Pneumonia Flashcards
2 types of pneumonia
Lobar and interstitial
Does lobar or interstitial pneumonia have better oxygenation?
lobar bc you can cough it out
A pneumonia that is acquired outside the hospital or within 48hrs admit
Community Acquired Pneumonia (CAP)
Top 3 CAP bacteria
S. pneumoniae (15%) (G+)
H. influenza (3-10%) (G-)
Mycoplasma Pneumonia (atypical)
CAP Viral
CAP Fungal Causes
- Coccidiomycosis “cactusidiomycosis”
- Histoplasmosis “ohio river valley”
- Blastomycosis “blasting leaves”
in HIV -> Pneumocystis jirovecii
ppl <5 yo usually get (viruses/bac)
ppl >/=5yo usually get (viruses/bac)
Bacterial infx = ____ cough. Viral infx = ____ cough
bacterial = WET Cough
Viral = DRY Cough
Signs of CAP
Fever, tachypnea, tachychardia, crackles, egophony E->A changes, increased tactile fremitus,
infants: nasal flaring, accessory muscle use, cyanosis
Pneumonia symp
cough, fever, chills, malaise, dyspnea, chest pain
pt presents to ER with acute dyspnea. Order what to diff pneumonia vs heart failure
Serum procalcitonin levels
procalcitonin is produced in response to bac infections and tissue injury
Criteria to determine if pt needs to be admitted to the hosp
CURB-65
does this pt need to go home, be admitted, or ICU?
confused, BUN 21mg/dL, RR 35bpm, hypotensive, 70yo man
ICU
pts must maintain an O2 of > ____% (norm) OR > _____% (COPD)
> 92% Norm
88% COPD
CAP Steroid Rx
inpt and outpt
- inpt -> methylprednisolone
- outpt -> prednisone
Because cultures have low yield, when empirically treating pneumonia, we must cover for all most common types…
G+: Strep pneumoniae
G-: H. Influenza
Atypicals: Mycoplasma, Chlamydia
Strep Pneumo Trmnts
Amoxil only for kids
Macrolides (Z-pak) for adults
what & CXR findings?
Pneumonia + high fever, rusty purulent sputum
what, CXR findings, & trmnt?
Pneumonia + COPD Smoker
what, CXR findings, trmnt
Pneumonia + WATER exposure, diarrhea, wet cough
what, CXR findings, & trmnt?
College teen living in dorm has pneumonia over WEEKS with dry cough
What & trmnt
Child with LOW FEVER, persistent DRY COUGH, H/A, ST, and hoarseness. PE: wheezing and ronchi
What, etiology, & trmnt
Alcoholic with Pneumoniae symptoms
what, etiology,
Chronic WET COUGH, NIGHT SWEATS, WT LOSS, HEMOPTYSIS, pleuritic CP, foul smelling sputum
CXR findings and trmnt
Chronic WET COUGH, NIGHT SWEATS, WT LOSS, HEMOPTYSIS, pleuritic CP, foul smelling sputum
HIV pt has fever, cough, dyspnea, and clear lungs. Wdyd?
order a serum test for CD4 count. always be suss for pneumonia in immunocompromised
Pneumocystis Jirovecii symptoms
HIV pts get this. They are immunocomp, so their only symptom may be fever
Pneumocystitis Jirovecii trmnt and prevention
IV Bactrim (sulfamethoxazole/trimethoprim)
Prevention: BACTRIM FOR LIFE
Pneumocystitis Jirovecii CXR fingings
diffuse interstitial infiltrates
what & orders?
Pneumonia + from Arizona, red bumps and circles on skin
trmnt
Coccidiomycosis trmnt
what & trmnt
Pneumonia + birds/bats
Itraconazole unless mod-severe-> amphotericin B for a lil bit and then -> itraconazole
Coccidiomycosis presentation
May be Asymptomatic aside from slight cold symptoms and skin lesions
Pneumonia with hemoptysis, wt loss, night sweats, and chunky/slimy jelly sputum. What, etiology, and trmnt?
Lung abscess from aspiration pneumonia
Gram (-) Klebsiella
Rx Augmentin (Amoxil/clavulanate for G- ) or Clindamycin (for anaerobes)
Lung abscess most common anaerobic pathogens?
Bacteroides, peptostrep, fusobacterium, prevotella
Lung abscess most common aerobic pathogens?
Strep and staph (G+)
Klebsiella (G-)
Pt who is an AC mechanic presents with flu like symptoms including high fever, myalgia, cough, and diarrhea had a (+) urine antigen test. What is it?
Legionella (legionnaire’s disease)
Special test for Legionella?
Urinary legionella antigen
Aspiration pneumonia
at risk population, microbes, Rx, complication?
Inhaling your own vomit
at risk -> Alcoholic, stroke, anything effecting swallowing
Microbes -> Anaerobes, G + (strep), G - (H. flu, Klebsiella), bacteroides
Rx -> Augmentin or clindamycin
Complication -> Lung abscess
