Infectious Pulm

Question 1

empiric treatment

Answer 1

cookie-cutter treatment, not sure what the true treat is

Question 2

pneumonia basic def

Answer 2

an infection that inflames the air sacs in one or both lungs

Question 3

Acute bronchitis

Answer 3

Cough for 3 weeks minimum + sputum
M/c viral
Influenza, parainflu., rhinovirus, RSV, adenovirus, coronav
“atypical” bacterial (mycoplasma, chlamdophila) =ABX
bordetella pertussis
H influenzae, S pneumonia
Covid-19

risk factors= immunosuppression, underlying respiratory DZ, chronic comorbids.

PE will be normal

Dx studies
chest x-ray
maybe CBC with diff
PFT (asthma breathing test) if doesn't resolve
COVID testing in 2020

Tx
supportive care
lots of ABX can lead to multi resist organisms
want to stop this from progressing in high risk pts
SABA (short acting beta agonistis) will lossen the sputum so they can get it up with a productive cough

Question 4

pneumonia dz

Answer 4

Very common 3 mill cases per year
500,000 adminssions per year
mortality 2-30% av 14%
winter
m/c men and blacks
m/c strep pneumonia

pathogenesis
defect in host defenses
exposeure to virulent microorganism
overwhelming inoculum (abount breathed in (wearing masks))

host defenses vs pneumonia
air filtration, cough reflex, tracheobronchial secretions, cell-mediated immunity

epidemiolic clues 
travel history
specific exposure to histoplasma, bat and bird shit
known outbreaks (SARS, covid etc)
immunosuppressed (HIV)

Question 5

Typical pneumonia

Answer 5

s. pneumoniae, Haemophilus influenzae, staph aureus, GAHBA(group a strep), moraxella catarrhalis, anerobes, aerobic gram neg bacteria

Question 6

Atypical pneumonia

Answer 6

Legionella spp (AC units in buildings), mycoplasma pneumonia (walking pneumonia)

Question 7

Strep pneumonia DD

Answer 7

productive cough with rust color
toxic apperence, rigors
mc in immunosuppressed/comp

Question 8

legionella sp DD

Answer 8

associated diarrhea and hyponoatremia
non productive or minimum productive cough
very high fever cases (20%), most will have some fever
bradycardia in eldery
exposure to contaminated AC or travel

Question 9

mycoplasma (walking) DD

Answer 9

young adults
dry cough
xray>clin apperence
extra pulmonary (derm, neuro, cardia, rheum)

Question 10

Haemophilus influenzae DD

Answer 10

— More common in patient with COPD / Lung Dz / CF — Exac COPD – Fever, Sputum, SOB (nl CXR)
— Pneumonia – similar to pneumococcal
— More likely to cause pleural dx

Question 11

Staph aureus DD

Answer 11

— MRSA vs Non MRSA

— Necrotizing pneumonia with Abscess formation — Extremely foul smelling

Question 12

Gram Negative bacilli (Klebsiella, Pseudomonas) DD

Answer 12

More common in patient with Lung Dz, hospitalized patients, and vent patients
— Klebsiella
— More common in patient with Alcoholics, DM, Lung Dz,
hospitalized patients, and vent patients — May lead to septecemia
— Pseudomonas
— Sweet or fruity smelling breath odor

Question 13

Pneumonia Diagnostic Studies

Answer 13

— CBC with differential (Look for elevated WBC and left shift)

— Access oxygenation (look on PPT)
— ABG on RA, Pulse Ox
—
— CXR

— Blood Cultures

— Sputum Gram Stain and Culture

Pneumococcal Pneumonia
— Gram stain and culture of sputum
— Urinary pneumococcal antigen assay has high predictive value
— CXR – Classic Lobar infiltrate

Question 14

pneumonia admission criteria

Answer 14

PSI(pnemonia severity index)

CURB-65 score
Confusion (based upon a specific mental test or disorientation to person, place, or
— time)
— Urea (blood urea nitrogen in the United
States) >7 mmol/L (20 mg/dL)
— Respiratory rate >30 breaths/minute
— Blood pressure [BP] (systolic <90 mmHg or diastolic <60 mmHg)
— Age >65 years
— Score 2 = Admit to hospital
— Score 4-5 = consider ICU

Blood gas is a good way to see if they will stay or go

Question 15

PCP Pneumonia (PJP)

Answer 15

Opportunistic infection of immunocompromised host —P.jiroveciiinfectshumans,whereasP.carinii this is
reason name change

— Risk Factors for Developing
— HIV with CD4 less than 200
— Immunosuppressive agents in transplant cases, Collagen Vascular Dz, Oral Steroids

Clinical Manifestation

— Dyspnea, Fever and Non productive cough
— Usually sub acute, often presenting after a few weeks of
symptoms.
— Exercise causes significant hypoxemia
—May appear after steroid tapering

—PE-
— Tachypnea, cyanosis, tachycardia

Diagnostic Studies
— CXR
— Galluim Scan
— ABG – Very Hypoxemic (Aa Gradient Elevated)
— LDH Elevated (liver test but also found in lungs)
— Sputum Induction

TX
Trimethaprim Sulphamethoxazol TMP-SMX, (Bactrim) (TMP: 5 mg/kg; SMX: 25 mg/kgb) q6–8 h PO or IV

PaO2<70 mm Hg= need steroids also

Question 16

brochiolitis

Answer 16

— Clinical syndrome that occurs in children <2 years of age and is characterized by upper respiratory symptoms (eg, rhinorrhea) followed by lower respiratory infection with inflammation, which results in wheezing and or crackles (rales)

— Viral Etiology
— Most common RSV (Respiratory Syncytial Virus)
— Other viral pathogens rhinovirus, parainfluenza, human Metapneumovirus, influenza virus, adenovirus, and coronovirus

— Late fall and winter outbreaks common
— Most common between 2—6 months of age

— History
— 3—6 days of URI before onset (nasal congestion, cough
and low grade fever
— Feeding issues

— Examination
— Tachypnea, mild—severe intercostal and subcostal
retractions, and expiratory wheezing
— May be associated with dehydration,lethargy, bradycardia and respiratory failure.