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Section 8: Pulmonary Disorders > Chapter 65: Community-Acquired Pneumonia, Aspiration Pneumonia, and Noninfectious Pulmonary Infiltrates > Flashcards

Chapter 65: Community-Acquired Pneumonia, Aspiration Pneumonia, and Noninfectious Pulmonary Infiltrates Flashcards

1
Q

Hospital-acquied pneumonia define as

A

New infection occurring ≥48 h after hospital admission

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2
Q

Ventilator-acquired pneumonia

A

New infection occurring ≥48 h after endotracheal intubation

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3
Q

Community-acquired pneumonia

A

Acute pulmonary infection in a patient who is not hospitalized or residing in a long-term care facility ≥14 d before presentation

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4
Q

Bacterias that produce pneumonia by hematogenous seeding

A

Staphylococcus aureus or Pneumococcus

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5
Q

Most common etiologic agent of CAP?

A

Pneumococcus

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6
Q

What are the atypical organisms that cause pneumonia?

A
  • Mycoplasma
  • Chlamydia
  • Legionella
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7
Q

Two organisms that account for the most severe CAP in otherwise healthy adults are?

A
  • Streptococcus pneumoniae

- Legionella

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8
Q

What are the special populations with pneumonia?

A
  • Nursing homes residents
  • Chronic alcoholism
  • HIV
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9
Q

Types of imaging seen in patient with pneumococcal pneumonia?

A

Lobar pneumonia

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10
Q

Upon auscultation, you heard inspiratory rales, bronchial breath sounds pleural effusion and rhonchi, and wheezing. What does it mean?

A
  • Alveolar fluid (inspiratory rales)
  • Consolidation (bronchial breath sounds)
  • Bronchial congestion (rhonchi and wheezing)
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11
Q

The patient had a history of recently hospitalized, debilitated,
or immunocompromised patients with fever, dyspnea, and cough. Chest Xray has bilateral lower lobe infiltrates. What is the most likely etiology of pneumonia?

A

P. aeruginosa

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12
Q

The patient had gradual onset, fever, dyspnea, and pleuritic chest pain; especially in the elderly, sickle cell patients, diabetes and COPD. Chest Xray shows pleural effusions and multilobar infiltrates. What is the most likely etiology of pneumonia?

A

Haemophilus influenza

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13
Q

A patient at nursing home that had history of alcoholism presented with brown currant jelly sputum. What is the most likely etiology of pneumonia?

A

Klebsiella pneumoniae

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14
Q

Sudden onset, fever, rigors, pleuritic chest pain, productive cough, dyspnea with rust-colored sputum. What is the most likely etiology of pneumonia?

A

Streptococcus pneumoniae

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15
Q

Consideration in patients with chronic lung disease, patients with laryngeal cancer, immunosuppressed patients, nursing home patients, after viral infection or others at risk for aspiration pneumonia

A

Staphylococcus aureus

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16
Q

Why atypical agents cause pneumonia do not respond to B-lactam antibiotics?

A

The lack cell wall

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17
Q

Patients at higher risk include cigarette smokers, patients with chronic lung disease, transplant patients, and the immunosuppressed. Most common in summer because it is not seasonal and complicated with GI symptoms. Chest xray shows patchy infiltrates with occasional hilar adenopathy and pleural effusion. What is the most likely etiology of pneumonia?

A

Legionella pneumonia

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18
Q

To confirm Legionella pneumonia. What test to do?

A

Urinary Legionella antigen test

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19
Q

Causes mild subacute illness with sore throat, mild fever and nonproductive cough. Chest xray showed patchy subsegmental infiltrate and linked to adult-onset asthma. What is the most likely etiology of pneumonia?

A

Chlamydia pneumonia

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20
Q

Frequently associated with retrosternal chest pain. What is the most likely etiology of pneumonia?

A

Mycoplasma pneumonia

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21
Q

Causative agent of Q fever. transmitted via infected animals dried urine that is inhaled or unpasteurized milk.

A

Coxiella burnetii

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22
Q

Treatment for Q fever (Coxiella burnetti)

A

Doxycycline or respiratory quinolone is the first-line treatment

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23
Q

True or False:

Antivirus is recommended for pregnant patients because they are more susceptible

A

True

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24
Q

Blood cultures are recommended for which patient with CAP?

A
  • ICU
  • Leukopenia
  • Cavitary lesions
  • Severe liver disease
  • Alcoholic
  • Asplenia
  • Pleural effusion
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25
Q

When to obtain Legionella urine antigen in a patient with CAP?

A
  • ICU
  • Alcoholics
  • History of travel in past 2 weeks
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26
Q

An etiologic agent that produces lung abscesses in pneumonia

A
  • S. aureus

- Klebsiella

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27
Q

An etiologic agent that mimics lung masses

A
  • Pneumococcal (round pneumonia)

- Staphylococcal

28
Q

True or False:
In general, patients with atypical or viral pneumonia are more likely to have unilobar or focal infiltrates than patients with bacterial pneumonia

A

False
In general, patients with bacterial pneumonia are more likely to have unilobar or focal infiltrates than patients with viral or atypical pneumonia

29
Q

True or False

Hilar adenopathy is not common in patients with atypical pneumonia

A

False

Hilar adenopathy is more common in patients with atypical pneumonia

30
Q

Compared to nonalcoholic, the alcoholic has greater oropharyngeal colonization of what?

A

Gram- negative bacteria

31
Q

The most common pathogen causing pneumonia in alcoholics

A

S. pneumoniae (also Klebsiella and Haemophilus)

32
Q

True or False

Infections due to S. pneumonia and influenza are associated with increased morbidity and mortality in diabetic patients.

A

True

33
Q

Antibiotic use in pregnant patients with pneumonia in ED

A

Acyclovir

34
Q

The most common cause of acquired immuno- deficiency syndrome-related death in pregnant women in the United States, with a mortality rate of approximately 50%.

A

Pneumocystis jirovecii

35
Q

Drug that improves survival compared with paitient treated with trimethoprim-sulfamethoxazole alone in PCP in pregnant

A
  • Pentamidine
  • Steroids
  • Eflornithine
36
Q

The most common serious viral infection in the elderly

A

Influenza

37
Q

Postinfluenza bacterial pneumonia is most commonly caused by S. pneumoniae, S. aureus, or H. influenzae

A

Postinfluenza bacterial pneumonia is most commonly caused by S. pneumoniae, S. aureus, or H. influenzae

38
Q

Temperature that gives clue of serious bacterial infection

A

> 38.3

39
Q

Eight variables are significant independent predictors of pneumonia in nursing home patients

A
  1. Increased pulse rate
  2. Respiratory rate ≥30 breaths/min
  3. Temperature ≥38°C (100.4°F)
  4. Somnolence or decreased alertness
  5. Presence of acute confusion
  6. Lung crackles on auscultation
  7. The absence of wheezes
  8. Increased leukocyte count
40
Q

The most frequently reported pathogens among patients with nursing home–acquired pneumonia are

A
  • S. pneumoniae
  • Gram-negative bacilli
  • H. influenzae
41
Q

The most common cause of bacterial pneumonia in patients with HIV

A

S. pneumoniae is the most common cause of bacterial pneumonia in patients with HIV. Also P. aeruginosa

42
Q

Level of CD4 that likely to cause pneumonia

A

> 800cells/mm3

43
Q

Level of CD4 that likely to cause pneumocystic pneumonia

A

<200cells/mm3

44
Q

Between CD4 of 250 and 500 cells/mm3, infection from which infection?

A

Between 250 and 500 cells/mm3, infection from M. tuberculosis, Cryptococcus neoformans, or Histoplasma capsulatum poses a greater risk

45
Q

In AIDS patient, miliary pneumonia on CT scan or chest radiograph may present what?

A

Varicella pneumonia

46
Q

Patient with uncomplicated pneumonia can send home with what antibiotics?

A
  • Clarithromycin 1000mg/tab OD x 7d ays
  • Azithromycin 500mg/tab OD on day 1 and 250mg/tab OD on day 2-5
  • Doxycycline 100mg BID x 10-14 days
47
Q

Patient with complicated pneumonia can send home with what antibiotics?

A
  • Levofloxacin 750mg/tab OD x 5 days
  • Moxifloxacin 400mg/tab OD x 7–14 days
  • Azithromycin 500mg/tab OD on day 1 and 250mg/tab OD on day 2-5
48
Q

What kind of disease you should not give fluoroquinolones?

A

Myastenia gravis

49
Q

Admitted patients with pneumonia that is non-ICU can be given with

A
  • Levofloxacin 750mg IV
  • Moxifloxacin 400mg IV
  • Ceftriaxone 1g IV plus Azithromycin 500mg IB
50
Q

Why respiratory fluoroquinolone is discouraged in in-patient with pneumonia?

A

Avoid resistance and Clostridium difficile outbreaks.

51
Q

The best studied and recommended tool in the disposition of pneumonia patient

A

Pneumonia severity index

52
Q

A score of ___ in CURB-65 or CRB-65 shows the low mortality rate

A

<2

53
Q

How to know who to admit to ICU in patient with pneumonia?

A

Pneumonia Severity Index class V and CURB-65 patients with a score of ≥3 may need intensive care

54
Q

The second leading cause of infection in nursing homes

A

Aspiration pneumonia second to UTI

55
Q

The leading cause for transfer from nursing home to the hospital and the leading cause of death in nursing home patients

A

Aspiration pneumonia

56
Q

Symptoms of aspiration pneumonia usually resolve within

A

48 hours

57
Q

Aspiration of such pills will cause local inflammation and lead to bronchial stenosis

A
  • Potassium
  • Iron
  • Metformin
58
Q

Aspiration of such pills will cause bronchial obstruction

A
  • Sucralfate

- Pomegranate

59
Q

The main symptom of noninfectious pulmonary infiltrates is?

A

Dyspnea

60
Q

The most common manifestation of pulmonary vasculitis from asymptomatic chest radiograph abnormalities to severe respiratory failure

A

Diffuse alveolar hemorrhage

61
Q

Necrotizing granulomatous vasculitis with involvement of upper respiratory tract, lung parenchyma, and kidneys.

A

Wegener’s

62
Q

Vasculitides are an allergic eosinophilic condition. most are asthmatic

A

Churg-Strauss disease

63
Q

Unknown origin but produces noncaseating pulmonary granulomas

A

Sarcoidosis

64
Q

Autoimmune disease affects the lungs and kidneys due to autoantibodies to type IV collagen

A

Anti–glomerular basement membrane antibody disease (Goodpasture’s syndrome)

65
Q

Most common cause of leukemic infiltrates with peripheral blast cell counts exceed 100000/mL

A

Myeloid leukemia

Section 8: Pulmonary Disorders (8 decks)

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