Habal: Pneumonia Flashcards
What makes up the mucociliary escalator?
mucous membrane ciliated epithelial cells alveolar macrophages
If your patient has no rales on auscultation and is breathing normally, yet has cough with purulent sputum, what can you exclude and include?
exclude pneumonia, think ACUTE BRONCHITIS
What is the normal duration of acute bronchitis?
5d-3w
Majority of cases of acute bronchitis are due to?
viral infection: influenza, parainfluenza (nursing homes), RSV (babies) If bacterial: Mycoplasma pneumonia, chlamydia pneumo, bordatella pertussis (a cute clam is on my board).
What are dx features of acute bronchitis?
COUGH with NO FEVER. CXR will R/O pneumonia.
Management of acute bronchitis?
Antibiotics not req’d. Bed rest, cool vapor, analgesics, antitussive, expectorants
What is the most common LRI in infants (1-24m)?
Bronchiolitis. Will have WHEEZING.
What two main things is bronchiolitis associated with?
crowded conditions and smoke exposure
MCC bronchiolitis?
RSV infection (70%).
Complications of bronchiolitis?
ARDS, Bronchiolitis obliterans organizing pneumo (BOOP. mucus plugs in alveoli -> irreversible).
What are the virulence factors of RSV?
Fusion Protein F: promotes fusion of infected cells (transfer of genetic material) –> form a giant cell called a “synctia”
Identify.
RSV. Note the multi-nucleated giant cell at the top right.
This recently identified virus can have sx from common cold to LRI and often has a co-association with RSV. What is it and how can you dx it?
Human Metapneumovirus; rtPCR
This infection causes consolidation of the affected part and filling of alveolar space with fluid.
Pneumonia.
Key differences of typical and atypical pneumonia?
Typical has a sudden onset with HIGH fever and productive cough. CXR: unilateral infiltrate. MCC Strep pneumo. Atypical has slow onset with low fever and dry cough. CXR: bilateral infiltrate. MCC: Mycoplasma pneumonia, Chlamydia, Legionella, Viruses.
What are the main dx tests you want to run if you suspect pneumonia in your patient?
ABG, CXR. Also: CBC, blood culture and gram stain, sputum culture
What are the two classes (with their MCC) of HAP?
Early onset (within first 5 days): MSSA, H. influenza, Enterobac, Strep pneumo Late onset (>5d/more opportunistic): P. aeruginosa, Acinetobacter, Enterobac, MRSA
What would you most likely suspect is the cause of pneumo in a patient with HIV? In a patient with a transplant? CF?
P. jiroveci; CMV; P. aeruginosa
What are common causes of lobar pneumonia? (one lobe)
S. pneumo, Klebsiella, H. influnza
What are common causes of patchy pattern in pneumo?
Atypicals; viral
What are common causes of interstitial pnuemo?
Viral, PCP/PJP, Legionella
What are common causes of Cavitary pneumo?
TB, fungi, klebsilla, anaerobes
What are common causes of large effusion on CXR?
S. aureus, klebsiella
Hantavirus is caused by inhalation of?
dry urine from rodents.
