Infections of the Lower Respiratory Tract Flashcards
What is the most common route of infection for pneumonia?
Micro aspiration of oropharyngeal secretions
What is the most common bacterial cause of CAP?
Steptococcus pneumoniae (Gram + cocci in pairs) 65%
What is the second most common bacterial cause of CAP?
Haemophilus influenzae (Gram - bacilli/rods)
What underlying pulmonary disease puts patients at an increased risk of getting pneumonia caused by h. influenza?
COPD! Cystic fibrosis!
What bacteria are responsible for hospital acquired pneumonia?
Gram negative rods: Pseudamonas*, klebsiella, enterobacter, serratia, achinetobacter, s. aureus
Pneumonia acquired OUTSIDE of the hospital setting and patient is not a resident of LTCF OR a patient who was ambulatory prior to admission who develops pneumonia within 48 hours of initial admission to hospital
Community acquired pneumonia
Pneumonia occurring >48 hours after hospital admission. Often caused by pseudomonas and other organisms found in the hospital.
Hospital acquired pneumonia (nosocomial)
Sudden onset of fever, productive cough with purulent sputum, pleuritic chest pain, rigors, tachycardia, tachypnea
Symptoms of pneumonia (typical)
Bronchial breath sounds
Dullness to percussion
Increase in tactile remits, ego phony
Inspiratory rales and crackles
Signs of consolidation on PE of pneumonia
Chlamydia, legionella, and viruses are all causes of which type of pneumonia?
atypical
What should you expect to see on a CXR of a patient with pneumonia?
Lobar pneumonia
If you look at an CXR of a patient who you suspect has pneumonia and you see diffuse, patchy infiltrates (reticulonodular or interstitial), what should you suspect?
Atypical pneumonia
Low grade fever, dry, non productive cough, and extrapulmonary sxs like myalgias, malaise, sore throat, HA, and NVD
Symptoms of atypical pneumonia
What does the PE of a patient with atypical pneumonia look like?
Often normal without signs of consolidation
Which type of atypical organisms causes hoarseness and fever which then turns to respiratory symptoms a few days later?
Chlamydia
Which type of atypical organisms causes ear pain, bullous myringitis, a persistent nonproductive cough, and an erythematous pharynx?
Mycoplasma
Which type of atypical organisms causes GI and neuro symptoms, increased LFTs, and hyponatremia?
Legionella
If you see abscess formation on a CXR, what organism could be causing it?
S. aureus
Klebsiella
Anaerobes
If you see that the upper lobe (esp RUL) has a bulging fissure or cavitations, what organism could be causing that type of pneumonia?
Klebsiella
What organism causes rust blood tinged sputum?
Strep pneumonia
What organism causes currant jelly sputum?
Klebsiella
What organism causes green sputum?
H flu, pseudomonas
What organism causes foul smelling sputum?
Anaerobes
With pneumonia, there is:
_____ on perussion
_____ tactile fremitus
___ and ____ breath sounds
Dullness on percussion
Increased tactile fremitus
Bronchial and egophony breath sounds
What is the DOC for Outpatient CAP treatment?
Macrolide or doxycycline*
What is the DOC for Inpatient CAP treatment?
Beta lactam + macrolide (or doxy)
OR broad spectrum floroquinolone
What is the DOC for inpatient CAP in the ICU?
B lactam + macrolide OR
B lactam + broad spectrum FQ
What is the DOC for treatment of hospital acquired PNA?
Anti-pseudomonal beta lactam and anti-pseudomonal AG or FQ
What do you add to the treatment of hospital acquired pneumonia (Anti-pseudomonal beta lactam and anti-pseudomonal AG or FQ) if you suspect MRSA?
Vanco
How do you treat aspiration pneumonia?
Clindamycin or augmentin +/- metronidazole
When should you change inpatient pneumonia therapy from IV abx to oral?
When clinically responding and able to take PO for 7-10 days
What is the pneumococcal vaccine for children?
PCV13
When should doses of pneumococcal vaccine be given to children?
2 months, 4 months, 6 months, after 4 years
What ist he adult pneumococcal vaccine?
PCV23
The PCV23 vaccine is a capsular _____
polysaccharide
Borders of the heart lost when similar density (pneumonia) lies adjacent?
Silhouette sign
Your patient presents with a 10 days history of increasing cough, purulent sputum, SOB, pleuritic chest pain, hypothermia, sweats, and rigors. What do you suspect?
CAP
Is a PE enough to diagnose pneumonia?
NO
What specific level would lead you to believe a pneumonia was caused by a bacterial origin vs a viral one?
Procalcitonin
When should you hospitalize a patient who has pneumonia?
When they have neutropenia, involvement of more than one lobe, or poor host resistance
Consider for those over 50 with comorbidities, etc.
How many strains does PCV23 or Pneumovax contain of pneumonia?
23
Who is at the highest risk of hospital acquired pneumonia?
Vent patients
What is the second most common cause of hospital acquired infection?
Hospital acquired pneumonia
What is the most likely pathogen to cause pneumonia in the ICU?
Pseudomonas
With hospital acquired pneumonia, what bacterial should you always treat against?
Pseudomonas
Inflammation of trachea/bronchi (conducting airways)
Bronchitis
What is bronchitis most commonly caused by?
Viruses
Which viruses commonly cause bronchitis?
Rhinovirus
adenovirus
coronavirus
RSV
What are some bacterial causes of bronchitis?
S. pneumonia
H. influenzae
M. catarrhalis
Mycoplasma
Bronchitis often follows a ____
URI
What is hallmark symptoms of bronchitis?
Cough that can be productive but doesn’t have to, lasts 1-3 weeks
How do you diagnose bronchitis?
Clinically
Is a CXR usually indicated for bronchitis?
Nah
How do you manage bronchitis?
Symptomatic tx of choice
Fluids, rest, antitussives, bronchodilators
Do antibiotics have any benefit at all in healthy patients with bronchitis?
NO don’t use them!
Is sputum color predictive of bacterial involvement?
NO damnit
Cough with or without sputum, dyspnea, fever, sore throat, headache, myalgia, substernal discomfort,
PE: Expiratory rhonchi or wheezes
Bronchitis
