Lower Respiratory Infections - Part 2- Exam 1 Flashcards
What is pneumonia defined as ? Leads to consolidation of the affected part and a filling of the alveolar air spaces with _______, ______ and _____. What are the 2 MC causes of pneumonia?
inflammation of the lung parenchyma
exudate, inflammatory cells and fibrin
bacteria and viruses
What is the pathophys behind pneumonia?
What are common strands of hospital acquired pneumonia? **What is the major one Olivia mentioned in lecture?
Pseudomonas aeruginosa
**Staphylococcus aureus (including MRSA)
Klebsiella pneumoniae
Serratia marcescens
Acinetobacter baumannii
**________ bacteria is known to cause painful cavitations and abscesses on the lungs. Is it usually hospital acquired or community acquired?
Staph aureus
hospital acquired
Is it more common to aspirate into the right or left lung? Why?
more common on the right
because it sits up higher aka its the first lung “tube” that the foreign substance comes across
How are pneumonias classified? 3 things
anatomic location (lobar, lobular/bronchial, intersititial)
mechanism of acquisition (ventilator- associated, aspiration)
setting of acquisition (Community acquired CAP or nosocomial)
watch this youtube video when you go back and study
https://www.youtube.com/watch?v=b8_83UDfbbU&t=7s
______ is the MC cause of bacterial pneumonia
streptococcus
**What lobe is S. pneumoniae classically found in?
Right Lower Lobe
**Klebsiella has a tendency to occur in the _____
upper lobes
**Legionella has a predilection for the ______
lower lung fields
What test can you order that will tell you if your pt has a strep or legionella infection?
urine
What are some common pathogens that cause patchy appearance, with peribronchial thickening and poorly defined air-space opacities on CXR. What does it usually lead to? **What is the major connection between ____ organism and PE finding of _____
S aureus, Strep species, H influenzae, Klebsiella, and P aeruginosa
leads to abscesses, cavitation, necrosis and pleural effusions
**Staph aureus leads to cavitation
What can interstitial pneumonia be classified as? What does it result from?
focal or diffuse
Results from edema and inflammatory cellular infiltrate into the interstitial tissue of the lung and fibrosis
What is the cause of interstitial pneumonia? What is the classic presentation? **What is the pattern?
Causes: typically unknown / “Idiopathic”
Viral-like prodrome with nonproductive cough
Bilateral, symmetric, diffuse pattern with “ground glass” appearance
If “ground glass” appearance is present on CXR need to think _____ as a cause
think viral cause
later interstitial pneumonia has a similar presentation to ______ so must rule this out
ARDS
Younger male in his 20’s, what is the typical classification of pneumonia? What is the MC organism?
lobar
95% pneumococcal
What kind of pneuomonia?
Central bronchi involved
Asymmetrical
Peribronchial cuffing
Extremes of age
Secondary, in sick
S aureus, Strep sp, P aeruginosa, Klebsiella, H flu
Patchy, basal, bilateral around small bronchi
Not limited by anatomic boundaries
bronchopneumonia
Ground glass appearance
Bilateral, symmetrical
What kind of pneumonia?
interstitial pneumonia
What is the difference between lobar and lobular pneumonia?
what is the location of the aspiration penumonia dependent on? What is the MC site of infiltration?
the position of the patient when the aspiration occurred
RLL because the right mainstem bronchus is more vertical
_____ most common aspiration pneumonia site with alcoholics who aspirate while in a prone position
Right Upper Lobe
What is the pathophys behind aspiration pneumonia?
When does ventilator associated pneumonia tend to show up? What is an important factor to remember? What is the abx of choice? What 2 bacteria strains are associated with higher mortality rates in VAP?
48 hours or longer after mechanical ventilation via ET tube or trach
Multidrug resistant gram negative bacteria
Cipro, Cefepime, Ceftazidime
Higher mortality rates with Pseudomonas and Acinetobacter
What is the pathophys behind VAP?
**What are the risk factors for developing MRSA VAP?
treatment in a unit in which more than 10-20% of Staph Aureus isolates are methicillin resistant
tx in a unit which the prevalence of MRSA is not known
Define community- acquired pneumonia.
Develops in the outpatient setting or within 48 hours of admission to a hospital
What would be considered a healthcare associated pneumonia?
assisted living facilty or rehab, aka hospital adjacent but not the hospital
What are the 5 risk factors for CAP?
Advanced age
Alcoholism
Tobacco use
Comorbid medical conditions, especially asthma or COPD
Immunosuppression
_____ are the MC causative pathogens for CAP. Which one is the cause of 2/3rd of cases?
**S pneumo - 2/3 of cases
Mycoplasma pneumonia
Haemophilus influenzae
Klebsiella
Staph aureus
**20 year old male pt with CAP, what is the most likely organism?
mycoplasma pneumonia
What 4 viruses are associated with CAP?
Influenza, RSV, Parainfluenza, and Adenovirus
Pt’s sputum is rust-colored, thinking ______ pathogen
S pneumoniae
Pt’s sputum is green, thinking ______ pathogen
Pseudomonas, Haemophilus and other pneumococci
Pt’s sputum is red currant-jelly like, thinking ______ pathogen
Klebsiella