Pneumonia

Question 1

Pneumonia

Answer 1

etiology:
epidemiology:

• elderly (over 65 yo) or very young
• underlying health problems
  
  • COPD
  • DM
  • alcoholism
  • CHF
  • renal failure
  • sickle cell anemia
• impaired immune system
  
  • AIDS
  • cancer
  • organ transplants

O:

• PE
  
  • general: toxic vs nontoxic
  • fever (Temp-pulse deficit?)
    
    • mycoplasma, chlamydophilia, legionella
  • tachycardia (elevated HR)
  • tachypnea (elevated RR)
  • oxygenation level
  • breath sounds
    
    • rhonchi, bronchial breath sounds, dullness, egophony (sign of consolidation)

A:

• chest XR
• CBC w/ differential
  
  • leukocytosis, L shift, bandemia
• chemistries
  
  • hyponatermia, serum creatinine
• sputum gram stain and culture
  
  • not everyone produces sputum for you to examine
  • significant oral contamination
• bronchoscopy
  
  • pneumo in immunosuppressed host
  • in suspected TB in absence of sputum
  • pneumo ass w/ neoplasm or FB
  • suspected pneumocystis
  • pt not responding to abx
• blood cx
• urine antigen tests
  
  • Strep pneumo urine Ag, Legionella urine Ag

Question 2

Pneumococcal Pneumonia

Answer 2

etiology:
* Strep pneumo

S:

• shaking chills
• pleuritic CP
• “rusty-colored” sputum

O:

P:

• pneumo vaccine
  
  • conjugate = in kids, now starting to use in adults
  • polysaccharide =

Question 3

Atypical Pneumonias

Question 4

Legionella Pneumonia

Answer 4

S/O:

• high fevers (>40C)
• Feiget’s sign
• GI sxs ie D
  *

Question 5

Mycoplasma Pneumonia

Answer 5

S:

• sore throat
• nonproductive cough
• HA

O:

• bullous myringitis (bullae on TM)
• XR often appear worse than clinical findings