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CPR Exam 2 > Clinical Med Part 2 (Tyler) > Flashcards

Clinical Med Part 2 (Tyler) Flashcards

1
Q

What is the overall mortality of pneumonia?

A
  • 10%
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2
Q

What microbes have the highest incidences of mortality?

A
  • Gram negative and S. aureus
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3
Q

What are some outpatient microbial causes of pneumonia?

A
  • S. pneumoniae
  • M. pneumoniae
  • H. influenzae
  • C. pneumoniae
  • Respiratory viruses
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4
Q

What are some non-ICU microbial causes of pneumonia?

A
  • S. pneumoniae
  • M. pneumoniae
  • C. pneumoniae
  • H. influenzae
  • Legionella spp
  • Respiratory viruses
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5
Q

What are some ICU microbial causes of pneumonia?

A
  • S. pneumoniae
  • S. aureus
  • Legionella spp
  • Gram negative bacilli
  • H. influenzae
  • Respiratory viruses
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6
Q

What is the most common cause of community acquired pneumonia?

A
  • S. pneumoniae
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7
Q

What are some causes of typical pneumonia?

A
  • S. pneumoniae
  • H. influenzae
  • S. aureus
  • Klebsiella pneumoniae and P. aeruginosa
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8
Q

What are some causes of atypical pneumonia?

A
  • M. pneumoniae
  • C. pneumoniae
  • Legionella spp
  • Respiratory viruses
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9
Q

What are some general risk factors for community acquired pneumonia?

A
  • Alcoholism
  • Asthma
  • Immunosuppression
  • Institutionalization
  • Age over 70
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10
Q

What is a risk factor for pneumonia specifically in the elderly?

A
  • Lack of a cough/gag reflex due to muscle weakness
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11
Q

What are some risk factors for the pneumococcal pneumonia?

A
  • Dementia
  • Seizure disorders
  • Heart failure
  • Cerebrovascular disease
  • Alcoholism
  • Tobacco smoking
  • COPD
  • HIV infection
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12
Q

Who does enterobacteriaceae tend to infect?

A
  • Those that have recently been hospitalized and/or received antibiotic therapy or who have comorbidities like alcoholism, heart failure, or renal failure
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13
Q

Who has a problem with P, aeruginosa?

A
  • Patients with severe structural lung disease like bronchiectasis, cystic fibrosis, or severe COPD
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14
Q

What are some risk factors for Legionella?

A
  • Diabetes
  • Hematologic malignancy cancer
  • Severe renal disease
  • HIV infection
  • Smoking
  • Male gender
  • Recent hospital stay or cruise
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15
Q

What are some fungi that could cause pneumonia?

A
  • Histoplasma capsulatum

- Coccidioides immits

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16
Q

How is pneumonia diagnosed?

A
  • CXR
  • Point of care ultrasound (POCUS)
  • Bronchoscopy
  • Tissue biopsy
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17
Q

What labs are used to help in the diagnosis of pneumonia?

A
  • Sputum gram stain and culture
  • Blood culture
  • CBC
  • PCR and antigen studies
  • Procalcitonin
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18
Q

What is the general appearance of someone with pneumonia?

A
  • Fever
  • Hypothermia
  • Malaise
  • Most appear ill
  • Alert to obtundent
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19
Q

What does the respiratory exam look like with pneumonia?

A
  • Adventitious sounds
  • Tachypnea
  • Hypoxia
  • Chest movement
  • Cough
  • Inspiratory crackles
  • Bronchial breath sounds
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20
Q

What does a cardiac exam look like with pneumonia?

A
  • Tachycardia
  • Hypo- or hypertension
  • Exacerbations of heart failure
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21
Q

What is the treatment of pneumonia?

A
  • Based on history
  • Use the ATSA/IDSA guidelines for management and treatment of CAP
  • Use CURB-65 to help determine level of morbidity
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22
Q

What are the risk factors for Pseudomonas with CAP?

A
  • Compromised immune system
  • Recent prior antibiotic use
  • Structural lung abnormalities (cystic fibrosis or bronchiectasis)
  • Repeated exacerbations of COPD requiring frequent glucocorticoid and/or antibiotic use
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23
Q

What are some risk factors for Pseudomonas with HAP?

A
  • Increased age
  • Length of mechanical ventilation
  • Antibiotics at admission
  • Transfer from a medical unit or ICU
  • Admission to a ward with high rate of Pseudomonas
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24
Q

What is hospital acquired pneumonia?

A
  • Infection acquired after at least 48 hours of hospitalization
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25
Q

What is the treatment for HAP?

A
  • There is a higher morbidity and mortality rate than CAP

- Need for a treatment for broadened scope of organisms is greater

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26
Q

What are some considerations in HAP and VAP?

A
  • Increased mortality
  • MDR pathogens and MRSA
  • MDR pathogens without MRSA
  • MRSA alone
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27
Q

What is healthcare associated pneumonia?

A
  • Used to identify patients at risk for infection with MDR pathogens
  • Classification has been very sensitive and lead to inappropriate antibiotic use
28
Q

What is ventilator associated pneumonia?

A
  • Type of HAP that develops more than 48 hours after endotracheal intubation
29
Q

What are some clues to VAP?

A
  • Difficult to wean off ventilator
  • Persistent lack of improvement overall
  • New infiltrates on CXR
  • New fevers
  • New changes in baseline data: CBC, CMP, etc
30
Q

What is aspiration pneumonia?

A
  • Most pneumonia arises following the aspiration of microorganisms from the oral cavity or nasopharynx
31
Q

What are some risk factors for aspiration pneumonia?

A
  • Neurologic disorders
  • Reduced consciousness
  • Esophageal disorders
  • Vomiting
  • Witnessed aspiration
32
Q

Who is aspiration pneumonia suspected in?

A
  • A lethargic, obtundent, or unconscious patient, esp those who have been vomiting
  • Stroke patients with swallowing dysfunction
  • Elderly
  • Patients with multiple sclerosis and bulbar symptoms
33
Q

What are the most likely considered pathogens in aspiration pneumonia?

A
  • Agents from oral cavity and pharynx
  • Primarily anaerobes
  • Gram positive cocci
  • Gram negative bacteria
  • S. anginosus group
34
Q

What are some clinical findings of aspiration pneumonia?

A
  • Indolent symptoms
  • Predisposing condition for aspiration
  • Absence of rigors
  • Failure to recover likely pulmonary pathogens with cultures of expectorated sputum
  • Sputum that has a putrid odor, which is diagnostic of anaerobic infection
35
Q

What imaging is seen in someone with aspiration pneumonia?

A
  • CXR showing involvement of dependent portions of lung or segments obstructed by malignancy, stricture, or foreign body
  • CXR or CT showing pulmonary necrosis with lung abscess or empyema
36
Q

What is the treatment for aspiration pneumonia?

A
  • Clindamycin (primarily outpatient)
  • Ceftriaxone and metronidazole
  • Ampicillin-sulbactam
  • Imipenem- tazobactam
  • Ertapenem
37
Q

What is a pleural effusion?

A
  • Excess fluid accumulation in the pleural space
38
Q

What causes a transudate?

A
  • Systemic influences on pleural fluid formation and resorption
  • Left ventricular failure, cirrhosis
  • Nephrotic syndrome
  • Myxedema
  • Peritoneal dialysis
39
Q

What causes an exudate?

A
  • Local influences on pleural fluid formation or resorption
  • Bacterial pneumonia
  • Malignancy
  • Viral infection
  • PE
  • TB
  • Fungal or parasitic infections
40
Q

What are the two most common causes of pleural effusion?

A
  • Heart failure

- Pneumonia

41
Q

How is the diagnosis for pleural effusion made?

A
  • Plain film radiographs
  • CT chest
  • Ultrasound
  • Often an area of egophony just superior to the effusion
42
Q

When is a thoracentesis done?

A
  • If effusions are asymmetrical, fever, chest pain, or failure to resolve
43
Q

What are some complications with a thoracentensis?

A
  • Pneumothorax
  • Hemothorax
  • Re-expansion pulmonary edema
  • Spleen/liver laceration
44
Q

What is the Light’s criteria used for?

A
  • Used to tell of exudates fulfill at least one of the criteria
45
Q

What is the Light’s criteria?

A
  • Protein pleural fluid/serum protein ratio (>0.5)
  • Pleural fluid LDH greater than two-thirds of the laboratory normal
  • Pleural/serum LDH ratio >0.6
46
Q

Do transudative effusions typically meet the Light’s criteria?

A
  • No
47
Q

What else should be tested for exudative effusions?

A
  • pH
  • Glucose
  • WBC count with diff
  • Microbiologic studies
  • Cytology
48
Q

What is the definition of ARDS?

A
  • Acute respiratory distress that includes:
  • Severe dyspnea
  • Diffuse pulmonary infiltrates
  • Hypoxemia
49
Q

What is a key diagnostic for ARDS?

A
  • Diffuse bilateral pulmonary infiltrates on CXR
  • PaO2/FiO2 <300 mmHg
  • Absence of elevated left atrial pressure
  • Acute onset within 1 week of a clinical insult or new or worsening respiratory symptoms
50
Q

What is the PaO2/FiO2 ratio?

A
  • Common measure of oxygenation and is most often employed in ventilated patients
51
Q

What do values under 300 mmHg represent in the PaO2/FiO2?

A
  • Abnormal gas exchange
52
Q

What are the risk factors for ARDS?

A
  • Sepsis
  • Pneumonia
  • Trauma
  • Multiple blood transfusions
  • Gastric acid aspiration
  • Drug overdose
  • Older age
  • Chronic alcohol abuse
  • Metabolic acidosis
  • Pancreatitis
53
Q

What is the exudative phase of ARDS?

A
  • Characterized by alveolar edema and neutrophil infiltration
  • Diffuse alveolar damage
  • Atelectasis and reduced lung compliance
  • Hypoxemia, tachypnea, progressive dyspnea, and hypercarbia
  • CXR reveals bilateral opacities consistent with pulmonary edema
54
Q

What is the proliferative phase of ARDS?

A
  • Lasts from 7 to 21 days after inciting insult

- Some develop progressive lung injury and have evidence of pulmonary fibrosis

55
Q

What is the fibrotic phase of ARDS?

A
  • Most recover within 3-4 weeks but some experience fibrosis

- INcreased risk of pneumothorax, reductions in lung compliance, and increased pulmonary dead space

56
Q

What is the treatment for ARDS?

A
  • Treatment of underlying medical condition that caused lung injury
  • Minimizing iatrogenic complications
  • Prophylaxis to prevent venous thromboembolism and GI hemorrhage
  • Prompt treatment of nosocomial infections
  • Adequate nutritional support
57
Q

How can we minimize the alveolar collapse and achieve adequate oxygenation?

A
  • Put patient into prone

- Low tidal volumes and positive end expiratory pressure

58
Q

What are some ancillary therapies with ARDS?

A
  • Patients have pulmonary vascular permeability leading to interstitial and alveolar edema
  • Receive IV fluids only as needed
  • Most patients require sedation and even paralytic agents
  • Avoid the use of glucocorticoids
59
Q

What are the clinical manifestations of the influenza virus?

A
  • Sudden onset respiratory illness (symptoms in 48-72 hours of exposure)
  • Rhinorrhea
  • Sore throat
  • Conjunctivitis
  • Cough
60
Q

What does the physical exam show of the influenza virus?

A
  • Non-localizing rales, rhonchi, and wheezing
61
Q

How is influenza distinguished from other respiratory illnesses?

A
  • Greater degree of accompanying fever, fatigue, myalgia, and malaise
62
Q

Who are influenza complications more common in?

A
  • Young children <5
  • Elderly
  • Pregnant women in second or third trimester
  • Patients with chronic disorders
63
Q

What are some respiratory complications with influenza?

A
  • Pneumonia
64
Q

What are some extrapulmonary complications with influenza?

A
  • Myositis (influenza B)
  • Reye’s syndrome
  • myo/pericarditis
  • CNS disease
65
Q

What is found in laboratory testing for influenza?

A
  • RT-PCR of respiratory samples is most sensitive for detecting influenza
  • Rapid tests can yield results quicker but are as sensitive
66
Q

What is the treatment for influenza?

A
  • Neuraminidase inhibitor for influenza A and B

- If started within 48 hours of infection, symptoms can resolve 1-2 days sooner

67
Q

What are the risk factors for COVID?

A
  • CV disease
  • Diabetes
  • HTN
  • Chronic lung disease
  • Cancer
  • Chronic kidney disease
  • Obesity
  • Smoking

CPR Exam 2 (12 decks)

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