Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Clin Med IIB Pulmonology > Lower Respiratory Infections: Part 2 - Pneumonia > Flashcards

Lower Respiratory Infections: Part 2 - Pneumonia Flashcards

(54 cards)

Start Studying
1
Q

What is the MC cause of death?

A

Pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the MC reason for hospitalization? Second MC?

A

MC = CHF
Second MC = Pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is pneumonia?

A

Inflammation of

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How is the pathophys of pneumonia different in bacteria vs viruses?

A

Pneumonia has a lung consolidation, otherwise same pathophys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the MC of pneumonia?

A

Strep pneomo (like 95%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Why do you classify pneumonia and how do you base this?

A

Allows you to know what likely caused it.

Should know the anatomic location\
The mechanism of acquisition
Setting of acquisition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the MC anatomic location of pneumonia?

A

Lobar pneumonia
Specifically Right lower lobe S. pneumoniae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When do you see Klebsiella?

A

Upper lobe of alcoholic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When do you see Legionella?

A

Lower lung fields in someone exposed to shower

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What do you see in CXR of lobular/bronchopneumonia?

A

Radiographically identified by its patchy appearance, with peribronchial thickening and poorly defined air-space opacities

The pathogens known to cause this pattern of pneumonia are particularly destructive
Frequently lead to abscesses, cavitation, necrosis and pleural effusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What typically causes lobular/bronchopneumonia

A

S aureus and other bacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is interstitial pneumonia?

A

Non-productive cough
Focal diffusive
Bilateral, symetrical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What differentiates lobar, bronchopneumonia, and interstitial pneumonia?

A

Lobar
Involves single lobe
Unilateral
Middle age - 20-50
Primarily a healthy adult
95% pneumococcal
Limited by anatomic boundaries

Bronchopneumonia
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

Interstitial Pneumonia
Involves interstitial space
Ground glass appearance
Bilateral, symmetrical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What patients are likely to have aspiration pneumonia?

A

Stroke victims
Swallowing issues
Alcoholics
GERD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the MC location of aspiration pneumonia?

A

RLL but RUL can be seen in alcoholics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the pathophys of AP?

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is ventilator associated pneumonia and the concern?

A

ET or tracheal tube

Multidrug resistance is very common

Need to do empiric therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the MCC organism of ventilator associated pneumonia?

A

Staph auerus (MC)
pseudomonas
ascinetobacter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Pathophys 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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is community acquired pneumonia and when does it occur? What if this is not the case?

A

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

All other pneumonia is concerned nosocomial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the Nosocomial Acquired Pneumonias and how do they differ?

A

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

Hospital Acquired Pneumonia (HAP)
Pneumonia that develops at least 48 hours after admission to a hospital

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What setting is CAP typically treated?

23
Q

What is the MCC of CAP?

Study These Flashcards
A

Strep pneumo

other bacteria are mycoplasma, H flu, klebsiella, staph aureus

Viruses: RSV, Parainfluenza, adenovirus

24
Q

What are the sputum for for S pneumo, pseudomonas, klebsiella, aneorbic?

Study These Flashcards
A

S pneumoniae- rust-colored sputum
Pseudomonas,Haemophilus and other pneumococci - green sputum
Klebsiella- red currant-jelly sputum
Anaerobic infections - foul-smelling or bad-tasting sputum

25
What are the symptoms of pneumonia?
Fever (80% of cases) Dyspnea (45 - 70% cases) Pleuritic chest pain (30% cases) Sweats Chills (40 - 50% cases) Rigors (15% cases) Pleurisy Hemoptysis Fatigue Myalgias Anorexia Headache N/V/D Mental status changes
26
What is the temperature of some1 w/ pneumonia?
Hyperthermia (typically >38°C) or hypothermia (<35°C)
27
What is the PE of PNA?
Febrile Hyperthermia (typically >38°C) or hypothermia (<35°C) Tachypnea (>24 bpm) Use of accessory respiratory muscles Tachycardia or bradycardia Central cyanosis Altered mental status Tracheal deviation Lymphadenopathy Adventitious breath sounds, such as rales/crackles, rhonchi, or wheezes Decreased intensity of breath sounds Egophony Whispering pectoriloquy (over consolidation) Dullness to percussion Pleural friction rub
28
What is the dx diagnosis of PNA?
CXR Can look at CT if it is inconclusive
29
How do you find the causitive organism for PNA?
CULTURE
30
If hospitalized (not outpatient) what labs do you order for PNA?
Outpatient management of patients with CAP does not require any additional testing Hospitalized patients benefit from the following: Sputum gram stain and culture NP swab / PCR Blood cultures CBC CMP ABG (if hypoxemic) 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
31
What is good about the Urinary antigen tests for S pneumoniae and Legionella
High specificity and
32
What is the #1 lab abnormality in PNA?
Abnormal WBC with left shift
33
How to determine inpatient or outpatient treatment?
PSI (more accurate) or CURB-65 (easier)
34
What is the CURB 65 criteria?
Clinical prediction of mortality in CAP and infection of any site C - Confusion of new onset U - Blood Urea nitrogen greater than 7 mmol/l (>19 mg/dL) R - Respiratory rate of >=30 breaths per minute B - Blood Pressure systolic <90 mmHG or diastolic <60 mmHG Age ≥ 65 years Death risk of 30 days increases as the score increases 2 or more = hospitalized
35
A 45 year-old male presents to the ER today with a one week history of cough, shortness of breath, fever and extreme fatigue. His past medical history includes a history of coronary artery disease in which he has had a stent placed, and hypertension that is somewhat controlled. Patient is alert and oriented to person, place and time. Vital signs include BP- 100/80, P - 100, T - 38 C, Resp - 30 Physical Exam reveals diminished breath sounds over the right lower lobe and dullness over this area as well Chest X-Ray reveals some consolidation in the right lower lobe Labs are normal with the exception of a blood sugar of 200 What is his CURB-65?
1 = outpatient (RR = 30)
36
How long should ABX be given for CAP?
At least 5-7 days AND additional 48 hours after pt becomes afebrile
37
In addition to ABX for pneumonia, what should you do?
Rest, hydration Analgesics (acetaminophen or ibuprofen) Expectorants Steroids (still being studied but showing positive effects)
38
If no comrobidities, no ABX w/in the last three months, what do you use? (avg patient)
Amoxicillin Azithromax (often have resistance though) Doxy
39
If a patient has been treated with ABX the last 3 months or comorbitdiy?
Azithromax plus amoxicillin, augmentin, ceftriaxone, OR fluroquinolone
40
check over other management of pneumo
ok
41
What 3 factors differ nosocomial from CAP?
(1) Different infectious causes (2) Different antibiotic susceptibility patterns, specifically, a higher incidence of drug resistance (3) Different underlying health status of patients putting them at risk for more severe infections
42
What is the MCC of nosocomial PNA? How does this differ from CAP?
S pneumo, but we are worried about drug-resistant
43
What are the s/s of nosocomial PNA?
Acute progression of signs and symptoms similar to CAP Cough, predominantly with purulent sputum, is most common Fever Rigors Myalgias Signs of hypoxemia Hemoptysis Dyspnea and/or respiratory distress Physical exam findings same as for CAP, only may appear more acutely ill
44
For nosocomial PNA, what do you start on?
empiric abx
45
What is kelbsiella seen in?
Typically alcoholics
46
What are the s/s of klebsiella?
Same as other pneumonia, but red jelly sputum
47
What do you see in CT of klebsiella
Ground glass opacities (100%) Alveolar consolidation Intralobular reticular opacities Pleural effusions
48
What is the typical patient with staph pneumonia?
COPD patients w/ MRSA
49
How does is staph pneumo differ in CXR?
Typically in multiple areas and not one
50
What are the features of mycoplasma?
Asymptomatic Mild cough Clear CXR Macrolides Fluroquinolnes
51
Can viral pneumonia lead to bacterial?
Yes, if there is mucous production, bacteria can grow here
52
When do you see pneumocystis Jiroeci
HIV patients Elevated LDH (lactate-dehydrogenase)
53
What is the halmark of CXR and CT of pneumocystis jiroveci?
CXR - diffuse, bilateral interstitial infiltrates CT scan - Hallmark ground glass opacities
54
How do you treat pneumocystis jiroveci?
ART initiated if not already Trimethoprim-sulfamethoxazole (Bactrim) Prophylaxis CD4 counts below 200 cells/mcL

Clin Med IIB Pulmonology (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions