Pneumonia

Question 1

Difference between pneumonia and pneumonitis

Answer 1

pneumonia - INFECTION of lung parenchyma by bacteria, viruses, fungi, and parasites

pneumonitis - INFLAMMATION of lungs from NON-INFECTIOUS causes such as autoimmune, chemicals, blood, or radiation

Question 2

Most common mechanism triggering pneumonia

Answer 2

upper airway colonization by pathogenic organisms that are then aspirated

Question 3

most common viral causes of community acquired pneumonia (CAP)

Answer 3

influenza A and B, parainfluenza, adeno, RSV

Question 4

most common bacterial causes of CAP

Answer 4

s pneumo (most common), h influenza (often seen with underlying COPD), moraxella catarrhalis

Question 5

rust colored sputum, fever, shaking chills, lobar infiltrate on chest xray…

Answer 5

PNEUMOCOCCAL PNEUMONIA

Question 6

bacterial causes of atypical pneumonia

Answer 6

mycoplasma pneumoniae, chlamydia pneumoniae, legionella + different viruses

most common in adolescents and adults, whereas typical is more common in very old and young

Question 7

How do atypical organisms present on xray

Answer 7

bilateral diffuse infiltrates rather than focal lobar infiltrates (seen in typical)

Question 8

Risk factors for health acquired pneumonia

Answer 8

hospitalization within 90 days, home infusion therapy, dialysis, living at nursing home

Question 9

Causative organisms for health acquired pneumonia

Answer 9

everything that causes CAP + gram negative aerobes (pseudomonas, klebsiella, acinetobacter) and gram positive cocci (staph aureus). MRSA getting more common

Question 10

symptoms of pneumonia

Answer 10

productive cough, fever, pleuritic chest pain, dyspnea

Question 11

pneumonia that is abrupt onset or abruptly worsening

Answer 11

pneumococcal pneumonia

Question 12

pneumonia + diarrhea, hyponatremia, elevated liver enzymes, and/or older patients

Answer 12

legionella

Question 13

common cause of post influenza pneumonia

Answer 13

staph aureus

Question 14

physical exam findings of pneumonia

Answer 14

tachycardia, tachypnea, fever, hypotension, low o2 sat
rhonchi/rales on lung exam
egophony (focal lung consolidation)
dullness to percussion (pulmonary effusion)

Question 15

What confirms dx of pneumonia and should be done in all patients suspicious of pneumonia?

Answer 15

CHEST X RAY (WILL SEE INFILTRATES)

but absence of infiltrate does not rule out pneumonia

Question 16

bilateral “ground glass” infiltrate

Answer 16

pneumocystis jiroveci often seen in AIDS patients

Question 17

apical consolidation on xray

Answer 17

TB

Question 18

Where is pneumonia caused by aspiration of GI contents seen?

Answer 18

RLL because of branching bronchial tree

Question 19

Other testing indicated in pneumonia

Answer 19

CBC, chem panel, blood/sputum culture (low sensitivity)

Question 20

What test can confirm legionella

Answer 20

urine antigen testing

Question 21

How to tell if patient with pneumonia can be managed inpatient vs outpatient

Answer 21

use a prediction scoring system!

CURB-65 (CAP)
pneumonia severity index (PSI/PORT score)

low risk = classes 1, 2 can be treated outpatient
high risk = classes 3-5 inpatient

Question 22

Risky lab findings in pneumonia

Answer 22

low pH, low sodium, low Hct, low o2 sat, high glucose, high BUN, pleural effusion on xray

Question 23

empiric treatment of CAP in healthy persons for outpatient

Answer 23

macrolide (clarithro/azithromycin) or doxy

Question 24

Treatment for patient with comorbidities like DM or heart/lung disease

Answer 24

flurouinolones (levofloxacin, moxifloxacin) or combo of b-lactam (high dose amox, augmentin) plus macrolide

Question 25

When should patient being treated outpatient return for follow up?

Answer 25

3-4 days, since no clinical improvement in 5-7 days can indicate bronchogenic carcinoma which can present with typical pneumonia

Question 26

how to treat pseudomonas pneumonia

Answer 26

pipercilin tazobactam (ZOSYN) plus fluroquinolone

Question 27

how to treat MRSA pneumonia

Answer 27

vanc

Question 28

How long does treatment usually last in CAP vs heatlh care acquired

Answer 28

depends on severity of symptoms

CAP 5-10 days (or 3 days afebrile)
HAP - two-3 weeks

Question 29

complications of pneumonia

Answer 29

bacteremia, parapneumonic pleural effusion, empyema, (may need to do thoracentesis of too much fluid)

Question 30

Who should get pneumococcal vaccine?

Answer 30

everyone over 65, adults with chronic cardiopulm diseases, cigarette smokers, immunocompromised

use 23 polysaccharide vaccine in adults 65 an dolder in addition to 13-valent conjugate vaccine.

Question 31

What other vaccine can you get to reduce risk of pneumonia

Answer 31

influenza! (prevents secondary pneumonia)