks
HIV with low CD4 counts

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11
Q

Common sxs of pneumonia

A 
Cough
Fatigue
Fever
Dyspnea
Sputum production
Pleuritic CP
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12
Q

Rust-colored sputum?

A

Steptococcus pneumoniae

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13
Q

Purulent sputum?

A

Staphylococcus aureus

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14
Q

Currant jelly sputum?

A

Klebsiella pneumonia

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15
Q

Patchy infiltrates with frequent abscess formation?

A

Pseudomonas aeruginosa

Recently hospitalized
Immunocompromised
Hot tubs

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16
Q

Gradual onset pneumonia?

A

Haemophilus influenzae

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17
Q

Pneumonia type more common in COPD’ers?

A

Moraxella catarrhalis

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18
Q

Gradual onset with putrid sputum?

A

Anaerobes

Think drunks

19
Q

Slide 13-14

A

More detail on species-specific sxs

20
Q

Classic presentation of pneumococcal pneumonia?

A 
Sudden onset
Rigors
Bloody sputum
High fever
CP
Lobar infiltrates
21
Q

At risk for pneumococcal pneumonia?

A 
Elderly
Kids under 2yrs
Minorities 
Children who attend day-care
Immunosuppressed
22
Q

Consider s. aureus pneumonia in what kind of patients?

A 
Chronic lung dz
Laryngeal CA
Immunosuppressed
NH patients 
Others at risk for aspiration pneumonia
23
Q

How will staphylococcal pneumonia look on CXR?

A

Extensive infiltration and effusion or empyema

24
Q

Staph vs klebsiella?

A

Staph insidious

Klebsiella rapid onset

25
Q

Describe pseudomonas pneumonia

A

Severe - cyanosis, confusion

Bilateral lower-lobe infiltrates with occasional empyema

Think prolonged hospitalization, nursing homes, steroid therapy, broad spectrum ABX use

26
Q

The atypical bacteria are:

A

Legionella, chlamydia, mycoplasma

They lack a cell wall, so they do NOT respond to beta-lactam ABX

They DO respond to macrolides OR a respiratory fluoroquinolone (levo, moxi)

27
Q

At risk for legionella?

A

Smokers
Chronic lung dz
Transplant patients
Immunosuppressed

28
Q

Legionella pneumonia is commonly complicated by:

A

GI sxs, including ABD pain, vomiting, and diarrhea

29
Q

Mycoplasma pneumonia is frequently associated with:

A

Retrosternal chest pain

Also, unlike legionella, mycoplasma does NOT have GI symptoms

30
Q

What extrapulmonary sxs can mycoplasma show?

A 
Rash
Neuro
Arthralgia
Heme
Kidney
31
Q

MC cause of viral pneumonia?

A

Influenza

32
Q

If your clinical findings suggest pneumonia but our CXR is neg:

A

Treat empirically anyway

33
Q

In the suspected pneumonia patient, an SpO2 < 91 is associated with:

A

More complications, and may warrant treatment beyond meds and discharge

34
Q

MCC of acquired immunodeficiency syndrome-related death in pregnant women in the United States?

A

Pneumocystis jiroveci pneumonia

35
Q

Common atypical pneumonia agent in the elderly?

A

Legionella

36
Q

MCC of bacterial pneumonia in patients with HIV?

A

S. Pneumoniae

37
Q

Common first choice for outpatient txt for CAP?

A

Single-drug therapy

Marcolide or a respiratory fluoroquinoline

Doxy as an alternative

Erythromycin is cost-effective but causes GI side effects in 25% of patients

Clarithromycin - metallic taste

Azithromycin - once daily dosing = better compliance

38
Q

CDC recommendations re: use of fluoroquinolones:

A

Reserved for pts who cannot tolerate other agents

Or

Have documented pneumococcal resistance

Or

Have failed other therapies

39
Q

Don’t use fluoroquinolones in patients with:

A

Myasthenia gravis

40
Q

Patients admitted to the ICU with healthcare-associated pneumonia should have coverage for:

A

Methicillin resistant s. aureus with drugs such as vanc or linezolid

41
Q

Do most patients with CAP require hospitalization?

A

Nope

Use the CURB-65 rule to aid in disposition decision-making

42
Q

Criteria for ICU admission

A 
Septic shock
Needing a vent
Markedly elevated RR
Partial pressure of arterial oxygen / fraction of inspired oxygen ratio <250
Multilobar infiltrates
Confusion
Uremia with a BUN > 20mg/dL
Leukopenia, thrombocytopenia, hypothermia, hyponatremia, lactic acidosis, asplenia
43
Q

What did the homeless man get for Christmas?

A

Pneumonia

Senior - EMED 2 (10 decks)

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