Pneumonia Flashcards
Cave exploring pneumonia = ?
Histoplasmosis
Bird associated pneumonia = ?
- C. Psittacosis
- Hypersensitivity pneumonitis
What are the three categories of pneumonia?
- Community acquired
- Atypical pneumonia
- Healthcare associated
IV therapy, wound care, or chemo in the last (__) days is suspicious for pneumonia
30 days
Hospitalization for over (__) days in the last (__) days is suspicious for healthcare associated pneumonia.
2
90
Treatment in a dialysis clinic in the last (__) days is suspicious for pneumonia
30
Who is the typical pneumonia patient?
Older black males
What is the all cause mortality for hospital acquired pneumonia
28%
What are the internal predisposing factors for developing pneumonia?
Hypoxemia
Acidosis
Pulmonary edema
Uremia
Why is it important to ask about altered level of consciousness with pneumonia?
Aspiration pneumonia
What is the most common infectious pneumonia? What is this associated with?
Strep. Pneumoniae
Smoking
How does smoking predispose to pneumonia?
Impairment of cilia
How does EtOH predispose to pneumonia?
Impairment of cilia/immune system
Aspiration
How does hypoxemia and acidosis predispose to pneumonia?
Lowered immune system
What are the three major genetic disorders that predispose to pneumonia?
CF
Kartagener’s syndrome
Common use of what in older patients predisposes patients to pneumonia?
Denture use while sleeping
Typical or atypical cause of pneumonia: strep pneumonia
Typical
Typical or atypical cause of pneumonia: HiB
Typical
Typical or atypical cause of pneumonia: Staph Aureus
Typical
Typical or atypical cause of pneumonia: GAS
Typical
Typical or atypical cause of pneumonia: mycoplasma pneumonia
Atypical
Typical or atypical cause of pneumonia: legionella
Atypical
Typical or atypical cause of pneumonia: moraxella catarrhalis
Typical
Typical or atypical cause of pneumonia: gram negative bacteria
Typical
Typical or atypical cause of pneumonia: Chlamydia pneumoniae
Atypical
Typical or atypical cause of pneumonia: Chlamydia psittaci
Atypical
What are the four most common infectious agents found to cause pneumonia?
- Strep pneumonia
- viruses
- Mycoplasma pneumoniae
- Legionella
What are the bacteria that you should consider with pneumonia post influenza?
Staph aureus (MRSA) Enterobacteriaceae Pseudomonas
What are the risk factors of developing an pneumonia/abscesses secondary to aspiration?
Anaerobic bacteria
What is the causative agent of Q fever? In whom is this commonly found? Why?
Coxiella brunetti
Farmers and vets d/t exposure to animal placentas
What is associated with francisella tularensis?
Rabbits
What is the test that can be run to detect Legionella (besides a culture/PCR)?
Urine antigen test
What is the bacteria that causes hospital acquired pneumonia?
Staph Aureus
In whom is H. influenzae seen?
Older pts and those with underlying lung disease
In whom is M. Pneumoniae usually seen?
Epidemics in schools or military recruits
What makes chlamydophila pneumoniae hard to diagnose?
Lack of s/s with serological testing
Intracellular pathogen
What are the common associations with legionella?
Water sources (air conditioners, showers, etc)
What is the prognosis with Legionnaires disease (generally)?
Bad
What is the usual bacterial cause of empyema?
Anaerobic bacteria
What are the risk factors for getting an anaerobic pneumonia?
Aspiration risks
In whom are anaerobic bacteria less common?
Edentulous
True or false: gram negative bacilli are uncommon causes of CAP, with the exception of patients requiring ICU treatment
True
What are the two most common infectious agents of CAP in the ICU?
S. pneumoniae
Gram negative
CF patients pneumonia = ?
Pseudomonas
Klebsiella pneumonia = ?
alcoholics
What is the sensitivity of clinical diagnosis of pneumonia (CXR, ssx)?
50%
What are the usual ssx of typical pneumonia?
Productive cough
Fever
Pleuritic chest pain
Dyspnea
What is the CBC finding of typical pneumonia?
Leukocytosis with a L shift
How often do patients with pneumonia have crackles and signs of consolidation?
1/3
What is the gold standard for diagnosing pneumonia?
CXR
True or false: most patients who are dehydrated may have a false- negative CXR,
false-Only a small proportion is this true
Air fluid level on CXR with density below and lucency above = ?
Lung abscess
True or false: establishing the specific pathogen for CAP is essential in the treatment of pneumonia
False–usual empiric therapy is sufficient
What organisms should be cultured, if suspected?
Legionella
Flu or MERS
MRSA
Why is a culture useful for hospitalized or pts in a nursing home?
Can help with treatment of others close to pt
True or false: the majority of pneumonia cases admitted are treated empirically
True
When is a sputum culture recommended?
- ICU admission
- Failure of abx
- Cavitary changes
- Immunocompromised
- Alcoholism
- COPD
- Pleural effusion
More than how many epithelial cells per HPF are sputum cultures rejected?
more than 10 per HPF
What fraction of blood cultures are positive in hospitalized patients with strep pneumoniae?
7-16%
What bacterial infections do we have urinary antigen tests for? Are these valid after abx treatment?
Legionella
Strep pneumoniae
Still valid even after abx treatment
What is the diagnositc test needed for C. Pneumoniae?
PCR or serological testing
What is the treatment for CAP?
Macrolide or doxycycline
What is the treatment for pneumonia in patients with comorbidities? (2)
Oral fluoroquinolone (floxacins) or beta lactam plus a macrolide
What is the treatment for inpatient pneumonia?
Fluoroquinolone
or
anti-pseudomonal beta lactam + a macrolide
What is the ICU treatment for pneumonia?
Antipseudomonal + beta lactam
OR
Azithromycin
What is the ICU treatment for pneumonia if pt has a PCN allergy?
Quinolone plus aztreonam
What is the treatment for MRSA?
nafcillin or oxacillin
How long should abx treatment for CAP be?
5 days
What are the criteria for discontinuation of abx with CAP?
afebrile for 47-72 hours
When are corticosteroids indicated for CAP?
Seriously ill patients, especially those in the ICU
What are the risk factors for developing pneumonia secondary to an aerobic bacterial infection?
Alcohol use
Seizures
Stroke
Why are GAS infections less common in edentulous patients?
GAS grows in periodontal area
