Lecture 7 Pneumonia (missed lecture)

Question 1

gold standard for diagnosis of pneumonia?

Answer 1

Chest X ray (although may be normal in up to 7% of patients)

Question 2

3 classes of initial clinical classification of pneumonia

Answer 2

major immunodefeciency, Tb, normal hosts

Question 3

4 classes of aquired pneumonia in normal hosts

Answer 3

Community, hospital acquired;

ventilator, health-care associated

Question 4

suspect Tb in patients with 2 of more of the classic symptoms:

Answer 4

hemoptysis, cough more than 2 weeks, night sweats, weight loss.

order airbone isolation and CXR

Question 5

CXR characteristics in patients with Tb:

____ lobe infilitrates, ____ pattern, ____ lesions , ____ infiltrate

Answer 5

upper, milliary, cavitary, nodular

Question 6

the _____ and the pneumonia severity index are used to determine weather treatment should be ____ or ____

Answer 6

CURB-65, in vs outpatient

Question 7

CURB65 is what?

scores above ____ should be considered for hospital stay

Answer 7

Confusion, 
urea ( greater than 7 mmol/L), 
respiratory rate greater than 30,
BP less than 90 systolic or 60 diastolic;
greater than 65 years of age;

scores above 1 (2 = short hospital stay, 3 = hospital)

Question 8

major criteria (2) designating need for ICU admission:

Answer 8

invasive mechanical ventilation or septic shock (need just one)

minor criteria (need 3, see notes)

Question 9

what somewhat new test helps indicate presence of bacterial infection?

Answer 9

PCT (pro-calcitonin) - indicates severe infection

Question 10

increased risk of pseudomonas is seen in patients with structural lung disease such as ______; extended _____ therapy, broad-spectrum Ab use, or malnutrition

Answer 10

bronchiectasis;

corticosteroid

Question 11

is it better to wait for results of culture/sputum sample before treating or to treat right away?

Answer 11

treat ASAP as possible,

Question 12

2 vaccines patients should get to prevent pneumonia

Answer 12

influenza, pneumococcus

Question 13

Lobar pneumonia is characterized by a ____ exudate which causes ____ of a lobar or the entire lung

Answer 13

intra-alveolar; consolidation

Question 14

according to FA, what 3 bacteria cause lobar pneumonia?

Answer 14

S. pneumo by far, legionalla, klebsiella

Question 15

bronchopneumonia is characterized by acute inflammatory infiltrates from the ____ into adjacent ____; distribution is characteriszed as ____

Answer 15

bronchioles, alveoli;

patchy (or multifocal)

Question 16

4 organisms listed in FA that cause bronchopneumonia

Answer 16

S. pneumo, S. aureus, H influenza, klebsiella;

also pseuodomonas

Question 17

interstitial/atypical pneumonia is characterized by ____ ____ inflammation localized to interstitial areas at alveolar walls. there is an increase in “lung ____”

Answer 17

diffuse patchy;

marking

Question 18

in addition to viruses, what bacteria can cause atypical pneumonia, according to FA

Answer 18

mycoplasma, legionella, chlamydia, coxiella

Question 19

what is empyema? What bacteria usually causes it?

Answer 19

pus in the alveolar space, s aureus

Question 20

do breath sounds increase or decrease with pneumonia? there is ____ to percussion

Answer 20

decrease; dullness