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Foundations-Pulmonary > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

Influenza etiology

A

Influenza virus: Type A & B

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2
Q

Type A subtypes

A
  1. Hemagglutinins H1, H2, H3

2. Neuraminidases N1, N2

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3
Q

Influenza clinical presentation

A 
FACTS:
F-Fever
A-Aches
C-Chills
T- Tiredness
S-Sudden onset
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4
Q

What is the gold standard diagnostic test for influenza? Why?

A

Viral Culture

Higher SENSITIVITY

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5
Q

Indications for antiviral treatment

A
  1. Illness requiring hospitalization
  2. Progressive, severe or complicated illness
  3. High risk complications
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6
Q

What are we worried about in children <19 y.o. on chronic ASA therapy? (high risk group)

A

Rye syndrome

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7
Q

List Antiviral medication and what strain it covers

A

Neuraminidase Inhibitors
-Oseltamivir (Tamiflu)
Influenza A/B

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8
Q

What antiviral medication is NOT recommended for use in the US?

A

Adamantanes

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9
Q

Zanamivir (Relexna) side effects and contraindications

A

ADE: Bronchospasm
Contraindicated: Respiratory dz

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10
Q

When must you initiate antiviral treatment to see benefit?

A

24-48 hrs
Relieve sx’s up to 3 days earlier
Less severe sx’s

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11
Q

What is the number one complication of influenza?

A

Pneumonia

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12
Q

Who should receive the influenza vaccine?

A

Universal vaccination >6 months

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13
Q

Who is the influenza vaccine contraindicate in?

A

Previous severe reaction to flu vaccine

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14
Q

How many doses do pediatric patients receive the first time the get the influenza vaccine?

A

2 doses

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15
Q

What is the most common cause of acute bronchitis?

A

Viral

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16
Q

What is the only bacterial organism that requires treatment in acute bronchitis?

A

Bordetella pertussis

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17
Q

What is the most common sx in acute bronchitis?

A

Cough >5 days

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18
Q

Acute bronchitis PEx

A
  1. Wheezing
  2. Rhonchi that clears with coughing
  3. Negative for rales and any signs of consolidation
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19
Q

When is a CXR indicated in suspected acute bronchitis?

A

Fever- R/O pneumonia

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20
Q

What is the most common cause for overly prescribed abx?

A

Acute bronchitis=60-90%

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21
Q

What is another name for Pertussis?

A

Whooping cough

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22
Q

What causes Pertussis?

A

Bordetella pertussis

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23
Q

Bordetella pertussis

MOA

A
  • Releases toxin that damages cilia and causes airways to swell
  • Causes classic cough
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24
Q

What population do we see Bordetella pertussis in?

A

< age 2 y/o

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25
Q

Bordetella pertussis incubation period

A

7-17 days

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26
Q

How long are you contagious for after onset of cough in pertussis?

A

2 week s

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27
Q

What are the 3 stages of Pertussis and time periods?

A
  1. Catarrhal: 1-2 weeks
  2. Paroxysmal: begins in 2nd week, last 2-3 mos.
  3. Convalescent: 1-2 weeks
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28
Q

Catarrhal sx’s

A
  • Malaise
  • Rhinorrhea
  • Cough
  • Cough
  • Lacrimation and conjunctival injection
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29
Q

Paroxysmal sx’s

A
  • Fits of numerous, rapid cough followed by “Whooping” sound

- Vomiting following coughing

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30
Q

Convalescent sx’s

A

Gradual reduction in frequency and severity of cough

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31
Q

Pertussis diagnosis

A

Nasopharyngeal culture

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32
Q

Pertussis treatment

A
  1. Macrolide

2. Bactrim

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33
Q

When should pregnant women receive their Tdap?

A

27-36 weeks gestation

34
Q

At what age do adolescents receive their Tdap booster?

A

11-18 y.o.

35
Q

What are the complication os pertussis in babies under 1 y/o?

A
  1. Hospitalization=50%
  2. Pneumonia=23%
  3. Apnea=61%
36
Q

What is the most common form of transmission of pneumonia?

A

Aspiration from the oropharynx

37
Q

What is the most common pneumonia?

A

Community Acquired Pneumonia

38
Q

What is the most common bacterial infection of CAP?

A

S. pneumoniae

39
Q

List Atypical bacteria in CAP

A
  1. Mycoplasma pneumoniae
  2. Legionella
  3. Chamydophilia
40
Q

Viral causes of CAP

A

Influenza

41
Q

CAP clinical presentation

A
  1. Fever
  2. Cough
  3. Dyspnea
  4. Chest discomfort
  5. Fatigue, weakness
  6. Myalgias, arthralgia
42
Q

CAP physical exam findings

A
  1. Fever
  2. Rales
  3. Signs of consolidation
  4. Tachypnea
  5. Tachycardia
  6. Low O2 sat
43
Q

What is another name for Mycoplasma Pneumoniae? What age group does it commonly occur in?

A

“Walking pneumonia”

Children and adolescents

44
Q

Legionella presentation

A
  • GI disorders: Watery diarrhea

- From contaminated water sources

45
Q

What organism has a usual complaint of “sudden onset of a single episode of rigors or chills”

A

S. pneumoniae

46
Q

Klebsiella pneumoniae

presentation

A
  • Currant jelly sputum

- Alcoholics, DM, COPD

47
Q

What is the gold standard diagnostics for CAP?

A

CXR

48
Q

What would you expect to see on CBC in pneumonia?

A

Leukocytosis with left shift

49
Q

CXR findings

A
  1. Lobar- One lobe consolidation
  2. Interstitial- patchy distribution
  3. Cavitation
50
Q

What organism would you use a urine antigen test?

A

S. pneumonia

Legionella

51
Q

What does Procalcitonin levels help you determine?

A

bacterial vs. viral

52
Q

CURB 65

A

C-Confusion
U- Urea >7 mol/L (BUN>20)
R-Respiratory Rate >30
B- Blood pressure, SBP<90 OR DBP < or equal to 60

65- Age> or equal 65

53
Q

CURB 65 score 0-1

A

Treat outpatient

54
Q

CURB 65 score 2

A

Admit

55
Q

CURB 65 score 3-5

A

Assess for ICU

56
Q

Who needs a follow-up CXR following abx treatment?

A

Smokers

57
Q

Abx treatment for outpatient and no abx in last 3 months

A
  1. Macrolide OR

2. Doxycyline

58
Q

Abx treatment for outpatient with:
abx in last 3 months
Macrolide resistant S.pneumoniae

A
  1. Respiratory Fluoroquinolone OR

2. Beta-Lactam + Macrolide

59
Q

Abx treatment for Inpatient, Non-ICU

A
  1. Respiratory Fluoroquinolone OR

2. Beta-Lactam + Macrolide

60
Q

Abx treatment for ICU patients

A

Anti-pneumococcal beta-lactam PLUS:

  • azithromycin OR
  • respiratory fluoroquinolone
61
Q

Abx treatment for ICU patients with PCN allergy

A

respiratory fluoroquinolone + aztreonam

62
Q

CAP treatment if pseudomonas risk

A

Antipneumococcal, antipseudomonal beta lactam*
+
ciprofloxacin or levofloxacin (750 mg)

63
Q

Duration of inpatient treatment

A

Minimum of 5 days and:

  1. Afebrile for 48-72 hours
  2. Supplemental O2 not needed
  3. Heart rate < 100
  4. RR < 24
  5. SBP ≥ 90 mm Hg
64
Q

List CAP Vaccination Prevention

A
  1. Influenza- All
  2. PPSV23 (Pneumovax)- Adults > 65 y.o.
  3. PCV13 (Prevnar)- All <2 y.o.
65
Q

Hospital Acquired Pneumonia (Nosocomial) Definition

A
  • 48 hours or more after admission

- Did NOT appear to be incubating at the time of admission

66
Q

Ventilator Associated Pneumonia definition

A
  • type of HAP

- Develops more than 48 – 72 hours after endotracheal intubation

67
Q

Etiology of HAP and VAP

A
  1. Aerobic gram-negative bacilli: E.coli, Klebsiella, enterobacter, pseudomonas aeruginosa
  2. Gram (+): S. aureus, Strept.
68
Q

HAP and VAP diagnosis

A

New lung infiltrate + evidence that the infiltrate is of infectious origin:

  1. New onset of fever
  2. Purulent sputum
  3. Leukocytosis
  4. Decline in oxygenation
69
Q

Duration of treatment in HAP/VAP

A

14-21 days

7 days if responding to tx

70
Q

What organism ALWAYS gets the full 14-21 days of tx?

A

Pseudomonas aeruginosa

71
Q

Best treatment of VAP

A

Prevention!

  • Avoidance of acid-blocking meds
  • Decontamination of oropharynx
72
Q

What is a common complication of viral pneumonia?

A

Secondary bacterial pneumonia= STAPH!

73
Q

What is the most common opportunistic infection in AIDS pt’s?

A 
Pneumocystis jirovecii (Pneumocystis carinii, ‘PCP’)
-Atypical Fungi
74
Q

Pneumocystis pneumonia treatment

A

TMP-SMX (Bactrim) x 21 days

+/- corticosteroids based on severity

75
Q

Prophylaxis Pneumocystis pneumonia Tx for AIDS pt’s

A

CD4 count < 200

TMP-SMX (bactrim)

76
Q

Organism that cause Aspiration Pneumonia

A
  1. Gram (-)

2. Anaerobic pathogens

77
Q

Aspiration Pneumonia clinical présentation

A

Cough with foul smelling purulence

Poor dentition

78
Q

How do you obtain a culture for Aspiration Pneumonia

A
  1. Transthoracic aspiration
  2. Thoracentesis
  3. Bronchoscopy
79
Q

What is a common CXR findings in Aspiration pneumonia?

A

RLL infiltrate

80
Q

Aspiration pneumonia abx treatment

A

Clindamycin or amoxicillin-clavulanate (Augmentin)

Foundations-Pulmonary (9 decks)

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