Pneumonia Flashcards
What is the pathophys of pneumonia
inflammation of the alveoli and bronchioles
What is pneumonia caused by
infection
aspiration
*from bacteria, viruses, fungi
What is the #1most deadly hospital acquired infection
Pneumonia
What is the #1 cause of bacterial pneumonia
strep pneumonia
What is the second most common bacterial pneumonia
H. influenza B
How do typical community acquired pneumonia present
caused by bacteria
alveolar inflammation / exudate
Productive cough
High WBC
What will be seen on CXR with typical community acquired pneumonia
Lobar consolidation
How do atypical community acquired pneumonia present
organisms invade / destroy lung interstitium
Lack of alveolar exudate
dry cough
normal WBC
How does atypical community acquired pneumonia present on CXR
Patchy infiltrate
What are example of atypical community acquired pneumonia
mycoplasma
chlamydia
viral
Where is the antibody created for typical community acquired pneumonia
in the spleen
What symptoms will a patient have with typical community acquired pneumonia
Chest pain
absent lung sounds
productive cough
crackles
What are some criteria for hospitalization of typical community acquired pneumonia
RR>30BPM
Mechanical ventilation
septic shock
O2 sat<90%
What are some typical diagnostics for community acquired pneumonia
Crackles on exam
absent lung sounds
increased whispered pectoriloquy
Egophony
bronchophony
tactile remits
lobar consolidation
How do you treat outpatient adult community acquired pneumonia
Azythromycin (zpack)
Doxy
Levofloxacin
How do you treat pediatric outpatient community acquired infection
amoxicillin
How do you treat inpatient adults with community acquired infection
Ceftriaxone + Azithromycin
OR
Levofloxacin
How do you treat inpatient pediatric community acquired infection
ampicillin (If fully immunized)
Ceftriaxone otherwise
Which population is atypical community acquired pneumonia more common in
Children
What is bronchopneumonia known as on xray
Patchy infiltrate
How does mycoplasma effect the lungs
Damage the epithelium allowing bacteria to overgrow
Where can chlamydia pneumonia come from
college
Koalas
Non-bullous myringitis
What type of pneumonia is legionnaires disease
gram negative bronchopneumonia
How is legionnaires disease transmitted
**NOT from person to person
Pathogen grows in water of vent systems
What are some symptoms of legionnaires pneumonia
fever
chills
malaise
dry cough
diarrhea
How do you test for legionnaires disease
urine antigen or sputum fluorescent antibody test
How do you treat legionnaires pneumonia
Levofloxacin
*any delay in treatment increases risk of mortality
When is pneumonia considered hospital acquired
Pneumonia present after 48 hours after admission
What pathogen is most prevalent in hospital acquired pneumonia (In ICU)
Pseudamonas
*Highest mortality rate
Which patients are at greatest risk for hospital acquired pneumonia
Intubation
tracheotomy
immunocompromised
chronic lung disease
What treatment is used for aspiration pneumonia
clindamycin
or
Metronidazole + ceftriaxone
Which drugs are commonly used in nosocomial pneumonia
Cefepime
Zosyn
Meopenem
Levofloxacin
What was one of the first diseases seen in the AIDS pandemic
PJP
How do HIV infected people acquire PJP
fungus found in soil
What is the presentation of PJP
Foamy exudates and cysts in lungs
Cough, fever, weight loss
CD4 <200
What is the leading cause of death for people with HIV world wide
pulmonary TB
How do you treat PJP pneumonia
Predisone first
then
TMP-SMX
Why are sickle cell disease patients prone to s. pneumoniae
from poor spleen function from infarct
What are the phases of fungal pneumonia
1: mild flu-like illness
2: Creation of cavitary lesions?similar to TB
3:Hepatosplenomegaly, pancytopenia, septic shock/death
Where does histoplasmosis come from
bird and bat droppings
How is histoplasmosis confirmed
urine testing
What is the treatment of choice for histoplasmosis
Itraconazole
What is another name for coccidiomycosis
valley fever (southwest U.S)
How is coccidiomycosis diagnosed
skin test
How do you treat coccidiomycosis
Generally self limiting
can treat with 3-6 months diflucan
How long can symptoms last with coccidiomycosis
months
Where does cryptococcus come from
bird droppings
What can cryptococcus cause
meningitis in HIV patients with CD4<50
How do you detect cryptococcus
Serum antigen testing
How do you treat cryptococcus
Fluconazole x10wks
How does mortality change with cryptococcus in those without HIV compared to those with
Mortality increases without HIV
How can you prevent pneumonia
PCV20
flu shot (over 6months of age)
