Pneumonia

Question 1

Respiratory Syndrome

Answer 1

Cough, SOB, sputum
Head: sinusitis, pharyngitis
Upper: COPD exacerbation, bronchiolitis
Lower: penumonia

Question 2

Pneumonia Dx

Answer 2

Cough, fever +/- sputum, CP, increased RR, abnormal lung exam, + CXR

Question 3

Typical Pneumonia

Answer 3

Purulent sputum
Gram neg (S. pneu, H. flu, M. catarrhalis, S. aureus)
Lobar infiltrate on CXR

Question 4

Atypical Pneumonia

Answer 4

Prominent cough +/- sputum
Gram neg (M. pneumo, C. pneumo, L. pneumo, Influenza, RSV, adenovirus)
Patchy/diffuse on CXR

Question 5

Mycoplasma

Answer 5

‘Walking pneumonia’ - bad CXR but walking around fine
Most common atypical
Pleomorphic, no wall. ‘Fried egg’. Has terminal organelle (P1)
Produces CARDS toxin (ADP ribosylating)
Tx: macrolides (mycins)

Question 6

S. pneumoniae

Answer 6

Aspiration into lungs -> adherence to epithelium

Most common CAP

Question 7

CAP Tx

Answer 7

Previously healthy: Macrolide/Doxy
Outpatient/w comorbidities: Respiratory Fluroquinolones, Marcrolide + Amox/Clav
Inpatient: Resp. FQ, Macrolide + beta-lactam
ICU: 3rd gen cephal + resp. FQ/Macrolide

Question 8

Legionella

Answer 8

Gram neg rod (but difficult to see) has to be grown on buffered yeast extract
Type III secretion - coiled phagocytosis by macrophage -> takes control of it & prevents fusion with endosome
Transmitted by water sources
Sx: diarrhea, high fever, low Na, 10 days after hospital discharge, no stain/beta-lactam resistance
Tx: Macrolides and Fluroquinolones