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Pneumonia Flashcards

1
Q

Cave exploring pneumonia = ?

A

Histoplasmosis

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2
Q

Bird associated pneumonia = ?

A
  • C. Psittacosis

- Hypersensitivity pneumonitis

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3
Q

What are the three categories of pneumonia?

A
  • Community acquired
  • Atypical pneumonia
  • Healthcare associated
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4
Q

IV therapy, wound care, or chemo in the last (__) days is suspicious for pneumonia

A

30 days

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5
Q

Hospitalization for over (__) days in the last (__) days is suspicious for healthcare associated pneumonia.

A

2

90

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6
Q

Treatment in a dialysis clinic in the last (__) days is suspicious for pneumonia

A

30

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7
Q

Who is the typical pneumonia patient?

A

Older black males

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8
Q

What is the all cause mortality for hospital acquired pneumonia

A

28%

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9
Q

What are the internal predisposing factors for developing pneumonia?

A

Hypoxemia
Acidosis
Pulmonary edema
Uremia

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10
Q

Why is it important to ask about altered level of consciousness with pneumonia?

A

Aspiration pneumonia

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11
Q

What is the most common infectious pneumonia? What is this associated with?

A

Strep. Pneumoniae

Smoking

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12
Q

How does smoking predispose to pneumonia?

A

Impairment of cilia

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13
Q

How does EtOH predispose to pneumonia?

A

Impairment of cilia/immune system

Aspiration

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14
Q

How does hypoxemia and acidosis predispose to pneumonia?

A

Lowered immune system

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15
Q

What are the three major genetic disorders that predispose to pneumonia?

A

CF

Kartagener’s syndrome

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16
Q

Common use of what in older patients predisposes patients to pneumonia?

A

Denture use while sleeping

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17
Q

Typical or atypical cause of pneumonia: strep pneumonia

A

Typical

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18
Q

Typical or atypical cause of pneumonia: HiB

A

Typical

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19
Q

Typical or atypical cause of pneumonia: Staph Aureus

A

Typical

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20
Q

Typical or atypical cause of pneumonia: GAS

A

Typical

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21
Q

Typical or atypical cause of pneumonia: mycoplasma pneumonia

A

Atypical

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22
Q

Typical or atypical cause of pneumonia: legionella

A

Atypical

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23
Q

Typical or atypical cause of pneumonia: moraxella catarrhalis

A

Typical

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24
Q

Typical or atypical cause of pneumonia: gram negative bacteria

A

Typical

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25
Typical or atypical cause of pneumonia: Chlamydia pneumoniae
Atypical
26
Typical or atypical cause of pneumonia: Chlamydia psittaci
Atypical
27
What are the four most common infectious agents found to cause pneumonia?
1. Strep pneumonia 2. viruses 3. Mycoplasma pneumoniae 4. Legionella
28
What are the bacteria that you should consider with pneumonia post influenza?
``` Staph aureus (MRSA) Enterobacteriaceae Pseudomonas ```
29
What are the risk factors of developing an pneumonia/abscesses secondary to aspiration?
Anaerobic bacteria
30
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
31
What is associated with francisella tularensis?
Rabbits
32
What is the test that can be run to detect Legionella (besides a culture/PCR)?
Urine antigen test
33
What is the bacteria that causes hospital acquired pneumonia?
Staph Aureus
34
In whom is H. influenzae seen?
Older pts and those with underlying lung disease
35
In whom is M. Pneumoniae usually seen?
Epidemics in schools or military recruits
36
What makes chlamydophila pneumoniae hard to diagnose?
Lack of s/s with serological testing Intracellular pathogen
37
What are the common associations with legionella?
Water sources (air conditioners, showers, etc)
38
What is the prognosis with Legionnaires disease (generally)?
Bad
39
What is the usual bacterial cause of empyema?
Anaerobic bacteria
40
What are the risk factors for getting an anaerobic pneumonia?
Aspiration risks
41
In whom are anaerobic bacteria less common?
Edentulous
42
True or false: gram negative bacilli are uncommon causes of CAP, with the exception of patients requiring ICU treatment
True
43
What are the two most common infectious agents of CAP in the ICU?
S. pneumoniae | Gram negative
44
CF patients pneumonia = ?
Pseudomonas
45
Klebsiella pneumonia = ?
alcoholics
46
What is the sensitivity of clinical diagnosis of pneumonia (CXR, ssx)?
50%
47
What are the usual ssx of typical pneumonia?
Productive cough Fever Pleuritic chest pain Dyspnea
48
What is the CBC finding of typical pneumonia?
Leukocytosis with a L shift
49
How often do patients with pneumonia have crackles and signs of consolidation?
1/3
50
What is the gold standard for diagnosing pneumonia?
CXR
51
True or false: most patients who are dehydrated may have a false- negative CXR,
false-Only a small proportion is this true
52
Air fluid level on CXR with density below and lucency above = ?
Lung abscess
53
True or false: establishing the specific pathogen for CAP is essential in the treatment of pneumonia
False--usual empiric therapy is sufficient
54
What organisms should be cultured, if suspected?
Legionella Flu or MERS MRSA
55
Why is a culture useful for hospitalized or pts in a nursing home?
Can help with treatment of others close to pt
56
True or false: the majority of pneumonia cases admitted are treated empirically
True
57
When is a sputum culture recommended?
- ICU admission - Failure of abx - Cavitary changes - Immunocompromised - Alcoholism - COPD - Pleural effusion
58
More than how many epithelial cells per HPF are sputum cultures rejected?
more than 10 per HPF
59
What fraction of blood cultures are positive in hospitalized patients with strep pneumoniae?
7-16%
60
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
61
What is the diagnositc test needed for C. Pneumoniae?
PCR or serological testing
62
What is the treatment for CAP?
Macrolide or doxycycline
63
What is the treatment for pneumonia in patients with comorbidities? (2)
Oral fluoroquinolone (floxacins) or beta lactam plus a macrolide
64
What is the treatment for inpatient pneumonia?
Fluoroquinolone or anti-pseudomonal beta lactam + a macrolide
65
What is the ICU treatment for pneumonia?
Antipseudomonal + beta lactam OR Azithromycin
66
What is the ICU treatment for pneumonia if pt has a PCN allergy?
Quinolone plus aztreonam
67
What is the treatment for MRSA?
nafcillin or oxacillin
68
How long should abx treatment for CAP be?
5 days
69
What are the criteria for discontinuation of abx with CAP?
afebrile for 47-72 hours
70
When are corticosteroids indicated for CAP?
Seriously ill patients, especially those in the ICU
71
What are the risk factors for developing pneumonia secondary to an aerobic bacterial infection?
Alcohol use Seizures Stroke
72
Why are GAS infections less common in edentulous patients?
GAS grows in periodontal area

Respiratory (34 decks)

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