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Clin Med B 2 > lower respiratory infections part 2 > Flashcards

lower respiratory infections part 2 Flashcards

1
Q

what is the most common infectious cause of disease in the world

A

pneumonia

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2
Q

what is the definition of pneumonia

A

Pneumonia is defined as inflammation of the lung parenchyma which leads to consolidation of the affected part and a filling of the alveolar air spaces with exudate, inflammatory cells, and fibrin

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3
Q

what are the MCC of pneumonia

A

bacteria or viruses

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4
Q

what are other causes of pneumonia

A

inhalation of chemical
trauma to chest wall
infection by other agents

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5
Q

what is the pathophysiology of pneumonia

A
  • infection of lung
  • inflammatory response initiated
  • alveolar edema + exudate formation
  • alevoli & resp bronchioles fill w serous exudate, blood cells, fibrin and bacteria.
  • consolidation of lung tissue
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6
Q

what 5 pathogens are more commonly found in health care acquired pneumonia

A
  • Pseudomonas aeruginosa
  • Staphylococcus aureus (including MRSA)
  • Klebsiella pneumoniae
  • Serratia marcescens
  • Acinetobacter baumannii
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7
Q

How is pneumonia classified

A
  • anatomic location
  • mechanism of acquisition
  • setting of acquisition
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8
Q

what is included in anatomic location

A

where in the lungs is it?

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9
Q

what is mechanism of acquisition

A

how did they get it? aspiration or ventilator associated

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10
Q

what is setting of acquisition

A

is it community acquired or nosocomial

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11
Q

what is a lobar pneumonia

A

acute exudative inflammation of an ENTIRE pulmonary lobe

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12
Q

what is the MCC of lobar pneumonia

A

Strep (95%)

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13
Q

what lobe is S. pneumo classically found in

A

RLL

this is because its location to the right main bronchus. therefore it is the most common

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14
Q

where does klebsiella tend to occur

A

upper lobes

(patients dirnk and then pass out prone… leading to upper lobe pnx)

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15
Q

where does legionella tend to occur

A

lower lung fields

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16
Q

how often is the right lung affected in pneumonia

A

2x as often as the left

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17
Q

how does lobular/bronchopneumonia appear on a CXR

A

patchy, with peribronchial thickening and poorly defined air-space opacities

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18
Q

what are the common pathogens for lobular/bronchopneumonia

A

S aureus
strep
H flu
klebsiella
p aurgionosa

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19
Q

what does lobular/bronchopneumonia lead to

A

Frequently lead to abscesses, cavitation, necrosis and pleural effusions

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20
Q

what are classifications of interstitial pneumonia

A

focal
diffuse

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21
Q

what does interstitial pneumonia result from

A

edema and inflammatory cellular infiltrate into the interstitial tissue of the lung and fibrosis

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22
Q

what is the cause of interstitial pneumonia

A

idiopathic

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23
Q

what is the pattern of interstitial pneumonia

A

bilateral, symmetric, diffuse.

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24
Q

how does interstitisal pneumonia present

A

Viral-like prodrome with nonproductive cough
Later - similar presentation to ARDS, so must rule this out

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25
Q

what type of pnuemonia is this

A

lobar

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26
Q

what type of pneumonia is this

A

bronchopneumonia

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27
Q

what pneumonia is this

A

bronchopneumonia

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28
Q

what pneumonia is this

A

lobar pneumonia

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29
Q

what pneumonia is this

A

interstitial pneumonia

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30
Q

what is this

A

right upper/right middle lobar pneumonia

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31
Q

what is this

A

she said you could argue bronchopneumonia but the ground glass appearance suggests more interstitial pneumonia

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32
Q

what is aspiration pneumonia

A

Pneumonia that develops after the inhalation of oropharyngeal secretions, gastric contents or colonized organisms

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33
Q

what does the location of aspiration pneumonia depend on

A

the position of the patient when the aspiration occurred

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34
Q

what is the MC site of infiltration in aspiration pneumonia

A

RLL

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35
Q

where would aspiration pneumonia present in a apatient who aspirated while lying in the left lateral decubitus position

A

left sided infiltrated

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36
Q

what is the MC site of aspiration pneumonia in alcoholics

A

RUL (aspiration in prone position)

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37
Q

what is the pathophysiology of aspiration pnemonia

A

Aspiration of gastric content or bacteria enter lung
Inflammatory response
Cavity extend to bronchus
Abscess become encapsulated
Tissues necrotize
Increase production of sputum
Purulent sputum

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38
Q

what is ventilator associated pneumonia

A

Pneumonia that develops 48 hours or longer after mechanical ventilation via ET tube or trach

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39
Q

how common is ventilator associated pneumonia

A

Complication of as many as 28% of ventilated patients and increases with length of ventilation; mortality is 27 - 76%

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40
Q

why is mortality rate so high in ventilator associated pneumonia

A

multidrug resistent gram negative bacteria is common

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41
Q

what are the MC pathogens in ventilator associated pneumonia.

A

Staph aureus (44%)
pseudomonas
acinetobactor

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42
Q

which pathogens are most associated with higher mortality rates in ventilator associated pneumonia

A

Pseudomonas and Acinetobacter

43
Q

what is the pathophysiology of VAP

A

Endotracheal tube placed
Impaired natural protection/clearance system
Contamination/colonization with bacteria
Aspiration of microorganisms into the lungs directly through the ET tube or around the cuff
Lungs contaminated with microorganisms

44
Q

ugh

A
45
Q

what is considered CAP

A

Develops in the outpatient setting or within 48 hours of admission to a hospital

46
Q

what is considered healthcare associated pneumonia (HCAP)

A

Pneumonia that develops within the first 48 hours of admission to the hospital, meaning it likely developed in an outpatient setting

47
Q

what is considered hospital acquired pneumonia

A

Pneumonia that develops at least 48 hours after admission to a hospital

48
Q

what is considered ventilator associated pneumonia

A

Pneumonia that develops more than 48 hours after endotracheal intubation or within 48 hours of extubation

49
Q

what are risk factors for the development of CAP

A

Advanced age
Alcoholism
Tobacco use
Comorbid medical conditions, especially asthma or COPD
Immunosuppression

50
Q

what are the MC bacterial causes of CAP

A

S pneumo - 2/3 of cases
Mycoplasma pneumonia
H flu
Klebsiella
S aureus

51
Q

what are the common viruses assocaited with CAP

A

influenza
RSV
Parainfluenza
adenovirus

52
Q

what is the sputum color for S pneumo

A

rust-colored sputum

53
Q

what is the sputum color for pseudomonas, haemophilus and other pneumococci

A

green

54
Q

what is the sputum color for klebsiella

A

red current-jelly sputum

55
Q

what is the sputum color for anaerobic infection

A

foul-smelling or bad-tasting sputum

56
Q

what are the MC symptoms of pneumonia. what are additional symptoms?

A

cough (productive)
fever - 80%
dyspnea - 45-70%
pleuritic CP - 30%
chills - 40-50%

HA
NVD

(theres more but these are the ones im doing)

57
Q

What does a PE show in pneumonia

A

+ egophony
louder whispering pectoriloquy
dullness to percussion
pleural friction rub
rhonchi/rales/wheezes
fever

again there are more but im using these

58
Q

what imaging is the gold standard for pneumonia

A

CXR with the presence of infiltrate

59
Q

what lab tests should be done on CAP treated outpatient

A

none

60
Q

what lab tests should be done on CAP treated inpatient

A

Sputum gram stain and culture
NP swab / PCR
Blood cultures
CBC
CMP
ABG (if hypoxemic)

61
Q

How would you test for Spneumo and legionella in pneumonia

A

urinary antigen tests

62
Q

what additional testing can be done in the assessment of pneumonia

A
  • Influenza testing if suspected
  • Urinary antigen tests for S pneumoniae and Legionella
  • Thoracentesis with pleural fluid analysis, gram stain and culture
  • Procalcitonin / CRP - Increased in bacterial infections and septic shock
  • Bronchoscopy
63
Q

what is used to determine whether a patient should be treated inpatient or outpatients

A

Pneumonia severity index (PSI)
CURB-65

64
Q

at what PSI and CURB-65 indicates in patient treatment

A

PSI - 3
CURB-65 - 2

65
Q

what is the CURB - 65 criteria

A

2 or more + = hospital

remember the number for uremia is >19! not 7.

66
Q

what other factors may indicate the need for hsopitalization

A
  • exacerbation of underlying disease
  • other medical/psychosocial needs
  • failure of outpatient therapy
67
Q

How do you treat CAP outpatient

A
  • antibiotics
  • expectorants
  • steroids (maybe)
  • rest
68
Q

how long should CAP outpatient stay on antibiotics?

A

at least 5-7 days and continued at least 48-72 hrs after pt is afebrile

69
Q

what antibiotics are used to empirically treat CAP in a previously healthy pt with no comorbidities that has NOT been on antibiotics in the past 3 months

A

beta-lactam (amoxicillin)
or
macrolide (azithromycin or clarithromycin)
or
doxycycline

70
Q

what is empiric treatment for outpatient CAP in a pt who has received ABX in the past 3 months or has a comorbidity

A

macrolide + beta lactam (rocephin)
or
levofloxacin or moxifloxacin (resp flouroquinolones)

71
Q

what is the management for a non-ICU inpatient CAP

A

Levofloxacin or moxifloxacin
OR
azithromycin + beta lactam (rocephin)

72
Q

How do you treat inpatient CAP that requires ICU placement

A
73
Q

how do you prevent pneumonia

A

pneumococcal vaccine

74
Q

oml plz no

A

yes. theres cards over this. just five it.

75
Q

what are risk factors for hospital acquired pneumonia

A
76
Q

what thre factors distinguish nosocomial pneumonia from CAP

A

(1) Different infectious causes
(2) higher incidence of drug resistant bacteria
(3) patients tend to be sicker = worse infections

77
Q

what are s/s of HAP

A

similar to CAP but get worse
hemoptysis
hypoxemia
rigors
respiratory distress

Not all of them

78
Q

what is the diagnostic evaluation for HAP

A
79
Q

how do you manage HAP

A
  • empiric ABX as soon as pnx is suspected
  • start ABX tailored to culture once its back
  • supportive care
80
Q

what antibiotics are used for HAP when there is low-risk for multi drug resistent pathogens

A

ONE of the following
levofloxacin
pip/taz
cefepime
imipenem
meropenem

81
Q

what is the antibiotic regimen for higher risk multi drug resistant pathogens DONT NEED ThIS JUST FLIP IT

A
  1. a. Cefepime or ceftazidime, plus
    b. Imipenem/Cilastatin (Primaxin) or meropenem, plus
    c. Piperacillin-Tazobactam (Zosyn)
  2. a. Levofloxacin or ciprofloxacin, plus
    b. Intravenous gentamicin, tobramycin, amikacin
  3. COVERS MRSA
    a. Intravenous vancomycin, or
    b. Linezolid (Zyvox)

she said “yall dont have to memorize this chart. i just want yall to know, its a big deal!!!” thank tha lort

82
Q

what are the key S/S for klebsiella pneumonia

A

red-currant jelly sputum
ground glass opacities on CT (100%)

83
Q

what is the treatment for pneumonia cuased by staph pneumo

A

clindamycin or inpatient vanc

84
Q

what is key s/s for mycoplasma pneumonia

A

bullous myringitis
nonproductive cough
CXR normal to patchy bilateral infiltrates
clear auscultation

85
Q

what is treatment for mycoplasma pneumonia

A

macrolides or flouroquinolones

86
Q

what is MCC of viral pnuemonia

A

influenza

87
Q

what is the treatment for viral pnuemonia

A

supportive. unless influenza, treat within 48 hours

88
Q

who is pneumocystis jiroveci MC in

A

HIV or immunocompromised pt

89
Q

what is the presentation of a patient with Pneumocystis Jiroveci Pneumonia

A

immunocomp patient with cough and fever

90
Q

what labs would you see in Pneumocystis Jiroveci Pneumonia

A

elevated LDH
elevated B D glucan level (indicated fungal infection)
CXR with diffuse bilateral interstitial infiltrates !!!! biggest thing
CT with HALLMARK ground glass opaciteis

91
Q

what is treatment for Pneumocystis Jiroveci Pneumonia

A

ART initiated if not already
+
Bactrim

92
Q

what are the MC pathogens in pneumonia with HIV

A

Pneumocystis jirovecii
Mycobacterium tuberculosis
Cryptococcus
Histoplasmosis

93
Q

what are the MC pathogens in pneumonia with Transplant patients

A

Fungi :
* Aspergillosis, Cryptococcus, Histoplasmosis
Nocardia
CMV

94
Q

what are the MC pathogens in pneumonia with neutropenic patients

A

Fungi (Aspergillosis)
Gram - bacteria

95
Q

what are the MC pathogens in pneumonia with smokers

A

s pneumo
H flu
M cat

96
Q

what is the MC pathogen in pneumonia with alcoholics

A

s pneumo
klebsiella
anaerobes

97
Q

what is the MC pathogen in pneumonia with IVDU

A

s aureus
pneumocystitis
anaerobes

98
Q

what is the MC pathogen in pneumonia with cystic fibrosis

A

pseudomonas
s aureus

99
Q

what is the MC pathogen in pneumonia with deer mouse exposure

A

hantavirus

100
Q

what is the MC pathogen in pneumonia with bat exposure

A

histoplasma

101
Q

the MC pathogen in pneumonia with rat exposure

A

yersinia pestis

102
Q

the MC pathogen in pneumonia with rabbit exposure

A

francisella tularensis

103
Q

the MC pathogen in pneumonia with bird exposure

A

C Psittaci
cryptococcus

104
Q

the MC pathogen in pneumonia with bioterrorism

A

bacillus anthracis
F tularensis
Y pestis

Clin Med B 2 (44 decks)

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