Clinical Pneumonia: Diagnosis and Management

Question 1

pneumonia produces dyspnea of ____ origin.

Answer 1

parynchemal origin. See scheme.

Question 2

fill out table for type of contact

Answer 2

Question 3

symptoms of pneumonia

Answer 3

• Symptoms
• Cough
• Productive, Smell/Taste, Hemoptysis • SOB • Fever • Assoc Sx: Chest Pain, Weight Loss, Rash

Question 4

typical vs atypical pneumonia

Answer 4

typica: sick, productive vough, LOBAR consolidation
atypical: less sick, non-productive cough, INTERSTITIAL cxr findings. no findings on consolidation,

Question 5

chronic vs acute pneumonia

Answer 5

acute: <8 weeks, often hours/days
chronic: >6 weeks, usually due to fungal or TB causes, less likely to be super spreadable.

Question 6

recurrent pneumonia is often due to ___-___ causes

Answer 6

post obstrucitve causes

Question 7

treatment for anthrax

Answer 7

• Treatment
• PCN/Cipro - Natural exposure
• Ciprofloxacin/Clinda - Bioterrorism
• Prophylax 60 days (Cipro) for spores

Question 8

T/F a negative sputum culture can rule out pneumonia

Answer 8

false. sensitivity is 50% therefore a negative result doesn’t mean NOT pneumonia

Question 9

possible bacteria from the CS?

Answer 9

this is gram positive diplococci– capsulated. staph stret.

therefore more liekly to be strep since staph is in clusters usually.

Question 10

type of pneumonia?

Answer 10

right middle lobe consolidation– this is lobar. it’s not diffuse. rilhouette sign on RIGHT side. hard to see heart border.

• since it’s lobar it’s probably a typical pneumonia. higher chance of CAP– strep pneumo, hemophilus in, moraxella cat.

Question 11

CAP tends to have ___ consolidation on xray

Answer 11

dense consolidationg.

Question 12

type of pneumonia? is this person really “sick?”

Answer 12

• diffuse consolidations point to atypical pneumonia. could be HAP. possible PJP, fungal, mycoplasma pneumo, legionella, chlamydialis.

atypical pneumonia prsentation tend to be less sick looking that typical pneumonia.

Question 13

types of bacteria that may cause bilateral hazy opacification to be seen

Answer 13

bacteria: chlamydophila pnuemo, myocplasma pneumo, legionella pneumo.
viral: influneza most common
fungal: dimorphic>mold.

Question 14

simple score used to determine need for admission

Answer 14

CRUB65

Question 15

Aspect of the CURB65 score

Answer 15

Question 16

early abx correlation with mortality

Answer 16

the longer delay, the higher the mortality. early abx is critical if someone presents with pneumonia sepsis.

Question 17

Answer 17

Question 18

• What is the BEST treatment for CAP
(admitted to hospital)?

1. Pip/Tazo
2. Ceftriaxone + Azithromycin
3. Vanco + Pip/Tazo
4. Ciprofloxacin

Answer 18

ceftriaxone and azithromycin

Question 19

• CAP pt in Septic Shock should get Abx in < ____hr(s)
1. One

2. Two
3. Four
4. Six

Answer 19

one hour. the longer you wait, the higher the likelyhood of mortality.

Question 20

Dense Consolidation - CAP– which bacteria?

Answer 20

STREP PNEUMO

• haemophilus influenzae
• moraxella catarrhalis

Question 21

Bilateral Hazy Opacification – bacteria?

Answer 21

atypical pneumonia

Question 22

Hospital Acquired Pneumonia (HAP)
• >/= ____ hrs after admission

Healthcare Associated Pneumonia (HCAP)
• Infxn within ___ days of D/C from Healthcare Facility

Ventilator Associated Pneumonia (VAP)
• Infxn (>___hrs) after intubation

Answer 22

Hospital Acquired Pneumonia (HAP)
• >/= 48 hrs after admission

Healthcare Associated Pneumonia (HCAP)
• Infxn within 90 days of D/C from Healthcare Facility

Ventilator Associated Pneumonia (VAP)
• Infxn (>48hrs) after intubation

Question 23

for HAP/VAP/HCAP which organisms (in addition to the normal ones) should be considered?

Answer 23

MRSA, MSSA, pseudomonas.

• they’re more resistant. require longer treatment.

Question 24

where does aspiration pneumonitis/pneumonia most likely consolidate?

Answer 24

the RLL- most direct route. eaiser for contents to enter the RB compared to the LB..

Question 25

causes why someone with pneomonia might not be improving in 48 hours.

Answer 25

• wrong bug: drug resistant organism; mrsa, pseudo, tb, viral, fungal.
• wrong drug: wrong dose, wrong duration, wrong route, doesn’t penetrate compartment.
• wrong diagnosis: non infectious: could be sarcoid, PE, CHF, infectious with septic PEs
• complication: lung abscess, parapneumonic effusion/empyema.

Question 27

• 80% Lung Abscesses from ____
• 40% of people aspirate in their sleep (70% with altered LOC)
• >______
bacterial/ml of sputum

Answer 27

• 80% Lung Abscesses from ASPIRATION
• 40% of people aspirate in their sleep (70% with altered LOC)
• >1,000,000
bacterial/ml of sputum

Question 28

T/F you should drain a lung abscess

Answer 28

false. no drainage. there is an incersed risk of a bronchopleural fistula.

Question 29

treatment of a lung abscess

Answer 29

• Mgmt = NO Drainage
• Increased risk of Bronchopleural fistula
• Ceftriaxone/Metro, Amox-Clav > Clinda

Question 30

Answer 30

lung abscess- could be due to aspiration pneumonia. the abscess has septations.

Question 31

• 68M with Fever, SOB, Cough with sputum

• Dx: CAP as outpt treated with Clarithromycin ED with increasing SOB
• After initial improvement presents to

• You order CXR…

Answer 31

this could be a pleural effusion (possible empyema or lung abscess complication) or a consolidation (wrong bug, wrong drug, getting worse)

Question 32

differentiate consolidationg vs effusion in terms of PE findings.

Answer 32

consolidation: dullness, increased tactile fremitus because it’s solid. Crackle and bronchiole breath sounds. whispering pectoriloque
effusion: dullness, DECREASED TACTILE FREMITUS beucase it’s liquid. decreased breath sounsd.

Question 33

lights criteria for transudative vs exudative

Answer 33

Question 34

pH of empymea

Answer 34

pH<7.2– acidic.

Question 35

69F discharged 3 days ago after fractured
leg presents with:
• Acute-onset SOB + Confusion
• 10L O2, RR = 40

• Cough (no sputum)
• Fever (38.9C)
• BP = 80/50
• Urea = 20
• describe the type of pneumonia and what antibiotics should you start?

Answer 35

this is hospital acquired pneumonia since it’s developed <48 hours after hospital care. Should start Vanco/Tazo for MRSA coverage.

Question 36

Answer 36

Question 37

duration of antibiotic treatment for MRSA and MSSA and pseodomonas

Answer 37

15 days. 8 days for all others.