Pneumonia Flashcards
Purpose of differential diagnosis
Eliminate potential diagnoses by systematically comparing and contrasting signs and symptoms
The three elements of problem statement
Who
When
Time Course
What
Define a problem representation
An evolving summary to organize the defining features of a patient presentation
Purpose of problem representation
To help form a focused differential diagnosis
What are key features?
Features present consistently and ideally exclusively in the condition
Differentiating features
Shared among other similar conditions but not present in many.
What is a diagnostic schema
Organizes cause of disease around a specific symptom
What is an illness script
A mental model with chunks of information
What is the illness script used for
To effectively collect and retrieve clinically information about a condition
Define pneumonia
An inflammatory disease the mostly affects the alveoli’s (usually infection)
Define community acquired Pneumonia
An acute infection of the parenchyma acquired outside of the hospital
Define nosocomial pneumonia
Acquired in the hospital up to or after 48 hours
What are the two types of Nosocomial pneumonia
Hospital acquired pneumonia
Ventilator associated pneumonia
Etiology of pneumonia
Two models
Targets lungs
Typical and Atypical microbes
Model “1” of pneumonia
Pathogens enter and multiples the alveoli’s
Macrophages produces cytokines
Polynucleic neutrophils enter the cell and cytokines enter systemic circulation
What is model “2” for pneumonia
Pathogens are expected
Infection caused by change in pH, nutrients and oxygen levels.
Name the three terms that place pneumonia by location
Bronchopneumonia (segmental)
Lobar pneumonia (results from severe ⬆️) one segment to the other.
Interstitial pneumonia (mycoplasma pneumonia or virus)
The four pathogens that can cause pneumonia
Bacteria
Viruses
Fungi
Parasites
What is the difference between typical bacteria and atypical bacteria
Typical:
High incidence
Detected through usual test
Readily cultured
Responds to beta lactam
What are typical bacteria
Streptococcus pneumoniae
Haemophilus influenza
Moraxella catarrhalis
Staphylococcus aureus
Group A streptococci
Gram negative typical bacteria
Klebsiella spp
Escherichia coli
What typical bacteria is associated with aspiration
Microaerophillic bacteria (anaerobic)
Which bacteria accounts for most bacterial pneumonia
Streptococcus pneumoniae
Is nonmotile streptococcus pneumoniae gram positive or negative
Gram positive
Which patients usually have streptococcus pneumoniae in their sputum
Chronic bronchitis
How is streptococcus pneumoniae transmitted
Aerosol (cough or sneeze)
What is streptococcus pneumoniae sensitive to
Penicillin and its derivatives
What does staphylococcus look like
Grape clusters
Is staphylococcus bacteria gram positive or negative
Positive
What kind of bacteria is MARSA
Staphylococcal
Which bacteria is occasionally necrotizing pneumonia
Staphylococcus
Which bacteria is the cause of pneumonia in older people and cultured from CF and COPD patients
Haemophilus influenzae
Who does Klebsiella pneumoniae cause severe pneumonia in
COPD
Diabetes
Alcoholism(theoretically)
Atypical pneumonia
Legionella spp
Where does legionella multiply
Standing water
How is legionella spread
Aerosolized
Three types of aspiration pneumonia
Chemical pneumonitis
Obstruction
Infection
Causes of aspiration pneumonia
Gastroesphageal reflux disease
Dysphasia
What is lung abscess made of
Air and fluid cavity
Liquified WBC remains, proteins, tissues debris
Encapsulated in fibrin, inflammatory cells, granulation tissue
What causes necrotizing PNA
Aspiration (polymicrobial)
Infection with necrotizing bacteria (staph aureus, Klebsiella pneumoniae, aeruginosa Pseudomonas)
Define prevalence
The presence of cases in a population (chronic diseases)
Define incidence
Associated with discrete events
The rate at which disease appear
Measured as annual appearance per population
What rank is the lower respiratory tract infection in cause of death worldwide
5th
What is the mortality rate for patients with (CAP) that are hospitalized
7%
Mortality from (CAP) over 65 yrs old while hospitalized
12%
What percent of patients hospitalized with (CAP) will return to the hospital
Nearly 9%
What is need to diagnose someone with (CAP)
Infiltrates in CXR
With clinical compatible syndrome (fever, dyspnea, cough, and sputum)
What do you do if a CXR is negative, but symptoms point highly to PNA
CT scan
History and physical development of PNA
Rapid onset
Chills
Rigors
Body aches
What type of chest pain is associated with pneumonia
Pleuritic rather than pressure
During inspiration (sometimes)
Not radiating
What happens to volumes with pneumonia
All volumes either stay normal or decrease
What happens to the FEV1/FVC ratio when
Normal or raised
What causes air bronchograms
Infiltrates/consolidation outlining large Aws
Incidence v. prevalence
Incidence: How often/rate at which you get the flu in an amount of time.
Prevalence: How many have it now within the population
How is incidence measured
How many cases over a set number of time with a set number of population
Organizations the guide diagnosis and management of Pneumonia
American thoracic society
Infectious disease society of America
Pathophysiology of Pneumonia
Inflammation
Leaky capillaries (serum, RBC)
Mucous accumulation (toward end to clear)
Explain deriving a validated system
Gather (population)
Derive (what information did you gather)
Validate (test on later patients)
What does CURB-65 stand for
Confusion
BUN
RR
BP
Equal to or greater than 65yr
CURB-65 low severity points and mortality rate
Points:
0-1
Risk of death
Equal to or less than 3%
CURB-65 moderate severity points and mortality rate
Points:
2
Risk of death:
9%
CURB-65 high severity points and mortality rate
Points:
3-5
Risk of Death:
15-40%
What is considered a low BUN
> 20mg/dL
Supportive care for pneumonia
O2
AW clearance
Lung expansion
Bronchospasm
Define sepsis
A dysregulated host immune response leads to organ damage
What are the two scoring systems for pneumonia
Pneumonia severity index
CURB-65
How many risk classes does the pneumonia index offer
Five
