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Pulmonary > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

Pneumonia definition

A

inflammatory condition of the lung affecting predominately the alveoli

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2
Q

Pathophys of pneumonia

A
  1. micro aspiration of organism
  2. defect in host defense system
  3. virulence of the organism
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3
Q

What is the number one cause of community acquired pneumonia

A

bacteria

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4
Q

What is the number one cause of pneumonia in children less than 5

A

viral

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5
Q

Community acquired pneumonia

A

non hospitalized patients without extensive health care contact

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6
Q

Health care associated pneumonia

A
  • non hospitalized paitents with extensive healthcare contact
  • hospitalized in an acute care setting >48 hours last 90 days
  • resides in NH or LTC
  • IV therapy, chemotherapy or wound care >30 days
  • attend hospital or dialysis clinic >30 days
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7
Q

Hospital acquired pneumonia

A

-pneumonia acquired while hospitalized after >48 hours

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8
Q

Ventilator acquired pneumonia

A

48-72 hours after intubation

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9
Q

Aspiration pneumonia

A

relatively large amount of material from the stomach or mouth entering the lungs

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10
Q

What types of pneumonia affect immunocompromised

A

fungal, parasites

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11
Q

Typical organisms of community acquired pneumonia (bacterial)

A 
strep pneumoniae (number 1)
H. flu
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12
Q

Atypical organisms of community acquired pneumonia

A

M. pneumoniae (number 2)

C. pneumoniae

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13
Q

Viral causes of pneumonia

A
  • influenza
  • RSV
  • adenovirus
  • rhinovirus
  • parainfluenza
  • coronavirus
  • SARS
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14
Q

Symptoms of pneumonia

A
  • fever
  • cough
  • chills
  • pleuritic pain
  • hemoptysis
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15
Q

Physical exam findings of pneumonia

A
  • rales/crackles
  • decreased/asymmetric breath sounds
  • expiratory wheezes
  • hypoxemia
  • tachycardia
  • hypotension
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16
Q

Most important diagnostics for pneumonia

A
  • clinical evaluation

- chest xray

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17
Q

Sputum color with S. pneumonia

A

rust color

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18
Q

Sputum with atpicals

A

scant or watery

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19
Q

Sputum with kiebsiella

A

hemoptysis or currant jelly

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20
Q

PE findings with legionella pneumonia

A
  • abdominal pain
  • diarrhea
  • confusion
  • high fever
  • recent travel
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21
Q

Gold standard for pneumonia diagnosis

A

chest xray

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22
Q

Criteria for getting a chest xray

A

1 or more of the following vital signs

 - temp >100
 - HR >100
 - RR >20

2 or more of the following clinical findings

 - decreased breath sounds
 - crackles
 - absence of asthma
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23
Q

Lobar findings are common with what?

A

step pneumoniae

24
Q

Interstitial and prebronchial pattern is common with what?

A

viral pneumonia, PCP

25
Q

Necrotizing pneumonia is common with what

A
  • aspiration pneumonia
  • strep pneumoniae
  • GAS
  • S. aures
26
Q

Caseating granulomas occur with what

A

TB

27
Q

When to do a sputum induction with pneumonia

A
  • admitting to the ICU
  • antibiotic failure
  • cavitary lesions on xray
  • active ETOH abuse
  • severe COPD/lung disease
  • immunocompromised
28
Q

When to do blood cultures with pneumonia

A
  • admission to ICU
  • leukopenia
  • ETOH abuse
  • chronic severe liver disease
  • cavitary lesions
  • pleural effusion
  • asplenia
  • positive pneumococcal UAT
29
Q

UAT will show what organisms

A

S. pneumoniae

Legionella

30
Q

Multiplex PCR shows what organisms

A
  • M. pneumoniae
  • C. pneumoniae
  • B. pertussis
  • many different viruses
31
Q

Serology shows what organisms

A
  • C. pneumoniae
  • M. pneumoniae
  • legionella
32
Q

What diagnostics to do for outpatients with suspected pneumonia

A
  • clinical diagnosis
  • CXR
  • only do organism testing if it will change treatment
33
Q

What diagnostic to do for inpatients with suspected pneumonia

A
  • CXR
  • CBC with diff, BMP or CMP
  • ? CRP, sed rate, lactic acid
34
Q

Diagnostics for ICU patients with suspected pneumonia

A
  • CXR
  • blood cultures
  • UAT
  • sputum
  • CBC with diff, BMP or CMP, lactic acid
  • ? CRP or sed rate
35
Q

Treatment for outpatients with no comorbidities or abx treatment in the last three months

A

macrolide (clarythro or erythro) x5 days
OR
doxy x5 days

36
Q

Outpatient treatment for patients with comorbidities, use of abx in the last three months or in regions with high DRP

A

fluroquinolone (moxi, levo) x5 days
OR
beta lactam (amox, augmentin, cefpo,cefur)
plus macrolide(clarythro or erythro)/doxy

37
Q

Inpatient non ICU treatment

A

fluroquiniolone (moxi, levo) IV +/- gluccocorticoid
OR
anti-pneumococcal beta lactam (ceftriaxone, unasyn) IV
plus macrolide/doxy IV +/- gluccocorticoid

38
Q

What does the Pneumonia Severity Index measure

A

mortality risk at 30 days

39
Q

Curb score criteria

A 
Confusion
Urea >19 mg.dL
Respiratory rate >30
BP <90
Age >65
40
Q

Scoring of CURB score

A 
0-1= outpatient
3= admission
>3= ICU admission
41
Q

What does the SMART-COP score measure

A

predicts which patients require intensive care and need of intensive respiratory or vasopressor support

42
Q

SMART- COP criteria

A 
Systolic BP
Multilobar
Albumin level
RR
Tachycardia
Confusion
Oxygen level
arterial Ph
43
Q

HAP/VAP early onset organisms

A
  • strep pneumoniae
  • H flu
  • MSSA
  • gram negative bacilli
44
Q

Treatment for early onset HAP/VAP

A 
Ceftriaxone PO
     or
Levo IV/PO
       or
Unasyn IV and Augmentin PO
45
Q

Late onset HAP/VAP organisms

A
  • pseudomonas
  • acinetobacter
  • MRSA
46
Q

Treatment for late onset HAP/VAP

A 
Cefepime IV    or
Ceftazadime    or
Meropenem IV      or
Zosyn IV          or
Levo IV

PLUS
Vanco IV or linesolid PO

47
Q

Risk factors for multi-drug resistant pathogens

A
  • abx therapy in last 90 days
  • hospitalization >5 days
  • high rate of abx resistance in hospital or area
  • presence of risk factors for HCAP
48
Q

Risk factors for aspiration pneumonia

A
  • altered LOC
  • dysphagia
  • neurological disorders
  • mechanical disruption
49
Q

Opportunistic pneumonia

A
  • tuberculosis
  • mycobacterium avium complec
  • PCP
  • cryptococcus
  • cytomegalovirus
  • influenza
  • Kaposi sarcoma
  • toxoplasmosis
50
Q

Risk factors for PCP pneumonia

A
  • advanced immunosuppression
  • previous PCP
  • oral thrush
  • recurrent pnuemonia
  • high plasma RNA
51
Q

Symptoms of PCP pneumonia

A
  • graudal onset
  • fever
  • non productive cough
  • dyspnea
  • fatigue
  • weight loss
52
Q

Mild PCP pneumonia treatment

A

TMP-SMX

53
Q

Moderate PCP pneumonia treatment

A

TMP-SMX PLUS adjunctive corticosteriods (prednisone)

54
Q

Severe PCP pneumonia treatment

A

TMP-SMX IV plus methylpred IV

55
Q

When to give PCP prophylaxis

A
  • CD4 <200
  • oral candidiasis
  • CD4 count <14%
56
Q

What to give for PCP prophylaxis

A

TMP-SMX

Pulmonary (3 decks)

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