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OS 213 Respiratory EXAM 1 > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

Abnormal inflammatory condition of the lung

A

Pneumonia

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2
Q

Most common cause of pneumonia

A

Bacterial

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3
Q

3rd leading cause of both morbidity and mortality in the philippines

A

Pneumonia

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4
Q

Least common entry of infection (pneumonia)

A

heamtogeneous spread

  • S. aureus from endocarditis
  • CXR : disseminated lesions
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5
Q

Spread of infection from a site near the lungs via physical infiltration

A

Contiguous

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6
Q

Common mode of entry of infection (pneumonia)

A

Inhalation

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7
Q

cut off size for large particle

A

> 10 um

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8
Q

cut off size for small particle

A

<10 um

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9
Q

Most common mechanism of entry of infection (pneumonia)

A

Aspiration

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10
Q

Acute infection of the pulmonary parenchyma
Accompanied by the presence of acute infiltrate on a chest radiograph, or auscultatory findings.

not hospitalized pt or residing in long term care facility for 14 days before onset of symptoms

A

CAP

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11
Q

Occurs 48 hours after admission to a hospital and not incubating at the time of admission

A

Hospital acquired oneumonia

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12
Q

Arises more than 48-72 hours after endotracheal tube intubation

A

Ventilator- acquired Pneumonia

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13
Q

Occurs within 90 days after receiving any form of health care

A

health care associated pneumonia

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14
Q

Acute vs Chronic pneumonia

A

Acute <2 weeks

Chronic > 2 weeks

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15
Q

Typical Pneumonia

A 
Sudden onset of fever
Cough with purulent sputum
dyspnea
pleuritic chest pain
Consolidation of PE
Usually caused my bacteria
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16
Q

Atypical Pneumonia

A 
Gradual onset of fever
Dry cough
Dyspnea
Extrapulmonary symptoms
Minimal signs on PE
Atypical microorganisms
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17
Q

Clinical Presentation of Pneumonia

A 
COugh
Fever
chills
Chest pain
Difficulty on Breathng
malaise
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18
Q

Herkerlings Score (threshold 2)

A 
Temp 37.8
Pulse >100 bpm
Rales
Decreased RBS
(-) asthma
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19
Q

Gennis Rule (threshold 1)

A

Tepm >37.8

RR>20

20
Q

Elements of Corrext X ray

A

Rotation
penetration
Inspiration/Epxiration

21
Q

Pathognomonic radiograph sign of pneumonia

A

Air bronchogram sign

22
Q

Air inside bronchi becomes more visible due to consolidation of suurounding lung

A

Air bronchogram sign

23
Q

Suggests that ung is filled woth fluid which forms a convexity.

A

Meniscus sign

24
Q

Presence of fluid

A

Decreased frenitus, dullness in percussion

25
Q

What modality is used to rule out malignancy (Ddx Hilar mass lesion)

A

CT Scan

26
Q

May also be metastatic lung CA, fungal pneumonia can present as mulitple nodules

A

Multiple Masses

27
Q

Seen in TB, atelectasis, Clearly defined margin showing that the right lung is being pulled down

A

RUL collapse

28
Q

Abscess or TB cavity or may also be malignancy. Pneumonia can look initially as the usual infiltrates and then necrotize and form a cavity

A

Cavitating lesion

29
Q

Light infiltrates, Miliary TB, fine diffused generalized lesions across most lung areas, disseminated

A

Millet seed

30
Q

3 most common bacterial causes of typical pneumonia

A

Streptococcus pneumoniae, hemophilus influenzae, and Moraxella catarrhalis

31
Q

______is needed to guide management (Management of Pneumonia)

A

Risk Stratification

32
Q

Management of Pneumonia

A

CAP low risk : Outpatient care
CAP moderate risk : Admit to ward
CAP high risk: ICU admission, may require vasopressors and mechanical ventilation

33
Q

Criteria for severe Community Acquired Pneumonia (CAP)

A
  1. Major
    - Invasive mechanical ventilation
    - Septic shock with the need for vasopressors
  2. Minor
    - Respiratory rate >30 breaths/min
    - PaO2/Fi2 ratio <250
    - Multilobar infiltrates
    - Confusion/disorientation
    - Uremia (BUN level >20mg/L)
    - Leukopenia
    - Thrombocytopenia
    - hypothermia
    - hypotension
34
Q

Penicillin and/or drug resistant S. pneumoniae

A
  • > 65 yrs old
  • Beta lactam therapy within the previous 3 months
  • Alcoholism
  • Immune-suppresice illness
  • multiple medical commorbidities
  • Exposure to child in day care
35
Q

Enteric gram (-)

A 
Moderate to severe types
Residence in a nursing home
Underlying cardiopulmonary disease
Multiple medical commorbidities
Recent antibiotic Use
36
Q

Pseudomonas aerugionasa

A 
Structural lung disease
Corticosteroid Therapy (>10 mg)
Broad spectrum antibiotic therapy (>7days)
Malnutrition
Associated with increased mortality
37
Q

Pulmonary TB

A

COugh more than 2 weeks

38
Q

Pneumonia in patient post chemotherapy or immunocompromised

A

Broaden empiric coverage for possible etiologies

39
Q

Pneumonia in HIV patients

A

PCP

Fungal etiologies

40
Q

Low Risk COP

A 
RR <30
DBP >60
SBP >90
PR <135
T <40
41
Q

Moderate Risk COP

A 
RR >30
Pulse >125
T <35 or >40
Chest X ray with bilateral or multilobar involvement
Pleural effusion
Abscess
Suspected aspiration
42
Q

High Risk COP

A

CXR as in moderate risk CAP plus
Unstable (Impending or frank respiratory, hemodyanamic alterations, altered mental state, DBP <60, SBP<90, urine Output <30

43
Q

Empiric therapy for Low risk CAP

A

Amoxicillin or extended macrolide (Clarithromycin or Azithromycin)

With satble comorbid illness: Beta lactam/ BLIC

44
Q

Empiric therapy for Moderate Risk CAP

A

IV non pseudomonal Beta lactam , BLIC

(+)

Extended macrolide or Respiratory fluoroquinolone

45
Q

Empiric therapy for high risk CAP

A

Depends on whether Pseudomonas is present or not.

BLIC, cephalosporin + IV macolide or IV quinolone

Risk of pseudomonas
IV pseduomonal coverage PLUS IV extended MAcrolide (+/-) aminoglycoside or IV Ciprofloxaxin

OS 213 Respiratory EXAM 1 (19 decks)

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