Clinical Pneumonia: Diagnosis and Management Flashcards
pneumonia produces dyspnea of ____ origin.
parynchemal origin. See scheme.
fill out table for type of contact
symptoms of pneumonia
- Symptoms
- Cough
- Productive, Smell/Taste, Hemoptysis • SOB • Fever • Assoc Sx: Chest Pain, Weight Loss, Rash
typical vs atypical pneumonia
typica: sick, productive vough, LOBAR consolidation
atypical: less sick, non-productive cough, INTERSTITIAL cxr findings. no findings on consolidation,
chronic vs acute pneumonia
acute: <8 weeks, often hours/days
chronic: >6 weeks, usually due to fungal or TB causes, less likely to be super spreadable.
recurrent pneumonia is often due to ___-___ causes
post obstrucitve causes
treatment for anthrax
• Treatment
• PCN/Cipro - Natural exposure
• Ciprofloxacin/Clinda - Bioterrorism
• Prophylax 60 days (Cipro) for spores
T/F a negative sputum culture can rule out pneumonia
false. sensitivity is 50% therefore a negative result doesn’t mean NOT pneumonia
possible bacteria from the CS?
this is gram positive diplococci– capsulated. staph stret.
therefore more liekly to be strep since staph is in clusters usually.
type of pneumonia?
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.
CAP tends to have ___ consolidation on xray
dense consolidationg.
type of pneumonia? is this person really “sick?”
- 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.
types of bacteria that may cause bilateral hazy opacification to be seen
bacteria: chlamydophila pnuemo, myocplasma pneumo, legionella pneumo.
viral: influneza most common
fungal: dimorphic>mold.
simple score used to determine need for admission
CRUB65
Aspect of the CURB65 score
early abx correlation with mortality
the longer delay, the higher the mortality. early abx is critical if someone presents with pneumonia sepsis.
• What is the BEST treatment for CAP
(admitted to hospital)?
- Pip/Tazo
- Ceftriaxone + Azithromycin
- Vanco + Pip/Tazo
- Ciprofloxacin
ceftriaxone and azithromycin
• CAP pt in Septic Shock should get Abx in < ____hr(s)
1. One
- Two
- Four
- Six
one hour. the longer you wait, the higher the likelyhood of mortality.
Dense Consolidation - CAP– which bacteria?
STREP PNEUMO
- haemophilus influenzae
- moraxella catarrhalis
Bilateral Hazy Opacification – bacteria?
atypical pneumonia
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
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
for HAP/VAP/HCAP which organisms (in addition to the normal ones) should be considered?
MRSA, MSSA, pseudomonas.
- they’re more resistant. require longer treatment.
where does aspiration pneumonitis/pneumonia most likely consolidate?
the RLL- most direct route. eaiser for contents to enter the RB compared to the LB..
causes why someone with pneomonia might not be improving in 48 hours.
- 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.
• 80% Lung Abscesses from ____
• 40% of people aspirate in their sleep (70% with altered LOC)
• >______
bacterial/ml of sputum
• 80% Lung Abscesses from ASPIRATION
• 40% of people aspirate in their sleep (70% with altered LOC)
• >1,000,000
bacterial/ml of sputum
T/F you should drain a lung abscess
false. no drainage. there is an incersed risk of a bronchopleural fistula.
treatment of a lung abscess
• Mgmt = NO Drainage
• Increased risk of Bronchopleural fistula
• Ceftriaxone/Metro, Amox-Clav > Clinda
lung abscess- could be due to aspiration pneumonia. the abscess has septations.
• 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…
this could be a pleural effusion (possible empyema or lung abscess complication) or a consolidation (wrong bug, wrong drug, getting worse)
differentiate consolidationg vs effusion in terms of PE findings.
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.
lights criteria for transudative vs exudative
pH of empymea
pH<7.2– acidic.
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?
this is hospital acquired pneumonia since it’s developed <48 hours after hospital care. Should start Vanco/Tazo for MRSA coverage.
duration of antibiotic treatment for MRSA and MSSA and pseodomonas
15 days. 8 days for all others.
