Pneumonia Flashcards
What are symptoms and special physical exam findings for pneumonia?
Symptoms: Fever, cough, sputum production, rigors, pleuritic chest pain, dyspnea, tachycardia
Special findings: Egophony, whispered pectoriloquy, increased tactile fremitus
What are the three categories for the most commonly identifiable causes of community acquired pneumonia? Give examples of each
Typical Bacteria: Strep. Pneumo, Haemophilus influenza, Moraxella catarrhalis, Staph aureus, Group A Strep, Aerobic gram negative bacteria
Atypical Bacteria: Legionella, Mycoplasma pneumoniae, Chlamydia pneumoniae, Chlamydia psittaci, coxiella burnetii
Respiratory Virus: Influenza A/B, SARSCOV2, rhinoviruses, parainfluenza virus, adenovirus, RSV, Human metapneumovirus, human bocaviruses
Which side is abnormal? What is this showing?
Side A is abnormal. It is showing pneumonia
Common clinical features of community acquired pneumonia?
1-10 day history of cough Fever Pleuritic chest pain Dyspnea Sputum production Gastrointestinal symptoms Mental status changes (especially elderly)
What is the pneumonia triad?
- Signs of infection (fever, chills, leukocytosis)
- Localization to the respiratory system (new or changed cough, shortness of breath, chest pain, adventitious lung sounds)
- New or changed infiltrate on CXR
What kind of pneumonia would you associate cold agglutinin titers with?
Viral pneumonia
Urine antigen tests are effective for diagnosing what types of pneumonia?
Legionella and Pneumococcal types
Treatment for pneumonia for patients <65 who are otherwise healthy and have not recently used antibiotics?
Amoxicillin plus a macrolide (azithromycin or clarithromycin) or doxycycline
Treatment for pneumonia for patients who have major comorbidities, smoke, and/or used antibiotics within past 3 months?
Augmentin plus macrolide or doxycycline
For patients who cannot use beta-lactam, can use fluoroquinolone or lefamulin
What are the factors for CURB-65?
Confusion
Urea
Respiratory rate >30 breaths per minute
Blood pressure (systolic <90 or diastolic <60 mmHg)
Age >65 years
What are the CURB-65 scores and what do they indicate?
0 or 1 = could be safely treated as an outpatient
2 = suggest closely supervised outpatient or inpatient observation
3, 4, 5 = inpatient treatment
When would you reevaluate a patient with pneumonia who you gave medications to?
After 48 hours if they have not improved by then
What are the types of fungal pneumonia and what are their causes?
Valley fever (coccidiodes) - due to fungal inhalation in western states. Look for this in patient with non remitting cough/bronchitis non-responsive to conventional treatments
Histoplasma capsulatum - bird or bat droppings
Cryptococcus - found in soil and can cause meningitis
Pulmonary aspergillosis - majority of cases occur in people with underlying illnesses such as TB or COPD, but otherwise healthy
What is the most common cause of atypical pneumonias?
Mycoplasma pneumoniae
What types of patients do atypical pneumonia normally affect? What symptoms are common?
Young, otherwise healthy adults (such as college students)
Symptoms: non-productive cough, myalgia, fatigue, low grade fever
What are the typical manifestations for the following organisms?
Formulate the most likely pathogens for these characteristics
