Pneumonia

Question 1

Pneumonia sx

Answer 1

Systemic: High fever, chills, prostration
Local: coughing, expectoration, SOB, dyspnea, tachypnea

Question 2

Sputum color

Answer 2

1. Strept pneumo: Rust-colored, blood tinged

2. Klebsiella pneumo: Current jelly

Question 3

Auscultation signs

Answer 3

Rales, rhonchi, other signs of consolidation

Question 4

CXR benefits

Answer 4

Localizes infiltrates & asses extent

Question 5

Diagnosis studies

Answer 5

1. CXR
2. Bacteriologic studies of sputum: what organism & guides for tx
3. Peripheral blood smears:
   Bacterial–Leukocytosis (high neutrophil count)
   Viral–Lymphocytosis (high lymphocyte count)
4. ABG: look for hypoxia, respiratory acidosis

Question 6

Treatment

Answer 6

Bacterial: eradicate with antibiotics
Viral: supportive

Question 7

Pneumococcal pneumonia

Answer 7

1. > 50% of bacterial pneumo are caused by Strept pneumo
2. Reach alveoli via mucus/saliva droplets
3. Lower lobes due to gravity in patchy–lobar
4. Clinically: fever, chills, pleuritic CP, rust-colored sputum, cough
5. Pneumovac: 80-90% effective, given to high risk
   Sickle cell, Multiple myeloma, elderly, DM, CA, alcoholics, splenectomy

Question 8

Staphylococcal pneumonia

Answer 8

Multiple abscesses
Mortality >50%
Common in hospitalized patients
“Grape-like clusters”

Question 9

Psuedomonas

Answer 9

MC nosocomial pneumonia/in cystic fibrosis
Vascular lesions–infarcts and necrosis of parenchyma
Common source: ventilatory equipment
Mortality >70%

Question 10

Klebsiella pneumonia

Answer 10

Who: Middle aged, alcoholic maless
Sputum: Current jelly

Question 11

Alveolar pneumonia location

Answer 11

PMNs inside alveolar sac
Focal or diffuse (+bronchi)
WORSE clinically

Question 12

Alveolar pneumonia pathology

Answer 12

Bacterial infection + pulmonary edema/CHF

Question 13

Types of alveolar pneumonia

Answer 13

1. Bronchopneumonia (patchy)

2. Lobar (diffuse)

Question 14

Bronchopneumonia characteristics

Answer 14

Limited to segmental bronchi & parenchyma

Patchy

Question 15

Lobar pneumonia characteristics

Answer 15

Confluent broncho, diffuse.
CXR: whiteout of total lobe
Gross exam: hepatization, texture is like liver

Question 16

Interstitial pneumonia location

Answer 16

Macrophages & Lymphocytes in the septae (NOT alveoli)

Diffuse & B/L

Question 17

Interstitial organism

Answer 17

1. VIRAL typically

2. Mycoplasma pneumonia (acts/size of virus–same sx)

Question 18

Etiologies of pneumonia

Answer 18

1. MCC= Bacterial 75%
2. Viral
3. Fungi, protozoa, parasites
4. Aspiration

Question 19

Aspiration pathophysiology

Answer 19

Infected particles of gastric contents (anaerobic) or commensal URI flora (aerobic).
Unconscious, Neuro deficit, alcoholic (no gag reflex)
Histology: Food particle + Bacteria + Neutrophils

Question 20

Gram positive aerobes

Answer 20

From normal URI flora

1. Strept
2. Staph
3. H. influenza (neg rod)

Question 21

Gram negative anaerobes

Answer 21

From GI/UTI, enteric flora

1. E. coli
2. Pseudomona aeruginosa

Question 22

Inhalation organisms

Answer 22

From inhalation/not normal flora

1. TB
2. Legionella pneumophilia (humidifier/AC)
3. Fungi
4. Virus (close contact, latent & reactivate in immunosuppressed–CMV/Herpes)

Question 23

Transmission routes/How do they reach the lung?

Answer 23

1. Inhale air droplets (virus, TB)
2. Aspiration from URI (Strept/Staph)
3. Aspiration from gastric contents (Anaerobic)
4. Hematogenous spread (via blood/sepsis, UTI/GI)

Question 24

Age groups

Answer 24

<5 or >70

Question 25

Primary/Community aquired

Answer 25

Previously healthy patient

Strept pneumo

Question 26

Secondary/Hospital aquired

Answer 26

Pre-existing illness, elderly, delibitated
Other RF: smoking, alcoholism, immunosuppressed
CAUSE: physicians

Question 27

Atypical pneumonia

Answer 27

Mycoplasma pneumoniae
Sx: milder, no chills, mild cough, no blood/purulent sputum
No s/s of sepsis, leukocytosis, abscesses