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Gen Med Unit 6 > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

what is the leading cause of death in children < 5 yo?

A

pneumonia

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2
Q

What are the risk factors for pneumonia?

A
  1. Smoking
  2. Premature birth
  3. Chronic medical conditions
    A. DM
    B. Heart disease
    C. COPD
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3
Q

define Community Acquired Pneumonia

A

Pneumonia in patients with limited or no contact with medical/institutional setting

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4
Q

Define Atypical pneumonia

A

Pneumonia caused by certain “atypical” bacteria, including Mycoplasma, Chlamydia and Legionella

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5
Q

Define nosocomial pneumonia

A

Acquired after at least 48 hours of admission to hospital and is not incubating at the time of admission

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6
Q

Define HIV-related Pneumonia

A

Pneumonia in HIV patient

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7
Q

What are common bacterial pathogens for pneumonia?

A
  1. Streptococcus pneumoniae
  2. Hemophilus influenzae
  3. Moraxella catarrhalis
  4. Klebsiella pneumoniae
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8
Q

which pneumonia pathogen is Most common and

Most commonly fatal?

A

Streptococcus pneumoniae

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9
Q

What are the common viral pneumonia pathogens?

A 
1. Influenza
A.Most common in adults
2. Adenovirus
A. Mild and self-limiting
3. Parainfluenza virus
A.Children < 2 years
4. Respiratory Synctial Virus (RSV)
A. Most common in infants < 1 yr
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10
Q

What are the symptoms of pneumonia?

A
  1. Fever, rigors
  2. Cough
  3. Dyspnea
  4. Pleuritic chest pain due to inflammed parenchyma or visceral pleura on inspiration
  5. Hemoptysis
  6. Fatigue
  7. Myalgias
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11
Q

What are the signs of pneumonia?

A
  1. Appears ill
  2. Tachycardia
  3. Tachypnea
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12
Q

What are the physical findings of pneumonia?

A
  1. Inspiratory Rales
  2. Dullness to percussion
  3. Bronchial breath sounds
  4. ↑ Tactile Fremitus
  5. Egophony
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13
Q

What are the typical sxs of Mycoplasma pneumoniae pneumonia?

A

HA, malaise, low grade fever, dry cough, cold agglutinins titer

“walking pneumonia”

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14
Q

Who contracts Pneumocystis jirovecii

pneumonia?

A

Immunocompromised patients (HIV)

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15
Q

What are the typical sxs of Legionella pneumophila

pneumonia?

A

Pneumonia, pleurisy, HIGH fevers (temp > 102 F)

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16
Q

What are the typical sxs of Chlamydia pneumoniae

pneumonia?

A

Pneumonia, ST, hoarseness

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17
Q

What are the typical sxs of Streptococcus pneumoniae

pneumonia?

A

Rigors, rust colored sputum

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18
Q

What are the typical sxs of Klebsiella pneumoniae

pneumonia?

A

Pneumonia, current jelly sputum, alcoholics

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19
Q

What is the most common pneumonia pathogen for alcoholics?

A

Klebsiella pneumoniae

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20
Q

What is the most common pneumonia pathogen for COPD pts?

A

Hemophilus influenzae

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21
Q

What is the most common pneumonia pathogen for cystic fibrosis pts?

A

Pseudomonas species

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22
Q

What is the most common pneumonia pathogen for college students and young adults?

A

Mycoplasma pneumoniae (most common), Chlamydia pneumonia

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23
Q

What is the most common pneumonia pathogen for immunocompromised pts and smokers?

A

Legionella pneumophila

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24
Q

What is the most common pneumonia pathogen for post splenectomy pts?

A

Strep pneumoniae (Most common), Hemophilus influenzae

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25
Q

What are the Dx studies for pneumonia?

A
  1. PA & Lateral CXR
  2. Pulse Oximetry
  3. ABG’s if needed
  4. Sputum gram stain & culture
  5. Blood cultures x 2
  6. CBC w/diff
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26
Q

What can Streptococus pneumoniae cause?

A

Most common cause of CAP, bacterial meningitis, bacteremia, & OM
Cause of sinusitis, septic arthritis, osteomyelitis, peritonitis, & endocarditis
Causes bacterial co-infection in influenza pt
High morbidity & mortality

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27
Q

What is the epidemiology of pneumonia?

A 
1. High-risk age groups 
A. Children < 5 yrs, ↑ ≤ 2 yrs 
B. Adults > 55-65 yrs
2. Immunocompromised
A. HIV, malignancy, DM
3. Decreased pulmonary clearance functions 
A. Asthma, chronic bronchitis, COPD
4. Presents late fall to early spring
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28
Q

What is the treatment schedule for pneumonia?

A
  1. Empiric based on epidemiologic data & PE
  2. Antibiotics should be started promptly after obtaining appropriate cultures
  3. Treat x 2 weeks
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29
Q

What are the outpt options for treating pneumonia?

A
  1. Macrolide (drug of choice in most ppl)
    A. Erythromycin, azithromycin(Zithromax), clarithromycin (Biaxin)
    OR
  2. Doxycycline
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30
Q

What pneumonia pathogens do macrolides treat?

A
  1. Atypicals
    A. Mycoplasma, Legionella, Chlamydia
  2. Hemophilus influenzae
  3. Strep pneumoniae
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31
Q

What pneumonia pathogens does doxycycline treat?

A
  1. Chlamydia pneumoniae
  2. Strep pneumoniae
  3. Gram (-)
    Hemophilus influenzae, Klebsiella pneumoniae, Pseudomonas aeruginosa, Bordetella pertussis, Moraxella catarrhalis
32
Q

What are pneumonia pts under 5 treated with?

A

amoxicillin (90 mg/kg/day in 2 doses or 45 mg/kg/day in 3 doses

33
Q

What are pneumonia pts over 5 treated with?

A

amoxicillin + macrolide

34
Q

What treatment is indicated if children are incompletely immunized against pneumonia?

A

3rd gen. cephalosporin IV (ceftriaxone or cefotaxime)

35
Q

When is vancomycin indicated in young pneumonia pts?

A

Vancomycin should be added for any concerns of infection caused by S aureus in childhood patients

36
Q

What treatment is indicated in pneumonia pts with comorbidities or antibiotics within 3 months?

A
  1. Beta-Lactam Abx
    A. Amoxicillin, Augmentin, 2nd - 3rd Gen. Cephalosporin (2nd cefuroxime/Ceftin; 3rd cefdinir/Omnicef, ceftriaxone/Rocephin)
    +
    Macrolide

OR
Fluoroquinolone
A. Levoquin, Avalox

37
Q

What pneumonia pathogen do fluoroquinolones target?

A

Strep pneumoniae

38
Q

What pneumonia pathogen does beta-lactam abx target?

A

H. influenza

39
Q

What additional treatments are possible for pneumonia pts?

A
  1. Analgesic/antipyretic
  2. Fluids
  3. Expectorant
  4. Prednisone
  5. Bronchodilator
    A. Beta 2 agonists via nebulizer or MDI
40
Q

What is the inpt treatment for pneumonia pts on the medical floor?

A
  1. 3rd gen Cephalosporin (ceftriaxone/Rocephin)
    +
  2. Macrolide (azithromycin/Zithromax or clarithromycin/Biaxin)
41
Q

What is the inpt treatment for pneumonia pts in the ICU?

A
  1. 3rd gen Cephalosporin (ceftriaxone/Rocephin)
    +
  2. Macrolide or Fluoroquinolone (levofloxacin/Levaquin or moxifloxacin/Avelox)
42
Q

What are the CDC immunization recommendations for pneumonia pts over 65?

A

All adults ≥ 65 years receive both (min. 8 weeks apart)
A. PCV13 (13-valent pneumococcal conjugate vaccine) Prevnar 13
and
B. PPSV23 (23-valent pneumococcal polysaccharide vaccine) Pneumovax 23

43
Q

What are pneumonia prevention tactics?

A
  1. Smoking cessation
  2. Immunizations
    A. Influenza vaccination
    B. Prevnar 13 + Pneumovax 23
    -Immunocompromised adults ≥ 19 yr
    -Asplenia, renal failure, nephrotic syndrome, cochlear implants, lung dz, CVD, DM, etc.

C. Infants

  • HIB (2,4,6,12-15 mo)
  • Prevnar (2,4,6,12-15 mo)
  • DTaP (2,4,6, 15-18 mo, 4-5 yr)
44
Q

What agents cause atypical pneumonia?

A
  1. Mycoplasma pneumonia
  2. Legionella pneumophila
  3. Chlamydia (Chlamydophila) pneumonia
45
Q

What is the most common cause of atypical pneumonia?

A

Mycoplasma pneumonia

46
Q

What are the characteristics of typical bacteria?

A

Typical bacteria have cell wall, cell membrane and ability to stain

47
Q

What are some characteristics of atypical pneumonia?

A

Some lack cell wall (Mycoplasma)

Some lack ability to stain with gram stain

48
Q

What symptoms are asst. with Mycoplasma pneumoniae

pneumonia?

A

Non productive cough, low grade fever, HA, malaise, slow progression

49
Q

What symptoms are asst. with Legionella pneumophila

pneumonia?

A
  1. High fevers( >102.2), watery diarrhea, dry cough, multilobar, M>F
  2. Often asst with contaminated water supply
50
Q

What symptoms are asst. with Chlamydia (Chlamydophila) pneumoniae

pneumonia?

A
  1. 80% are asymptomatic

2. URI sx’s, “flu-like illness”

51
Q

What are the physical findings in atypical pneumonia?

A
  1. Fever
  2. Dullness to percussion
  3. Egophony
  4. Tachycardia
  5. Tachypnea
52
Q

What are the CBC w/ diff results for atypical pneumonia?

A
  1. Normal WBC to mild leukocytosis

2. Exception: leukopenia with influenza pneumonia

53
Q

What are the CXR results for atypical pneumonia?

A

Infiltrate

54
Q

What are the less common dx studies for pneumonia?

A 
1. Urine Antigen Assay 
A. Legionella pneumophila
2. Polymerase Chain Reaction (PCR)
A. Legionella pneumophila
B. Mycoplasma pneumoniae 
-PCR highly sensitive & specific 
C. Chlamydia pneumoniae
55
Q

What drug is used to treat mycoplasma and legionella in atypical penumonia?

A

Macrolide

56
Q

What drug is used to treat Chlamydia in atypical pneumonia?

A

Doxycycline

57
Q

What drug is used to treat severe cases or comorbidities in atypical pneumonia?

A

Fluoroquinolone

58
Q

How long must a pt be in the hospital for pneumonia to be considered nosocomial?

A

Occurs > 48 hours after hospitalization or admission to health care facility AND excludes any infection at time of admission

59
Q

Who is at high risk for nosocomial pneumonia?

A

ICU pt

Ventilator pt

60
Q

what are the mortality rates for nosocomial pneumonia?

A

Mortality rates 20% - 50%

61
Q

What pt factors can increase risk for nosocomial pneumonia?

A
  1. Malnutrition
  2. Advanced age
  3. Altered level of consciousness
  4. Swallowing disorders
  5. Chronic lung disease
62
Q

What pathogen is asst. with ground glass opacities in pneumonia?

A

Mycoplasma

63
Q

What is the most common pathogen in nosocomial pneumonia? What other pathogens?

A 
1. Pseudomonas aeruginosa
A. MOST common in ICU HAP
2. Staph aureus (MSSA and MRSA)
3. Strep pneumonia (often drug-resistant)
4. Enterobacter 
5. Klebsiella pneumoniae
6. E. coli
64
Q

What are the sxs for nosocomial pnuemonia?

A

Fever
Cough
Purulent sputum
Leukocytosis

65
Q

How are the bacteria colonized in nosocomial pneumonia?

A

Instrumentation in upper airway leads to bacterial colonization:

66
Q

What are the dx studies in nosocomial pneumonia?

A
  1. Sputum C&S
  2. Blood C&S
  3. ABG’s
    A. Helps determine severity of illness
    B. Determines need for supplemental oxygen
  4. CXR
    A. Progression of infiltrates during abx treatment is poor prognostic sign
67
Q

What is the treatment timeline for nosocomial pneumonia?

A 
Abx should be started ASAP due to high mortality rate
Abx selection determined by:
Severity of illness
Risk factors
Length of hospitalization
68
Q

What pathogens are targeted in nosocomial pneumonia if pt has been there for more than 5 days?

A

Pseudomonas aeruginosa

Enterobacter sp.

69
Q

What treatment is used for pathogens that are a low risk for multi-drug resistant (MDR) ? Where is this?

A
  1. Nursing Home
    A. Fluoroquinolone po
    OR
    B. Amoxicillin clavulanate po + macrolide po
  2. Hospital
    A. Fluoroquinolone IV
    OR
    B. Macrolide po + 3rd gen cephalosporin IV
70
Q

What treatment is used for pathogens that are a high risk for multi-drug resistant (MDR) ? What is high risk?

A
  1. Age > 60 years
  2. Hospitalization in the previous year
  3. Previous abx therapy
    A. Imipenem IV (antipseudomonal coverage)
    +
    B. Levofloxacin IV (add’l antipseudomonal agent)
    +
    C. Vancomycin IV (MRSA coverage)
71
Q

When is vancomycin used in pneumonia?

A

When MRSA is suspected

72
Q

What pathogen is asst. with HIV related pneumonia?

A

Pneumocystis jirovecii
Formerly called Pneumocystis carinii (PCP)
Yeast-like fungal infection of lungs
MOST common opportunistic infection in patients with HIV/AIDS
Can also occur in cancer patients, organ transplant pts, pts w/ chronic lung disease
High mortality rate if untreated
Other organisms include bacteria, other fungi, Mycobacterium and Legionella

73
Q

What is the clinical presentation for HIV related pneumonia?

A 
Fever
Dry Cough
Dyspnea 
DOE
Fatigue
74
Q

What are the dx results in hiv related pneumonia?

A
  1. CXR
    A. Perihilar infiltrates
    B. Diffuse granular opacities
  2. CD4 counts are low
    A. All HIV-infected pts w/ CD4 < 350 cells/μl get TMP-SMX prophylaxis
  3. Induced sputum or bronchoalveolar lavage
  4. PCR (Polymerase Chain Reaction)
75
Q

What is the treatment of choice for hiv related pneumonia?

A
  1. Antibiotic of choice
    A. Trimethoprim/sulfamethazole (TMP-SMX) x
    3 weeks minimum
  2. Untreated- fatal disease

Gen Med Unit 6 (14 decks)

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