Pneumonia Flashcards
MC cause pneumonia
streptococcus pneumoniae
Typical sx pneumonia
fever
productive cough
pleuritic chest pain
dyspnea
rigors (severe chills with violent shaking)
atypical sx pneumonia
low grade fever
dry nonproductive cough
extra pulmonary sx (myalgias, malaise, pharyngitis, N/V/D)
PE pneumonia - typical
tachypnea
tachycardia
signs of consolidation - bronchial breath sounds, dullness to percussion, increased tactile fremitus, ego phony, inspiratory rales (crackles)
PE atypical pneumonia
pulmonary exam often normal
may have crackles (rales)
MC cause of community acquired pneumonia
streptococcus pneumonia
gram stain streptococcus pneumonia
gram positive diplococci
what color is sputum for streptococcus pneumonia
blood-tinged (rusty) sputum
klebsiella pneumonia sputum
current jelly - thick, mucoid and blood-tinged
gram stain for haemophilus influenza
gram negative rod
gram stain klebsiella pneumoniae
gram negative rod
staphylococcus aureus and pneumonia is associated w
a superimposed infection after a viral infection
hospital acquired pneumonia (MRSA)
gram stain staphylococcus aureus
gram positive cocci in clusters
most common cause of atypical (walking) pneumonia
mycoplasma pneumonia
community acquired pneumonia
outside hospital setting
< 48 hours in hospital setting
hospital acquired pneumonia
> 48 hours in hospital setting
Admission for pneumonia
CURB65 - admission if at least 2
Confusion
Uremia (> 30 mg/dL)
Respiratory rate >/= 30
BP low SBP < 90 or DBP < 60
Age > 65
pneumococcal vaccines for >/= 65
PCV15
PCV20
if PCV15 is given, what should you do ONE YEAR LATER
PPSV23
what pneumococcal vaccine is used in childhood
PCV13
tx community acquired pneumonia in otherwise healthy
Amoxicillin or Macrolide (Azithromycin) or Doxycycline
Tx community acquired pneumonia in pts w comorbidities
Amoxicillin clavulanate or a cephalosporin plus a macrolide
or mono therapy fluoroquinolone (Levofloxacin, Moxifloxacin, Gemifloxacin)
community acquired tx inpatient nonsevere
Beta lactam plus a macrolide
or fluoroquinolone
cause of tuberculosis
Mycobacterium tuberculosis (acid-fast bacteria)
major pathology of tuberculosis
granulomatous inflammation with caseation (central necrosis) - caseating granulomas
patients with what type of TB are not infectious
latent
sx tuberculosis
prolonged fever (often w diurnal pattern)
cough (often mild and nonproductive and then becomes productive and foul-smelling)
pleuritic chest pain
dyspnea
hemoptysis
fever
chills
night sweats
can affect any organ
PE for tuberculosis
often normal - may have clubbing
if chest image is suggestive of TB, what should you do
3 sputum samples collected and sent for acid fast bacilli staining and culture
one sample tested with nucleic acid amplification (NAAT)
how is latent TB diagnosed
tuberculin skin test
cxr for TB
hilar adenopathy MC
pleural effusions
pulmonary infiltrates
tx latent TB
9 month therapy of isoniazid and pyridoxine
or 4 mos Rifampin if intolerant to Isoniazid
if positive tuberculin skin test, what is done to confirm
interferon gamma release assay
what do you do if tuberculin skin test positive and interferon gamma release assay are both positive
screen for active TB (CXR and sputum tests)
tx active TB
RIPE
Rifampin
Isoniazid
Pyridoxine
Ethambutol
