B3.014 Big Case Pneumonia

Question 1

bibasilar

Answer 1

at the base of both lungs

Question 2

rales

Answer 2

crackles

Question 3

where to auscultate for rales

Answer 3

over lung field and airways

heard commonly in bases of lower lung lobes

Question 4

rales timing

Answer 4

more commonly inspiratory

Question 5

cause of rales

Answer 5

air passing through fluid or mucus in any air passage (normally small airways)

Question 6

description of rales

Answer 6

light crackling, bubbling, high pitched

Question 7

rhonchi

Answer 7

gurgles

Question 8

where to auscultate for rhonchi

Answer 8

over larger airways

Question 9

rhonchi timing

Answer 9

more pronounced during expiration

Question 10

rhonchi cause

Answer 10

airways narrowed by bronchospasm or secretions

Question 11

rhonchi description

Answer 11

coarse rattling
gurgling
harsh
moaning or snoring quality
may be cleared by cough

Question 12

where to auscultate for wheezes

Answer 12

overall lung fields and airways

Question 13

wheezes timing

Answer 13

inspiration or expiration

Question 14

cause of wheezes

Answer 14

air passing through narrowed airways

due to inflammation

Question 15

wheezes description

Answer 15

creaking
whistling
high pitched
musical squeaks

Question 16

difference between arterial and venous pH

Answer 16

about 0.05 higher in arterial

Question 17

which blood gas value doesn’t correlate well between arterial and venous blood gases

Answer 17

PO2

Question 18

what causes respiratory acidosis

Answer 18

not breathing enough

sleep apnea, obesity, aspiration, etc.

Question 19

what causes respiratory alkalosis

Answer 19

tachypnea leading to blowing off CO2 too quickly

Question 20

how does pneumonia appear on a chest X-ray

Answer 20

white, fuzzy infiltrates in what should be clear lung fields

Question 21

which lung has 2 lobes? 3 lobes?

Answer 21

left - 2 lobes

right - 3 lobes

Question 22

what is the CURB65?

Answer 22

a metric used to determine whether to admit or discharge a patient
confusion
urea >20
RR >30
BP <90
age >65
0-1 = outpt
1-2 = inpt
>3 = ICU

Question 23

CAP

Answer 23

community acquired pneumonia

acute infection of the lung parenchyma acquired in the community

Question 24

HAP

Answer 24

hospital acquired pneumonia

pneumonia occurring 48 hours or longer after admission

Question 25

HCAP

Answer 25

health care associated pneumonia old definition, not used except in billing associated with increased risk for multi-drug resistant pathogens must have visited or been admitted to hospital, long term care facility, dialysis center within 90 days

Question 26

VAP

Answer 26

ventilator associated pneumonia | pneumonia occurring 48 hours or longer after ventilation

Question 27

aspiration pneumonia/ chemical pneumonitis

Answer 27

aspiration of toxic substance into the lungs | most common aspirate is gastric contents

Question 28

post-obstructive pneumonia

Answer 28

a pneumonia usually due to obstruction of the central or lower airways due to malignancy

Question 29

which organisms cause the majority of CAP cases?

Answer 29

streptococcus pneumoniae staph aureus enterobacteriaceae pseudomonas aeruginosa

Question 30

atypical causes of pneumonia

Answer 30

M. pneumoniae Legionella C. pneumoniae C. Psittaci

Question 31

who might have chlaymydia psittaci?

Answer 31

bird owners

Question 32

who might have pneumocystis jirovecii?

Answer 32

HIV/AIDS patients

Question 33

outpt with no comorbidities and no prior antibiotic

Answer 33

macrolide (azithromycin) OR doxycycline in areas of high macrolide resistance

Question 34

outpt with comorbidities or prior antibiotic use

Answer 34

fluoroquinolone

Question 35

inpt pneumonia treatment without pseudomonal risks

Answer 35

``` IV or PO levofloxacin (fluoroquinolone) IV ceftriaxone (antipneumococcal beta lactam) and azithromycin (macrolide) ```

Question 36

what are pseudomonal risks

Answer 36

documented bronchiectasis | COPD w previous antibiotics or chronic corticosteroid use

Question 37

MRSA

Answer 37

methicillin resistant staph aureus

Question 38

risk factors for multi drug resistant pathogens

Answer 38

``` septick shock ventilator support IV antibiotics in the last 90 days structural pulmonary disease (CF) sputum culture w gram negative bacilli (pseudomonas) ```

Question 39

if you have risk factors for multi drug resistant pathogens, what do you have to make sure gets covered?

Answer 39

MRSA gram neg bacilli MDR pseudomonas

Question 40

what drug combo do you use for multi drug resistant pathogens

Answer 40

piperacillin-tazobactam antipseudomonal fluoroquinolone linezolid vancomycin

Question 41

what do you use to treat VAP?

Answer 41

piperacillin-tazobactam levofloxacin carbapenems cefepime (4th gen cephalosporin)

Question 42

how can you prevent VAP?

Answer 42

keep head of bed elevated 30-45 deg increase gastric pH (PPI, H2 blocker) endotracheal tube suctioning extubation asap

Question 43

when is fungal pneumonia found?

Answer 43

most commonly found and more importantly symptomatic in immunocompromised patients -invasive aspergillosis

Question 44

histoplasmosis

Answer 44

found along Ohio river valley | proliferates in soil contaminated with bird and bat droppings

Question 45

what is a feature of histoplasmosis on xray?

Answer 45

granuloma | usually asymptomatic

Question 46

crytococcus

Answer 46

also through soil co-infects CNS multiple, small granulomas on imaging

Question 47

blastomycosis

Answer 47

inhalation endemic in SE and S central US and great lakes involves skin !!

Question 48

coccidiodomycosis

Answer 48

endemic in American SW | spread by pigeons

Question 49

masquerading conditions that may resemble pneumonia

Answer 49

CHF | COPD

Question 50

COPD on xray

Answer 50

giant lung fields

Question 51

pleural effusion on Xray

Answer 51

cant make out costophrenic angle