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Medicine Clerkship > Learning Objectives - Pneumonia > Flashcards

Learning Objectives - Pneumonia Flashcards

1
Q

Organisms associated with typical pneumonia?

A

Pneumococcus

Hemophilus

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2
Q

Organisms associated with atypical pneumonia?

A

Chlamydia
Mycoplasma
Legionella
Respiratory viruses

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3
Q

Define nosocomial/healthcare-associated pneumonia?

A

After 72 hours in the hospital or hospitalized in the last 90 days; nursing homes, dialysis centers, home wound care, tube feedings, family member with MDR pathogen

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4
Q

What are the dependent zones of the lungs?

A

Apical segments of the right lower lobe, posterior segments upper lobe

R>L (R more vertical in orientation)

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5
Q

Patients at risk for aspiration pneumonia?

A 
Alcoholic use disorder
Seizures
CVA
Drugs
NG/ET tube
Anesthesia
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6
Q

Organisms causing aspiration pneumonia?

A

Oral anaerobes (prevotella, peptostreptococcus, bacteroids), GN rods (Klebsiella), S. aureus

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7
Q

Rx PJP pneumonia?

A

Bactrim

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8
Q

Rx TB pneumonia?

A

RIPE

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9
Q

Rx cryptococcal pneumonia?

A

Amphotericin

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10
Q

Rx strongyloides pneumonia?

A

Albendazole

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11
Q

Rx MAC pneumonia?

A

Macrloides

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12
Q

Organisms causing pneumonia in patients with hematologic malignancy/BM transplant?

A 
GN enteric rods
Aspergillus
MRSA
Pseudomonas
CMV
PJP
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13
Q

Rx MRSA pneumonia?

A

Vancomycin

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14
Q

What can be used to decide whether or not to hospitalize patients with CAP?

A

CURB-65

Confusion
blood Urea nitrogen (>19)
RR (>30)
BP (systolic <90, diastolic <60)
Age (65+)
0-1 = outpatient
3+ = inpatient
4-5 = probably ICU
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15
Q

Which patients with pneumonia should be directly admitted to the ICU?

A 
Septic shock requiring pressors
Acute respiratory failure requiring intubation and mechanical ventilation
3 minor criteria for severe CAP:
1. RR >30
2. PaO2/FiO2 ratio <250
3. Multilobar infiltrates
4. Confusion/disorientation
5. Uremia (BUN>20)
6. Leukopenic (WBC count <4000)
7. Thrombocytopenia (<100,000)
8. Hypothermia (<32.2 C)
9. Hypotension requiring aggressive fluid resuscitation
10. Non-invasive ventilation (substitutes for RR>30 or ratio <250)
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16
Q

Most common cause of pneumonia?

A

S. pneumonia

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17
Q

Rx - uncomplicated CAP, no comorbidities or recent ABX:

A

Macrolides or doxycycline

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18
Q

Rx - uncomplicated CAP, comorbidities or recent ABX:

A

FQ (levo/moxi), amox/augmentin/3rd gen ceph + macrloide

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19
Q

Inpatient Rx - CAP?

A

FQ

Cef + azithro

20
Q

Rx nosocomial CAP?

A

Carbapenem
4th gen ceph
Pip/Tazo

21
Q

What does ceftriaxone cover?

A

Most but not all pneumococci, beta-lactamase producing H. influenzae, MSSA, enterobacter

NOT atypicals

22
Q

What does azithro cover?

A

Mycoplasma
Chlamdophila
Legionella

23
Q

What does levofloxacin cover?

A

Most pneumococci, beta-lacatamse producing H. influenzae, MSSA, Enterobacter, Mycoplasma, Chlamydophila, Legionella

24
Q

Why is amp/sulbactam a good choice for CAP aspiration pneumonia?

A

Activity against oral anaerobes including beta-lactamase producing GN anaerobes

25
Q

List # complications of acute bacterial pneumonia.

A
  1. Bacteremia
  2. Sepsis
  3. Parapneumonic effusion
  4. Empyema
  5. Meningitis
  6. Metastatic micro-abscesses
26
Q

What is the difference between uncomplicated and complicated parapneumonic effusion?

A

Uncomplicated: exudative with PMNs, no bacteria, due to inflammation, resolves with ABX

Complicated: bacterial invasion into pleural space, increased PMNs, decreased glucose, increased LDH, needs drainage, +/- thrombolytics and surgical lysis of adhesions

27
Q

Indications for pneumococcal vaccines?

A

Pneumovax 23: >65, immunosuppressed, chronic medical conditions, smoking, alcohol use

Prevnar 13: >65, CKD, immunosuppressed

28
Q

Vesicular vs. bronchial breath sounds?

A

Vesicular: normal, long inspiratory phase, short expiratory phase

Bronchial: abnormal, louder, shorter inspiratory phase, louder, prolonged expiratory phase

29
Q

Why are bronchial breath sounds heard in consolidation?

A

Sound is transmitted through solid or liquid media better than air.

30
Q

Dullness to percussion?

A

Suggests pleural effusion

31
Q

Hyperresonance to percussion?

A

Suggests pneumothorax

32
Q

Physical exam findings suggesting consolidation?

A

Egophany
Tactile fremitus
Whispered pectoriloquy

33
Q

Findings of effusion?

A

Dullness to percussion
Decreased breath sounds
Decreased fremitus

34
Q

When should an ABG be ordered in the setting of suspected pneumonia?

A

Rarely useful; can be useful if on the fence about intubation or if there is concern for retaining excess CO2

35
Q

Findings of pneumonia on CBC?

A

Elevated WBCs, PMNs, left shift, absence does not rule out

36
Q

Define a high quality sputum sample.

A

> 25 PMN
<10 epithelial cells
Per 100 power field

37
Q

In which patients should a Legionella and Strep urinary antigen be ordered?

A

Severe CAP
Admission to ICU
Hx of active alcohol use
Failed outpatient treatment

38
Q

Pneumonia infiltrates present on CXR may take up to ___ weeks to resolve

A

12

39
Q

Radiographic findings of pneumonia?

A
  1. Silhouette sign - pus produced by inflammatory response obliterates the normal air-diaphragm interface
  2. Focal consolidation
  3. Interstitial infiltrates
  4. Effusions (most common with pneumococcus)
40
Q

Cause of hypoxia in pneumonia?

A

V/Q mismatch (affected area of the lung is poorly ventilated and oxygen exchange is limited)

41
Q

DDx - Fever, Dyspnea, Purulent Cough, Hemoptysis

A
  1. Pneumonia
  2. Lung cancer
  3. Influenza
  4. PE
    Less likely: common cold, acute bronchitis, acute COPD exacerbation, CHF
42
Q

Safe resting O2 saturation?

A

~92-93%

43
Q

What 4 ways do bacteria get to the lung? Which is most common?

A
  1. Aspiration (most common)
  2. Respiratory droplet/airborne inhalation
  3. Hematogenous
  4. Direct inoculation
44
Q

Empiric therapy for pneumonia?

A

Ceftriaxone +/- macrolide

OR

FQ (NOT cipro)

45
Q

When should a CXR be repeated following pneumonia? (indications)

A

Clinical worsening

Follow-up of a pleural effusion

Medicine Clerkship (15 decks)

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