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NEUMONIA Flashcards

1
Q

QUE ES LA NEUMONIA?

A

ES UNA INFECCION AGUDA DEL PARENQUIMA + NUEVO INFILTRADO EN RX TORAX

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2
Q

PRUEBA UTIL PARA DX?

A

RX TORAX

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3
Q

NEUMONIA DE LA COMUNIDAD

A

<48 H

NUEVO INFILTRADO DE RX TORAX + INFECCION DE VIA RESPIRATORIA BAJA (TOS + EXPECTORACION + FIEBRE)

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4
Q

NEUMONIA ADQUIRIDA EN COMUNIDAD

A

<48 HORAS DEL INGRESO HOSPITALARIO

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5
Q

NEUMONIA INTRAHOSPITALARIA

A

> 48 HORAS DEL INGRESO HOSPITALARIO

>7D DEL ALTA HOSPITALARIA/ RESIDENCIAS*

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6
Q

DIVISION NEUMONIA EN LA COMUNIDAD

A

TIPICA / ATIPICA

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7
Q

NEUMONIA TIPICA

A 
TOS+ EXPECTORACION
BRUSCO
FEBRIL
SD CONSOLIDACION (SOPLO BRONQUICO O TUBARICO, CREPITOS FINOS, VV +)
DERRAME PLEURAL  50% DE LOS CASOS
EVOLUCION ES DE 24-48H
ETIOLOGIA: BACTERIAS (C/ PARED CELULAR)
TTO: BETALACTAMICOS
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8
Q

NEUMONIA TIPICA BACTERIAS

A

NEUMOCOCO
HAEMOPHILUS
MORAXELLA

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9
Q

TRANSMISION DE LAS NEUMONIAS TIPICAS BACTERIANAS ES POR …

A

MICROASPIRACION

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10
Q

ESTAFILOCOCO AUREOS ES POR

A

SIEMBRA HEMATOGENA

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11
Q

NEUMONIA ATIPICA ES MAS FREC

A

+ FREC. ADOLESCENTES Y JOVENES

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12
Q

NEUMONIA ATIPICA CARACTERISTICAS

A 
INSIDIOSO
TOS SECA, NO PRODUCTIVA
SUBFEBRIL
DISOCIACION CLINICO RADIOLOGICA
INFILTRADO INTERSTICIAL 
SINTOMAS RESPIRATORIOS ALTOS
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13
Q

NEUMONIA ATIPICA BACTERIAS ATIPICAS/ VIRUS

A 
BACTERIAS ATIPICAS:
MYCOPLASMA
LEGIONELLA
CHLAMYDIA
SON INTRACELULARES

MECANISMO: INHALACION

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14
Q

NEUMONIA ATIPICA BACTERIAS

A

BACTERIAS VIDA INTRACELULAR NO TIENEN PARED CELULAR

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15
Q

NEUMONIA TIPICA BACTERIAS DE VIDA..

A

VIDA EXTRACELULAR CON PARED CELULAR

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16
Q

TTO NEUMONIA ATIPIA

A 
MACROLIDOS (AZITRO - CLARITO- ERITRO), TETRACICLINAS (PROTEINAS) (DOXI- MINO)
MATERIAL GENETICO (FLUOROQUINOLONAS- LEVO - MOXI - CIPRO)
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17
Q

STREPTOCOCO NEUMONIAE

A

GRAM +
SENSIBLE A PENICILINA
RESISTENTE: VANCOMICINA
GERMEN TIPICO + FREC

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18
Q

HAEMOPHILUS INFLUENZA

A

GRAM -
DESNUTRIDOS CRONICOS, EPOC, BRONQUIECTASIAS Y OH
GERMEN TIPICO

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19
Q

MORAXELLA CATARRALIS

A

GRAM-

GERMEN TIPICO

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20
Q

KLEBSIELLA, PSEUDOMONA, SA

A

BACILO GRAM -

GERMEN TIPICO

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21
Q

GERMENES ATIPICOS

A

MYCOPLASMA PNEUMONIAE
CLAMYDIA PNEUMONIAE
LEGIONELLA

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22
Q

GERMENES TIPICOS

A 
STREPTOCOCO NEUMONIAE
HAEMOPHILUS INFLUENZA
MORAXELLA CATARRALIS
KLEBSIELLA
PSEUDOMONA
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23
Q

MYCOPLASMA PNEUMONIAE

A

ADOLESCENTES Y JOVENES
DOLOR DE GARGANTA,OTALGIA Y RASH SEVERO
ATIPICO

24
Q

CLAMYDIA PNEUMONIAE

A

ANCIANOS

25
Q

CLAMYDIA PSITACI

A

ASOCIADA A AVES

26
Q

LEGIONELLA

A

AIRE ACONDICIONADO

BRADICARDIA Y HEMATURIA

27
Q

LEGIONELLA SP

A

NAC

INTRAHOSPITALARIO

28
Q

AGENTES VIRALES

A 
INFLUENZA
PARAINFLUENZA
CORONAVIRUS
ADENOVIRUS
VIRUS SINCITIAL RESPIRATORIO
29
Q

INFLUENZA Y PARAINFLUENZA

A

NEUMONIA POR BROTES CADA AÑO

CUADRO ATIPICO

30
Q

ADENOVIRUS

A

JARDINES DE NIÑOS
DIARREA EN NIÑOS
ADULTOS - NEUMONIA

31
Q

VSR

A

CLIMAS FRIOS - NEUMONIA

32
Q

CLINICA DE LA NEUMONIA

A 
FIEBRE
ESCALOFRIOS
TOS SECA Y/o EXPECTORACION
LEUCOCITOCIS
CREPITANTES
DISMINUCION DEL MV
VV+ = CONSOLIDACION
33
Q

NEUMONIA DX

A

RX TORAX CON NUEVO INFILTRADO PULMONAR

34
Q

PRUEBAS DE ORINA

A

ANTIGENOS
NEUMOCOCO
MICOPLASMA
LEGIONELLA

35
Q

HOSPITALIZACION EN NEUMONIA

A 
SPO2 <92%
NO TIENE VIA ORAL
NO PUEDE CUMPLIR TTO
ENF. MENTAL O DETERIORO COGNITIVO
NO APOYO SOCIAL
CURB 65 Y PSI
36
Q

CURB 65 MANEJO

A

AMBULATORIO: 0-1
HOSPITALARIO : 2
GRAVE >3

37
Q

CURB 65 CRITERIOS

A 
C: CONFUSO
U: BUN >19 O UREA >42
R: FR>30
B: PAS <90 O PAD<60
65: > 65 AÑOS
38
Q

PACIENTE AMBULATORIO RIESGO DE RESISTENCIA

A 
USO DE ATB <90d
COOMORBILIDADES : DM, ERC, ICC, CIRROSIS
INMUNOSUPRESION: NM, VIH, CORTICOIDES 
BLACTAMICOS+ MACROLIDOS (AZITROMICINA O CLARITROMICINA)
ALTERNATIVA DE MACRO = DOXI
39
Q

NO HAY FACTORES DE RIESGO DE RESISTENCIA EN PACIENTE AMBULATORIO

A

MACROLIDO: AZITROMICIA, CLARITROMICINA

ALT A MACROLIDOS: DOXI

40
Q

TRATAMIENTO NAC AMBULATORIO

A

SIN FX RX: MACROLIDO (AZITRO O CLARITRO)

CON FX RX: BETALACTAMICO (CEFTRIAXONA) + MACROLICO (AZITRO)

41
Q

TTO NAC HOSPITALARIO

A

BLACTAMICO+ MACROLIDO INTRAVENOSO

CEFEPIME + MACROLIDO

42
Q

CRITERIOS PARA UCI

A

ESTADO MENTAL ALTERADO
CLINICO: HIPOTENSION, HIPOTERMICO, FR>30
LABORATORIOS: PAFI<250,>20 DE BUN , LEUCOPENIA, PLAQUETOPENIA
RX: INFILTRADOS MULTILOBARES (BRONCONEUMONIA)

43
Q

COMPLICACIONES DE LA NEUMONIA

A 
ATELECTASIAS
DERRAME PLEURAL PARANEUMONICO (EMPIEMA*)
ABSCESO (+ ASPIRATIVAS)
CAVITACIONES (S.A, ANAEROBIOS)
BRONQUIECTASIAS: SECUELA TARDIA
44
Q

NEUMONIA ASPIRATIVA

A

OH/ ALT DE LA CONCIENCIA / TEC/ ICTUS
TOS ABUNDANTE/ MAL OLOR/FETIDO
LOCALIZACION DERECHA *
ANAEROBIOS

45
Q

COMPLICACION + FREC NEUMONIA ASPIRATIVA

A

ABSCESO PULMONAR / EMPIEMA

46
Q

NEUMONIA ASPIRATIVA TTO COMUNIDAD

A

AMPICILINA SULBACTAM

AMOXI CLAVULANICO

47
Q

NEUMONIA ASPIRATIVA TTO HOSPITALARIO

A

PIPETAZO
CLINDA + BETALACTAMICOS
6-8 SEMANAS

48
Q

NEUMONIA INTRAHOSPITALARIA

A

> 48H DEL INGRESO
NUEVO INFILTRADO EN RX + SIGNO DE INFECCION
ETIOLOGIA: SA VS BACILO GRAM -

49
Q

NIH ETIOLOGIA

A

SAMR

BG- (KLEBSSIELA/ PROTEUS/ E. COLI)

50
Q

SIGNOS DE INFECCION

A

FIEBRE
TOS
LEUCOCITOSIS
PCR ELEVADO

51
Q

TTO NIH

A 
1ER NIVEL: CEFTRIAXONA
2 Y 3ER NIVEL: CEFEPIME +/- VANCO
PSEUDOMONA:CEFTACIDIMA +/- CIPROFLOXACINO
ALERGICO A BETALACTAMICO: AZTREONAM
FALLA TTO: CARBAPENEMS
52
Q

NEUMONIA ASOC A VENTILACION

A

48H DESPUES DE INTUBACION

NUEVO INFILTRADO + SIGNO DE INFECCION

53
Q

ETIOLOGIA NEUMONIA ASOC A VENTILACION

A

PSEUDOMONA AURIGINOSA
ACENETOBACTER BAUMANII
SAMR

54
Q

TTO NEUMONIA ASOC A VENTILACION

A

CARBAPENEM ANTIPSEUDOMONA = IMIPENEM O MEROPENEM+ VANCOMICINA O AMIKACINA (ACINETOBACTER)

55
Q

NAV MECANISMO FISIOPATOLOGICO

A

COLONIZACION
FORMACION DE BIOPELICULA
MIGRACION DE LAS BACTERIAS
SECRECIONES

56
Q

F RIESGO DE NN Y NAV

A 
EDAD
EPOC
NN
TIEMPO DE HOSPITALIZACION
GRAVEDAD
INMUNODEPRESION
SONDA NASOGASTRICA
QX TORAX
QX ABDOMINAL ALTA
ATB PREVIA
TRASTORNO DEL SENSORIO
REINTUBACION (NAV)
PCR (NAV)
SEDACION  (NAV)
NUTRICION ENTERAL  (NAV)

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