Pneumonia

Question 1

What is pneumonia

Answer 1

1. Acute infectious inflammatory process of the parenchyma of the lungs
   *lower respiratory tract infection
   *disrupts ventilation / perfusion of the body
   *will be accumulation of fluid in the alveoli

Question 2

What is the parenchyma of the lungs

Answer 2

From the alveoli to the bronchioles
1. Functional component
2. Site of gas exchange

Question 3

What is ventilation

Answer 3

1. Exchange of CO2 and O2
   *occurs in the alveoli
2. Gas exhange occurs in the blood flow that is coming through the body

Question 4

What happens if O2 is being breathed in and cannot get through to the alveoli

Answer 4

1. Then CO2 will accumulate
2. No more O2 can accumulate in the blood and the Hgb will start letting of of the O2

Question 5

In healthy breathing what happens to the oxyhemoglobin dissociation curve

Answer 5

1. Creates a left shift in the OD curve
   *Hgb has an increased affinity for O2 and binds to O2 without difficulty (release O2 more reluctantly)

Question 6

In healthy breathing what is the parietal pressure of the O2

Answer 6

1. PP of O2 is high, Hgb grabs and releases carbon dioxide (CO2) at same time
   *it is a good thing

Question 7

Does pneumonia cause a right shift or a left shift

Answer 7

Right shift
1. There will be decreased oxygenation and retained CO2 because of the consolidated alveoli
*Hgb will let the O2 go to the tissues that need it bc it knows it can go back to the has exchanged to get more O2

Question 8

What do we not want the partial pressure of oxygen dropping to

Answer 8

1. 60
   *will cause a right shift
   *oxygen Hgb saturation will decrease and will affects organs

Question 9

Why does pneumonia cause a right shift

Answer 9

1. The body is expecting to get more O2 but its not bc
   *Hgb should be grabbing/holding on to any and all O2 but the consolidation is not allowing more O2 which leads to
   *SOB, dyspnea

Question 10

Is identification of the organism causing pneumonia usually present at the time of diagnosis?

Answer 10

No
*but that does not mean to delay treatment

Question 11

How to classify pneumonia

Answer 11

1. In terms of the epidemiologic factors/etiology of the most likely infecting organism
   *do not use “typical or Atypical pneumonia”

Question 12

What are the most likely pathogens of bacterial pneumonia

Answer 12

1. Streptococcus pneumonia (2/3 of the cases)
2. Haemophilus inflenuza
3. Staphylococcus aureus
4. Moraxella catarrhalis
5. Group A strep
6. Aerobic gram neg (klebsiella, E. Coli)

Question 13

What are the not expected bacteria causes of pneumonia

Answer 13

1. Mycoplasma pneumonia
2. Legionella species

Question 14

What are some respiratory viruses that can cause pneumonia

Answer 14

1. Influenza A and B viruses
2. SARS-CoV-2
3. Rhinoviruses
4. Parainfluenza viruses
5. Adenoviruses

Question 15

Organism s.pneumonia, H. Influenza are found in what clinical setting

Answer 15

S = follow URI, chronic cardiopulmonary disease
H = follow URI, chronic cardiopulmonary disease

Question 16

Organisms s. Aureus, klebisella are found in what clinical setting

Answer 16

S = residence in LTC, hospital associated, influenza epidemics, CF, infection drug users, bronchiectasis
K = alcohol abuse, diabetes, hospital associated

Question 17

Organism e. Coli, pseudomonas, and anaerobes are found in what clinal setting

Answer 17

E = hospital (rare), more community acquired
P = hospital, CF, bronchiectasis
A = aspiration, poor dental hygiene

Question 18

Organisms mycoplasma pneumoniae, Legionella species are found in what clinal setting

Answer 18

M = young adults, summer fall (walking pneumonia)
L = summer fall, exposure to contaminated water source (AC)

Question 19

Organisms chlamydophila and Moraxella catarrhalis are found in what clinal setting

Answer 19

C = prodromal symptoms over 2 weeks, sore throat and hoarseness
M = pre-existing lung disease, elderly, corticosteroids or immunosuppressive therapy

Question 20

Organisms pneumocystitis jirovecii and SARS Covs are found in what clinical setting

Answer 20

P = HIV AIDS
S = pandemic, more severe, elderly, multiple comorbdiites

Question 21

What are histoplasma capsulatum

Answer 21

Found in Mississippi and ohio river valleys, and bird and bat feces
1. Asymptomatic usually
2. Resolves on its own but if symptomatic give anti-fungals
3. Will look like pneumonia on chest X-rays
4. Have enlarged lymph nodes

Question 22

What is coccidioidomycosis

Answer 22

Found in soil and valley fever (Arizona)
1. Usually asymptomatic
2. Have constitutional symptoms
3. Watch in the elderly and immunocompromised
4. Give anti-fungal