Lecture 60 - Dx and Tx of PNA Flashcards

1
Q

Define PNA:

A

• “an abnormal inflammatory condition of the parenchyma of the lung ”

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2
Q

What are the classifications of PNA?

A

CAP: Typical vs Atypical

Nosocomial: HAP, VAP, HCAP

Aspiration

Opportunisitic (Immunocompromised host)

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3
Q

PNA in general (CAP typical?) — symptoms?

Signs?

A

Symptoms
§ Cough – productive vs non productive, +/- hemoptysis

§ Chest pain – pleuritic vs non-descript

§ Dyspnea - SOB –

§ Constitutional – malaise, fever, weight loss, night sweats, anorexia

Signs:
Tachypnea, tachycardia, hypoxemia, crackles
consolidation (dullness to percussion, egophony)

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4
Q

Differentiate signs and symptoms of PNA vs Acute Bronchitis

A

PNA - cough, fever, ABN VITALS, Tachypnea, crackles, consodlidaiton
Opacities CXR

Acute Bronchtiis –
cough (+/- fever),
Normal vitals
Rhonchi, wheezes, crackles

Normal CXR

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5
Q

Imaging – CXR findings of

  • lobar PNA
  • Atypical PNA
  • Aspiration PNA
A

Lobar – consolidation to 1 or more lobes

Atypical – NO CONSOLIDATION; increased marking of the interstitium; diffusely

Aspiration – consolidation of dependent lobes (RLL, RML)

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6
Q

Are PFTs used for the dx of PNA?

how is the clinical Dx of PNA made?

A

No – not very useful

Clinical dx is made on CXR

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7
Q

what are some predisposing risk factors for PNA?

How can bacteria reach the lungs?

A

redisposing factors:
• Loss or suppression of cough reflex; injury or defect to mucociliary, impairment of the phagocytic process, pulmonary congestion; accumulation of secretions

Bacteria can enter the lungs via inspiration, aspiration, hematogenous

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8
Q

what are some predisposing risk factors for a nosocomial PNA?

A

host factors, prior antibotics, invasive devices, medications altering gastric pH

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9
Q

what are some common pathogens that cause typical CAP ?

A
S. Pneumonia (majority) 
S. Aureus -- IVDU, foreign body, 
Klebsiella 
H flu 
Catarrhalis
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10
Q

what are some bacterial causes for atypical pneumonia?

A

Mycoplasma pneumonia

Legionella

Chlamydia

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11
Q

What viruses are known to cause atypical PNA

A

CMV
RSV
Influenza
Parainfluenza

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12
Q

Causes of Nosocomial PNA:

early onset vs late onset

A

Early Onset: S. Pneumo, MSSA, H flu, anaerobes

Late Onset – Pseudomonas, klebsiella, serratia, enterobacter, MRSA

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13
Q

Who needs to be cultured to purse a definitive etiology?

A

Severe CAP, failure of out patient threapy, nosocomial, pt has structureal disease, liver disease, alcohol abuse, asplenia

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14
Q

Causes of aspiration PNA?

CXR?

A

Anaerobes (Bacteroides, fusobacter)

CXR – dependent lobar opacities

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15
Q

Fungal PNA –

causes-

endemic vs opportunisits

A

Inhalation or hematogenous spread

endemic: histo, blasto, cocci

Opportunistic – candida, aspergillus, cryptococcus,

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16
Q

where is coccidiodes found?

where is histoplasma cfound?

A

Cocci – SW USA

histo – bat/birds droppings, caves