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lymphoreticular pathology > medicine > Flashcards

medicine Flashcards

1
Q

Causes of pneumonia

A

bacteria
virus
fungi(rare)

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2
Q

definition of pneumonia

A

infection of the pulmonary parenchyma resulting in a respiratory and constitutional symptoms accompanied by clincal examinations findings and/or a new infiltrate on chest x-ray consistent with pneumonia.

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3
Q

Anatomical classification

A

lobar pneumonia
bronchopneumonia
interstitial pneumonia

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4
Q

clinical classification

A

CAP(Typical and atypical)
Nosocomial - HAP/VAP/HCACP
Aspiration pneumonia
Pneumonia in immunocompromised host

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5
Q

CAP

A

occurs without prior contact to the healthcare system in OPD or within 48hours of hospital admission.

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6
Q

HAP

A

occurs 48 hours after admission and no signs of pulmonary infection on admisson

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7
Q

VAP

A

develops 48 hours or more on mechanical ventilation

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8
Q

HCAP

A

Occurs in non-hospitalized patients who has had significant contact with the health care system

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9
Q

what causes the clinical syndrome of pneumonia

A

the body’s inflammatory response against it causes the clinical syndrome of pneumonia

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10
Q

rare causes of pneumonia pathogenesis

A

Pneumonia can also rarely result from a hematogenous or contiguous focus of infection (e.g., tricuspid valve endocarditis, hepatic abscess etc.

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11
Q

predisposing factors to pneumonia

A
  1. smoking
  2. alcholism
  3. recent upper respiratory tract infections
  4. pre-existing lung diseases(COPD, bronchiectasis, lung cancer)
  5. Factors that reduce the host defenses against pnemonia
  6. Aspiration of gastric or nasopharyngeal secretions
  7. Bacteria introduced into lower respiratory tract.
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12
Q

still on predisposing

which medications

A

PPI

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13
Q

factors that reduce host defenses against penumonia

A

Reduce immune defenses and comorbid conditions (e.g Malignancy, diabetes, corticosteroid treatment, heart failure, renal failure) • Reduce cough reflex (e.g. stroke, sedating medications) • Disordered mucociliary clearance (e.g. anaesthetic agents ) • Bulbar or vocal cord palsy

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14
Q

CAP related microorganisms

A 
S. pneumonia
S. aureus
K. pneumoniae
H. influenzae and M. catarrhalis
P. aeruginosa
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15
Q

features of K. pneumonia

A

seen in alcholics or smokers. greater tendency for abscess formation

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16
Q

features of H. influenza and M.catarrhalis

A

Pneumonia in elderly and patients with COPD

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17
Q

most common pathogen in atypical pneumonia

A

Mycoplasma pneumoniae

18
Q

features of mycoplasma pneumoniae

A

skin rashes
erythema
arthritis
aseptic meningitis

19
Q

note this

A

viral or fungal infections are uncommon immunoomptetent hosts

20
Q

HAP, VAP and HCAP related microorganisms

A

Pseudomonas aeruginosa,Klebsiella pneumoniae, Escherichia coli, Enterobacter spp, Serratia spp, Staphylococcus aureus

note they are usually drug resistant

21
Q

immunocompromised patient microorg

A

P. jiroveci
M. tuberculosis
Norcardia spp
Asperigullus spp

22
Q

features of sputum in pneumonia

A

Rust-coloured sputum: S tr e p t o c o c c u s p n e u m o n i a e
• Green sputum: P s e u d o m o n a s , H a e m o p h il u s , and Pneumococcal species
• Red currant-jelly sputum: K l e b si e ll a species • Foul-smelling sputum: Anaerobic infections

23
Q

what about cough in atypical pneumonia

A

prolonged dry cough

24
Q

presence of rigors

A

pneumococcal pneumonia

25
Q

Atypical pneumonia

A

In atypical pneumonia, constitutional symptoms such as headache, low-grade fever, malaise often predominate over respiratory symptoms

26
Q

Aspiration risks

A 
Alcoholism
altered mental status
dysphagia
GERD
seizure
27
Q

comorbid conditions

A 
asthma
COPD
HIV
DM
smoking
28
Q

Chest examination findings

A 
Reduced chest expansion,
Increased tactile fremitus 
• Dullness to percussion 
• Decreased intensity of breath sounds, Bronchial breath sounds,
 Coarse inspiratory crackles, 
Whispering pectoriloquy, 
bronchophony or egophony, 
Pleural friction rub 
• Increased vocal resonance
29
Q

gold standard investigation

A

chest xray

30
Q

two widely used clinical prediction rules to admission and triage decisions

A

PSI - Pneumonia severity index

CURB-65

31
Q

CURB65

A

Confusion – Altered mental status • Urea – BUN level greater than 7mmol/L • Respiratory rate – greater than 30 breaths per minute • BP – Systolic pressure < 90 mm Hg or diastolic pressure < 60 mm Hg • Age 65 years or more

32
Q

interpretation of score

A

Score of 0-1 – Outpatient treatment
• Score of 2 – Admission to medical ward
• Score of 3 or higher – Admission to intensive care unit (ICU)

33
Q

differentials for pneumonia if it’s not resolving

A

PTB
Sarcoidosis
malignancies
congestive heart failure

34
Q

pneumonia complications

A 
SLAP HER
Septicemia
lung abscess
ARDS
para pneumonic effusions
hypotension
empyema
respiratory failure or renal failure
35
Q

leukopenia sign of

A

sepsis

36
Q

only chest sign in atypical pneumonia

A

Mild crackles

37
Q

what stain for P.jiroveci

A

Silver stain

38
Q

Legionella pneumonia: how it presents

A

Bradycardia, fever, diarrhea

39
Q

txt - OPD

which med for previously healthy patient who hasnt taken antibiotics within the past 3 months

A

Macrolide(clari or azi)

40
Q

txt - OPD

pt with comorbid medical conditions

A

respiratory fluoroquinolone - moxifloxacin
OR
a macrolide plus beta- lactam - amoxicillin clavulanate, cefuroxime

41
Q

when should clinical response to antibiotuc therapy be evaluated

A

within 48 - 72 hours of initiation

lymphoreticular pathology (7 decks)

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