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3401 PDQ > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

Definition

A

Infection of the lung(s) that usually occurs in defined lobar patterns, but might also be diffuse

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2
Q

Common causes
neonates (0-6wks)

A

Group B Strep
E. coli

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3
Q

Common Causes
Children (6wks-18yrs)

A

RSV (<1 yr)
Parainfluenza (2-5yrs)
Mycoplasma
Chlamydia pneumoniae
Streptococcus pneumoniae

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4
Q

Common Causes
Adults 18-40

A

Mycoplasma
C. pneumo
S. Pneumo

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5
Q

Common Causes
Adults 40-65

A

Mycoplasma
S. pneumo
Haemophilus influenzae
Anaerobes
Viruses

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6
Q

Common Causes
Elderly > 65

A

S. pneumo
viruses
Anaerobes
H. flu
Gram(+) rods

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7
Q

Recurrent Pneumonia

A

chronic obstruction i.e. foreign object aspiration, classically right middle or lower lobe pneumonia
Bronchogenic carcinoma
Lymphoma
Immumodeficiency
Wegener’s granulomatosis; carriers of unusual organisms; Nocardia, Coxiella, Aspergillus (leads to fungal balls), Pseudomonas (CF patients ,difficult to treat definitively)

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8
Q

Characteristics and History with Atypical Presentation

A

Mycoplasma
Legionella
Chlamydia

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9
Q

Characteristics and History with Hospital Acquired Pneumonia

A

Staph
Gram(+) rods
Anaerobes
Gram(-) rods

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10
Q

Characteristics and History with Immunocompromised hosts

A

Staph
Gram + rods
Fungi
Viruses

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11
Q

Characteristics and History with HIV Patients

A

Pneumocystis carinii (jiroveci) - however, S. pneumoniae remains the most common
causative bacterial pathogen overall in HIV+ patients
CMV

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12
Q

Characteristics and History with Aspiration Pneumonia

A

Anaerobes
Usually occurs in intubated patients or those with speech/ swallow pathology

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13
Q

Characteristics and History with Air Conditioning in closed quarters or aerosolized water

A

Legionella

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14
Q

Characteristics and History with Alcoholics/IV drug users

A

Klebsiella
Current jelly sputum
S. pneumo
Staph. aureus

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15
Q

Characteristics and History with Bird Droppings

A

Chlamydia Psittaci or Histoplasma spp

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16
Q

Characteristics and History with Recent Immigrant

A

Tuberculosis

17
Q

Characteristics and History with CF patients

A

Pseudomonas ; breath smells like grapes
S. Aureus

18
Q

Characteristics and History with COPD

A

H.Flu
Moraxella Catarrhalis
S.pneumo

19
Q

Characteristics and History with known TB

A

Aspergillus (in pulmonary cavitation)

20
Q

Characteristics and History with Postviral

A

S. aureus - may cause necrotizing pneumonia
H. flu

21
Q

Symptoms

A

Classically presents with sudden-onset
Fever
Productive cough
Purulent yellow-green
Hemoptysis
Dyspnea
Night sweats
Pleuritic chest pain

Atypical presentations are gradual in onset and flu-like
Dry cough
Headaches
Myalgias
Sore throat

22
Q

Physical Exam

A

Auscultation of the lungs reveals
Decreased or bronchial breath sounds
Crackles/rales
Wheezing
A-to-e egophany

Percussion reveals
Dullness over affected lobe(s)
Tactile fremitus

Elderly and patients with chronic lung disease, diabetes, or immunocompromised status may minimal exam findings

23
Q

Evaluation
CXR

A

May show lung consolidation in affected lobe(s)
Establishes diagnosis in combination with Gram stain or culture

24
Q

Evaluation
CBC

A

Elevated WBC with pathogen-dependent shift

25
Q

Sputum Gram stain and cultures

A

Identify pathogen
Directs medical treatment

26
Q

Evaluation
ABGs

A

Characterizes respiratory status and compromise
Hypoxia may cause increased respiratory rate, resulting in respiratory alkalosis

27
Q

Evaluation
Specific Pathogens

A

Legionella
Urine Legionella antigen test
Sputum staining with direct fluorescent antibody
Culture

Chlamydia pneumoniae
Serologic testing
Culture
PCR

Mycoplasma
Diagnosis is usually made clinically
Serum cold agglutinins
Serum Mycoplasma antigen

28
Q

Differential

A

Common cold, influenza, pulmonary effusion, tuberculosis, acute respiratory distress

29
Q

Treatment Non-Operative

A

Outpatient oral antibiotics in uncomplicated cases; Medications directed at sensitivity of known pathogens and/or additional broad coverage

In-hospital IV antibiotics recommended in patients
>65 yrs and/or with multilobar pneumonia
May be necessary in patients with significant comorbidities including
Alcoholics
COPD
Malnutrition
Diabetes
Immunocompromised
Altered mental status
Required in unstable patients or those in respiratory failure

30
Q

Treatment
Operative

A

Interventional treatments are rare in cases of pneumonia
Usually indicated to treat secondary pathology
Recurrent pleural effusions
Fungal ball removal
Intubation

31
Q

Prognosis

A

Highly depends on patient comorbities and type of pneumonia
Usually resolve without complications in otherwise healthy patients

32
Q

Prevention

A

Safe medical practice (i.e. handwashing) can prevent spread of nosocomial disease
Carefully monitor intubated patients and those with speech/swallow pathology
Incentive spirometry and deep breathing post-operatively can prevent atelectasis anresultant pneumonia

33
Q

Complications

A

If left untreated, can lead to respiratory failure, sepsis, shock, and/or death

3401 PDQ (18 decks)

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