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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
Necrotizing pneumonia is common with what
- aspiration pneumonia - strep pneumoniae - GAS - S. aures
26
Caseating granulomas occur with what
TB
27
When to do a sputum induction with pneumonia
- admitting to the ICU - antibiotic failure - cavitary lesions on xray - active ETOH abuse - severe COPD/lung disease - immunocompromised
28
When to do blood cultures with pneumonia
- admission to ICU - leukopenia - ETOH abuse - chronic severe liver disease - cavitary lesions - pleural effusion - asplenia - positive pneumococcal UAT
29
UAT will show what organisms
S. pneumoniae | Legionella
30
Multiplex PCR shows what organisms
- M. pneumoniae - C. pneumoniae - B. pertussis - many different viruses
31
Serology shows what organisms
- C. pneumoniae - M. pneumoniae - legionella
32
What diagnostics to do for outpatients with suspected pneumonia
- clinical diagnosis - CXR - only do organism testing if it will change treatment
33
What diagnostic to do for inpatients with suspected pneumonia
- CXR - CBC with diff, BMP or CMP - ? CRP, sed rate, lactic acid
34
Diagnostics for ICU patients with suspected pneumonia
- CXR - blood cultures - UAT - sputum - CBC with diff, BMP or CMP, lactic acid - ? CRP or sed rate
35
Treatment for outpatients with no comorbidities or abx treatment in the last three months
macrolide (clarythro or erythro) x5 days OR doxy x5 days
36
Outpatient treatment for patients with comorbidities, use of abx in the last three months or in regions with high DRP
fluroquinolone (moxi, levo) x5 days OR beta lactam (amox, augmentin, cefpo,cefur) plus macrolide(clarythro or erythro)/doxy
37
Inpatient non ICU treatment
fluroquiniolone (moxi, levo) IV +/- gluccocorticoid OR anti-pneumococcal beta lactam (ceftriaxone, unasyn) IV plus macrolide/doxy IV +/- gluccocorticoid
38
What does the Pneumonia Severity Index measure
mortality risk at 30 days
39
Curb score criteria
``` Confusion Urea >19 mg.dL Respiratory rate >30 BP <90 Age >65 ```
40
Scoring of CURB score
``` 0-1= outpatient 3= admission >3= ICU admission ```
41
What does the SMART-COP score measure
predicts which patients require intensive care and need of intensive respiratory or vasopressor support
42
SMART- COP criteria
``` Systolic BP Multilobar Albumin level RR Tachycardia Confusion Oxygen level arterial Ph ```
43
HAP/VAP early onset organisms
- strep pneumoniae - H flu - MSSA - gram negative bacilli
44
Treatment for early onset HAP/VAP
``` Ceftriaxone PO or Levo IV/PO or Unasyn IV and Augmentin PO ```
45
Late onset HAP/VAP organisms
- pseudomonas - acinetobacter - MRSA
46
Treatment for late onset HAP/VAP
``` Cefepime IV or Ceftazadime or Meropenem IV or Zosyn IV or Levo IV ``` PLUS Vanco IV or linesolid PO
47
Risk factors for multi-drug resistant pathogens
- 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
Risk factors for aspiration pneumonia
- altered LOC - dysphagia - neurological disorders - mechanical disruption
49
Opportunistic pneumonia
- tuberculosis - mycobacterium avium complec - PCP - cryptococcus - cytomegalovirus - influenza - Kaposi sarcoma - toxoplasmosis
50
Risk factors for PCP pneumonia
- advanced immunosuppression - previous PCP - oral thrush - recurrent pnuemonia - high plasma RNA
51
Symptoms of PCP pneumonia
- graudal onset - fever - non productive cough - dyspnea - fatigue - weight loss
52
Mild PCP pneumonia treatment
TMP-SMX
53
Moderate PCP pneumonia treatment
TMP-SMX PLUS adjunctive corticosteriods (prednisone)
54
Severe PCP pneumonia treatment
TMP-SMX IV plus methylpred IV
55
When to give PCP prophylaxis
- CD4 <200 - oral candidiasis - CD4 count <14%
56
What to give for PCP prophylaxis
TMP-SMX

Pulmonary (3 decks)

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