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Pulmonary > PNA / Influenza > Flashcards

PNA / Influenza Flashcards

1
Q

T/F: pneumonia is a disease of the lungs that is characterized by inflammation of the parenchyma

A

True

Definition: A disease of the lungs that is characterized by inflammation of the parenchyma of the lung (alveoli) and accumulation of abnormal alveolar filling with fluid of lung tissue

**Most commonly caused by infection

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2
Q

What is most commonly caused of infectious pneumonia?

A

Inhalation of infectious particles!

Other causes:

  • Inhalation of oropharngeal or gastric contents
  • Hematogenous spread
  • Infection from adjacent or contiguous structures
  • Direct inoculation
  • Reactivation
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3
Q

What two types of classic differentiations can pneumonia be categorized into? What kinds of bugs cause these?

A
  1. Typical:
    * S. pneumoniae, H. influenzae, S. aureus, group A streptococci, Moraxella catarrhalis, anaerobes, and aerobic gram-negative bacteria
  2. Atypical
    * Legionella spp, M. pneumoniae, C. pneumoniae, and C. psittaci (All the weird ones)
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4
Q

What types of things should you ask about when getting a clinical history?

A
  1. Age
  2. Presentation (Acute, Subacute, or Chronic)
  3. Personal Factors: Smoking History, Alcohol/Drug Abuse. HIV Risk Factors, Occupational History/Allergic History
  4. Underlying Cardiopulmonary Disease
  5. Co-Morbidities (Aspiration Risk, IV Drug Use, Pregnancy)
  6. Drugs (allergies, abuse)
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5
Q

What are some typical presentations of pneumonia? What could you find on physical exam?

A

Symptoms:

  • Fever, cough, SOB, pleuritic chest pain, sputum production, GI symptoms, mental status changes

Physical Exam

  • Fever – 80% (may be absent in elderly)
  • Tachypnea – 45 to 70%
  • Audible crackles
  • Evidence of consolidation – bronchial breath sounds, egophany, dullness to percussion
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6
Q

T/F: blood cultures are the most sensitive test to detect pneumonia

A

False

Blood Cultures – positive in <20% of patients

Sputum Cultures – positive in <10% of patients

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7
Q

What different patterns could exist on an Xray?

A
  • Alveolar
    • Lobar
    • Multifocal
  • Interstitial
  • Pleural Effusion
  • Nodular
  • Millary
  • Cavitation

DISCLAIMER: x-ray alone cannot differentiate or confirm diagnosis, but its a good place to start

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8
Q

What is the acronym for all the types of fluids that can fill alveoli?

A

Poor - Pus

Funny - Fluid

Boy - Blood

Can’t - Cells/Cancer

Piss - Protein

For - Fat (Lipid)

Crap - Calcium

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9
Q

What pneumonia pattern is shown?

A

Lobar consolidation

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10
Q

What pneumonia pattern is shown?

A

Multifocal pneumonia

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11
Q

What pneumonia pattern is shown?

A

Cavitation

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12
Q

What pneumonia pattern is shown?

A

Miliary pneumonia: from hematogenous spread or tuberculosis

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13
Q

What pneumonia pattern is shown?

A

Interstitial Pneumonia

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14
Q

What are some differentials for airway diseases?

A
  • Cryptogenic Organizing Pneumonia (COP)
  • Allergic Bronchopulmonary Aspergillosus (ABPA)
  • Bronchiectasis
  • Bronchopulmonary sequestration
  • Bronchocentric granulomatosis
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15
Q

What are some differential diagnosis for vascular disease?

A
  • Alveolar Hemorrhage Syndromes
  • Eosinophilic lung diseases
  • Pulmonary infarction
  • Fat emboli
  • Vasculitis
  • Collagen Vascular Diseases
  • Vascular tumors
  • Acute chest syndrome in sickle cell crisis
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16
Q

Can you think of some other differentials for parenchymal disease?

A
  • Hypersensitivity pneumonitis (occupational)
  • Drug reaction
  • Transfusion reaction
  • Alveolar proteinosis
  • Granulomatous lung diseases
  • Lipoid pneumonia
  • Pulmonary edema
  • Neoplasms
  • ARDS
  • Radiation pneumonitis
  • Idiopathic interstitial pneumonias
17
Q

What does CAP, HAP, VAP, and HCAP stand for?

A
  • Community Acquired Pneumonia (CAP)
  • Hospital (Nosocomial) Acquired Pneumonia (HAP)
  • Ventilator Associated Pneumonia (VAP)
  • Healthcare-Associated Pneumonia (HCAP)
18
Q

Strep pneumo is the most common cause of CAP. What are the in-patient and outpatient pharmacologic treatments?

A

Outpatient Treatment (5 days)

  • Macrolide or Doxycyline
  • Respiratory Fluoroquinolone

Inpatient Treatment (6 days)

  • Non - Intensive Care Unit (ICU)
    • Respiratory Fluoroquinolone
    • Beta-lactam + Macrolide
  • Intensive Care Unit (ICU)
    • Beta-lactam + Macrolide
    • Beta-lactam + Respiratory Fluoroquinolone
    • Consider Anti-MRSA Therapy (Vancomysin)
19
Q
  • 21yoF with 3 days of fevers, chills, cough, and purulent sputum presenting to clinic
  • VS: 38.5, 105, 120/80, 24, 92% on RA
  • Exam: appears mildly ill, tachycardic, tachypnic, crackles@LLL, dullness@LLL
  • WBC 12, nl BMP

What is your diagnosis? What’s the treatment?

A

Community acquired pneumonia (not hospital related)

Outpatient Treatment

  • Macrolide or Doxycyline
  • Respiratory Fluoroquinolone
20
Q

How do you differentiate between the healthcare related HAP / VAP/ HCAP?

A

Hospital (Nosocomial) Acquired Pneumonia (HAP)

  • PNA > 48 Hrs after Hospital Admission

Ventilator Associated Pneumonia (VAP)

  • PNA > 48 - 72 Hrs after Endotracheal Tube Intubation

Healthcare Associated Pneumonia (HCAP)

  • PNA in a non-hospitalized patient with extensive healthcare contact
    • IV Therapy, Wound Care, IV Chemotherapy within 30 days
    • Resident of Nursing Home or Long-Term Acute Care (LTAC)
    • Hospitalized in Acute Care Hospital > 2 Days with prior 90 Days
    • Attendance at Hospital or Hemodialysis Clinic with 30 Days
21
Q

Explain how HAP / VAP/ HCAP organisms infect the patient? Describe the organisms

A
  • Organism that colonize the oropharynx enter lower respiratory tract (LRT) by micro- or macro-aspiration
  • Infections are frequently polymicrobial in origin
  • Organisms tend to be Multi-drug Resistant (MDR)
    • Gram negative pathogens= “SPACE”
  • Serratia
  • Pseudomonas*
  • Acinetobacter
  • Citrobacter
  • Enterobacter* or Escherichia coli*
22
Q

Its important to treat HCAP / VAP / HAP within 48 -72 hours and can last 7- 8 days. What medications would you use?

A
  1. Antipseudomonal Agent:
  • Beta-Lactam + Beta-lactamase Inhibitor
  • 4th Generation Cephalosporin
  • Carbopenem
  1. Plus 1 of the Following:
  • Anti-pseudomonal Fluoroquinolone
  • Anti-Gram Negative Aminoglycoside
  1. Plus 1 Anti-MRSA Medication:
  • Linezolid
  • Vancomycin
23
Q

Recognize that there are a lot of different viruses that cause respiratory infection. Influenza outbreaks vary and can change properties- what causes this variation in the IFN virus?

A

IFN viruses undergo periodic changes in the antigenic characteristics of their envelope glycoproteins:

  • Hemagglutinin
  • Neurominidase

**Major changes in these glycoproteins are referred to as antigenic shifts

**Minor changes in these glycoproteins are referred to as antigenic drifts.

24
Q

Describe how the pathogenesis of how the influenza virus is initiated and spread

A
  1. IFN Hemagglutinin surface glycoprotein binds to sialic acid residues on respiratory epithelial cell surface glycoproteins - Infection Initiation.
  2. After viral replication, progeny virions are also bound to the host cell membrane.
  3. Neurominidase cleaves these links to liberate new virons and spread infection.
25
Q

Which of the following would be the most effective in diagnosis influenza?

  1. Rapid Antigen Tests
  2. Immunofluorescence
  3. Polymerase Chain Reaction (PCR)
  4. Viral Culture - 48 Hour Culture
  5. Serologic Testing
A

These can all be used but PCR is probably best

  1. Rapid Antigen Tests: not very sensitive
  2. Immunofluorescence
  3. Polymerase Chain Reaction (PCR)
  4. Viral Culture - 48 Hour Culture: too slow
  5. Serologic Testing: limited
26
Q

Influenza treatment gives greatest benefit if started within the first 24- 30 hours. What antiviral medication could you give?

A

Neurominidase Inhibitors - Active against IFN A and B

  • Oseltamivir and Zanamivir
27
Q
  • 40yoF, recent f/c/myalgia 1wk prior; improved; now worsening f/c, cough, bloody purulent sputum, dyspnea
  • VS: 38.6, 115, 90/60, 32, 80% on RA
  • Exam: in distress, crackles at RUL and LLL, decreased breath sounds at LLL

What is wrong? What is the treatment?

A

Post influenza secondary bacterial pneumonia (Idk it was his example)

Treat inpatient with vancomysin

28
Q
  • 56yoM c/ PMH OLT s/p recent admission for tacrolimus toxicity; 5d f/c, rigors, cough
  • VS: 38.8, 120, 80/40, 32, 84% on RA
  • Exam: acute distress, accessory muscle usage, tachycardic, tachypnic, diffuse crackles
  • WBC 1.5, Plts 20, Na 128, Creat 3.2, INR 5, Fibrinogen 50

What’s the diagnosis? What’s the treatment?

A

Hospital acquired pneumonia (recent admission, immunocompromised, xray)

  • ICU - broad spectrum antibiotics
    • Vanco + carbepenem

Pulmonary (36 decks)

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