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Clin Med I - Pulmonary > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

What is the definition of pneumonia (PNA)?

A
  • infection of the pulmonary parenchyma
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2
Q

What are the types of PNA?

A
  • community acquired (CAP)
  • nosocomial/hospital acquired (HAP), healthcare associated (HCAP), ventilator associated (VAP)
  • anaerobic PNA and lung abscess
  • HIV related
  • TB
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3
Q

What is the pathophysiology of PNA?

A
  • increased microbial pathogens at alveolar level

- host’s inability to fight off said pathogens

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4
Q

How can microorganisms gain access to the lungs in PNA?

A
  • MC: aspiration from oropharynx
  • inhaled as contaminated droplets
  • hematogenous spread
  • extension from infected pleural or mediastinal space
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5
Q

What is the physiologic result of PNA?

A
  • alveolar capillary leak results in an infiltrate and rales
  • alveolar filling results in hypoxemia
  • leakage of erythrocytes can lead to hemoptysis
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6
Q

What are the etiologies of CAP-typical?

A
  • MC: S. pneumonia
  • H. influenza
  • S. aureus
  • Klebsiella pneumonia
  • P. aringinosa
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7
Q

What is CAP-atypical resistant to?

A
  • beta-lactams (PCN, amoxicillin)
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8
Q

How does CAP-atypical present?

A
  • zero to moderate sputum production
  • no lobar consolidations
  • only small increases in WBC
  • few physical signs; patient looks better than symptoms/CXR suggest
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9
Q

What type of PNA is restricted to small areas rather than a whole lobe?

A
  • CAP-atypical
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10
Q

What are the etiologies of CAP-atypical?

A
  • MC: Mycoplasma pneumonia
  • Chlamydia pneumonia
  • Legionella spp
  • Moraxella
  • virus: flu, adenovirus, RSV
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11
Q

What is the patient population likly to be infected by the MC etiology of CAP-atypical?

A
  • younger

Mycoplasma pneumonia

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12
Q

What is the patient population likely to be infected by C. pneumonia?

A
  • outpatient

Chlamydia pneumonia

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13
Q

What is the patient population likely to be infected by Legionella spp?

A
  • inpatients
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14
Q

What infection is associated with exposure to contaminated water droplets from cooling and ventilation systems?

A
  • CAP-atypical Legionella
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15
Q

What are CAP-typical S&S?

A
  • acute or subacute onset of cough w/ or w/o production
  • dyspnea
  • fever, chills, sweats
  • chest pain
  • hemoptysis
  • GI complaints
  • fatigue
  • HA
  • myalgias
  • kids present with belly pain
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16
Q

What are CAP-atypical S&S?

A
  • low grade fever
  • relatively mild pulm symptoms
  • myalgias & fatigue
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17
Q

T/F: CAP S&S in elderly patients are often discrete/obvious.

A
  • False, subtle/vague
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18
Q

What are the common PE findings of CAP?

A
  • fever
  • tachypnea
  • tachycardia
  • hypoxia
  • increased tactile fremitus
  • egophony
  • altered breath sounds
  • dullness to percussion
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19
Q

What testing would an outpatient CAP patient get?

A
  • CXR
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20
Q

What testing would an inpatient CAP patient get?

A
  • POC diagnostic tests
  • blood cultures
  • ABG
  • HIV testing
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21
Q

T/F: Treatment for CAP must with held until blood cultures return.

A
  • false
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22
Q

What can be found on CXR for CAP patients?

A
  • patchy airspace infiltrates
  • lobar consolidation
  • diffuse alveolar or interstitial infiltrates
  • pleural effusion
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23
Q

When is a CT scan indicated for CAP patients?

A
  • in severe, unresolving cases of PNA or complicated cases
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24
Q

What is the treatment for outpatient CAP?

A
  • healthy w/o abx in last 3 mo: macrolide

- comorbidities or abx w/in 3 mo: fluoroquinolones OR b-lactam + macrolide

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25
Q

How can CAP be prevented?

A
  • flu and pneumo vaccine
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26
Q

What is the outpatient f/u in CAP?

A
  • 2-3d w/o improvement or sooner if sx worsen

- fever resolves in 2-4d

27
Q

When is a repeat CXR taken for CAP?

A
  • smokers

- elderly

28
Q

What is the inpatient f/u in CAP?

A
  • repeat CXR in 4-6w
29
Q

What should be ? if relapse or recurrence of CAP, particularly in same segment of lung?

A
  • underlying neoplasm
30
Q

Define HAP

A
  • sx after hospitalization for 48 hours
31
Q

Define VAP

A
  • PNA that has developed more than 48 hours following endotracheal intubation and mechanical ventilation
32
Q

What are the common etiologies of HCAP/HAP/VAP?

A
  • S. pneumo
  • S. aureus
  • P. aeruginosa: MC in ICU
  • Klebsiella
  • E. coli
  • Enterobacter
  • VRE
33
Q

What are the S&S of HCAP/HAP?

A
  • similar to CAP but may be nonspecific

- 2+ clinical findings in the setting of a new or progressiv pulm opacity on CXR

34
Q

What test should be done for HCAP/HAP/VAP?

A
  • gram stain & sputum culture
  • blood cultures from 2 sites
  • ABG/pulse ox
  • CXR
35
Q

What is the tx of HCAP/HAP/VAP?

A
  • start empirical and modify with culture results
36
Q

What is the cause of anaerobic PNA & lung abscess?

A
  • aspiration into dependent lung zones
37
Q

What is a dependent lung zone?

A
  • based on body position at time of aspiration
38
Q

Describe the onset of anaerobic PNA & lung abscess?

A
  • insidious
39
Q

What is the clinical presentation of anaerobic PNA & lung abscess?

A
  • fever
  • wt loss
  • malaise
  • cough w/ FOUL-SMELLING PURULENT SPUTUM
  • poor dentition
40
Q

What diagnostic tests should be done for anaerobic PNA & lung abscess?

A
  • sputum culture

- CXR

41
Q

What is the treatment for anaerobic PNA & lung abscess?

A
  • abx

- drainage

42
Q

_______ disease is one of the most frequent complications of _______.

A
  • pulmonary

- HIV

43
Q

What are the 3 MC AIDS defining illnesses?

A
  • recurrent bacterial pneumonia
  • TB
  • Pneumocystis jiroveci
44
Q

How does HIV related pneumonia present?

A
  • nonspecific symptoms
  • fever, cough, SOB
  • unexplained wt loss
  • hypoxia
45
Q

What diagnostics should be done in HIV related PNA?

A
  • sputum samples
  • CXR
  • CT scan
46
Q

What will be seen on CXR in HIV related PNA?

A
  • ground glass appearance
47
Q

What is the tx for HIV related PNA?

A
  • Bactrim (TMP/SMX)

- steroids when hypoxic

48
Q

How long should tx be for HIV related PNA?

A
  • 21d
49
Q

What should follow HIV related PNA initial tx?

A
  • prophylaxis with Bactrim or dapsone in all pts with CD4<200 or hx of PCP
50
Q

What causes Tuberculosis?

A
  • Mycobacterium tuberculosis
51
Q

How is TB transmitted?

A
  • airborne droplets
52
Q

What are the risk factors for TB?

A
  • HIV +
  • foreign born
  • disadvantaged populations
53
Q

What are the stages of TB?

A
  • primary
  • primary progressive
  • latent
  • secondary/reactivation
54
Q

Define primary TB

A
  • clinically & radiographically silent

- granulomas form around organism to limit multiplication

55
Q

How does TB present?

A
  • slow, progressive, constitutional symptoms
  • chronic cough
  • patient appears ill & malnourished
56
Q

What testing should be done for TB?

A
  • culture

- CXR

57
Q

What will be seen on CXR of primary TB?

A
  • small, homogeneous infiltrates
  • paratracheal LN enlargement
  • Ghon & Ranke complexes
58
Q

What is a Ghon complex?

A
  • calcified primary focus
59
Q

Whar is a Ranke complex?

A
  • calcified primary focus & hilar LN
60
Q

What is used to determine if someone has even been infected with TB?

A
  • PPD/Mantoux test
61
Q

What must be seen on a + TB test?

A
  • transverse induration
62
Q

What are the 4 major drugs used as 1st line tx for TB?

A
  • Isoniazid
  • rifampin
  • pyrazinamide
  • ethambutol
63
Q

What is the tx regimen in HIV (-) TB(+)?

A
  • 2mo of all 4 drugs

- 4 mo of isoniazid & rifampin

64
Q

What is the tx regiment in HIV and TB (+)?

A
  • similar to HIV (-) but longer

- direct observation therapy to increase pt compliance

Clin Med I - Pulmonary (16 decks)

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