Pneumonia

Question 1

“PNA is a great neglected diz of mankind”. Elaborate.

Answer 1

often misdiagnosed
mistreated
underestimated

Question 2

causes of resp sx besides pna to rule in/ rule out

Answer 2

pharyngitis
sinusitis
bronchitis
copd

Question 3

PNA- basically, what is it?

Answer 3

infx of pulm parenchyma from alveoli

LOWER RESP tract infx

Question 4

where does the pain associated with pna came from generally?

Answer 4

pleura

Question 5

req for diagnosis of PNA?

Answer 5

• cough, fever, +/- sputum
• increased RR
• abnl lung exam
• infiltrate on CXR

Question 6

what demo makes up the majority of deaths from PNA?

Answer 6

kiddos :(

Question 7

what are some general PNA prevention measures

Answer 7

breast milk
not smoking
not having wood burning stoves in the house all day

Question 8

cardiovascular complications assoc with pna

Answer 8

MI, CHF, afib, CVA

Question 9

CURB65 what and why?

Answer 9

grading how sick someone is
C= confusion
U= uremia
R= rr > 30
B= BP <90/60
65= >65

Question 10

general appearance of TYPICAL CAP on CXR? Typical appearance of ATYPICAL CAP on CXR?

Answer 10

lobar

patchy, diffuse

Question 11

lobar pna

Answer 11

• intra-alveolar exudate and consolidation
• s. pneumo= #1
• leigonella, klebs

Question 12

bronchopneumonia

Answer 12

• acute inflammatory infiltrates from bronchioles into adjacent alveoli
• s. pneumo, s. aureaus, h flu, klebs

Question 13

sup with the gram stain in atypical pna?

Answer 13

PMNs but few organisms

Question 14

atypical bugs

Answer 14

mycoplasma
chlamydophila pneumo
legionella
influenza, RSV, adenovirus

Question 15

what do you mean you get pna from influenza?

Answer 15

gets complicated by s pneumo, s. aureus, group a strep

Question 16

#1 cause of CAP
#2 cause of CAP

Answer 16

s. pneumo

s. aureus

Question 17

fungal causes of CAP

Answer 17

histoplasmosis
blastomycosis
coccidiomycosis
aspergillus

Question 18

mech of pneumococcus

Answer 18

gets into alveoli –> adheres -> produce H2O2 and pneumolysin –> blow holes through epi cell membrane

***goal of vaccine/ immunity is to have bug bind antibodies or macs –> clear infx

Question 19

when is a smokers cough worse? why?

Answer 19

morning

smoking slows cilia. deprived of smoke overnight so cilia wake up irritated and ready to go

Question 20

what do you treat HEALTHY pt with CAP with?

Answer 20

macrolide, doxy

Question 21

how do you treat outpatients with comorbidities?

Answer 21

resp flouroquinolone (levo or moxi)
mac+ amox/clav

Question 22

how do you treat inpatients not in the icu?

Answer 22

resp flouroquinolone
mac
b-lactam 3rd gen ceph

Question 23

how do you treat ICU patients

Answer 23

3rd gen ceph

resp flouroquin or mac

Question 24

23 valent pneumo vax?

Answer 24

ADULTS

• effective for bacteremia but not mucosal infx
• adults over 65
• asplenic pt

Question 25

13 valent pneumo vax conjugate?

Answer 25

CHILDREN and old adults

-polysach capsule + protein conjugate