Pneumonia Flashcards
what is the most common lethal nosocomial infection
- hospital acquired pneumonia
the most common route of bacterial infection in the lung is
- aspiration of pathogen
what is aspiration
- inhaling of pathogens that colonize the oropharynx
what organism is well spread by hematogenous route of infection
- staph aureus
onset of typical pneumonia
- rapid onset
appearance of patient with typical pneumonia
- ill appearing
lung exam of patient with typical pneumonia
- consolidation
- crackles on exam
white count of patient with typical pneumonia
- high white count
CXR of patient with typical pneumonia
- airspace filling
- lobar infiltrate
typical pneumonia organisms
- Strep pneumo
- Staph aureus
- gram negative bacilli
onset of atypical pneumonia
- later onset
appearance of patient with atypical pneumonia
- less ill appearing
lung exam of patient with atypical pneumonia
- crackles without consolidation
white count of patient with atypical pneumonia
- mild/no elevated white count
CXR of patient with atypical pneumonia
- patchy/interstital infiltrates
atypical pneumonia organisms
- mycoplasma
- chlamydia
- viruses
what pneumonia causing organisms are associated with alcoholism, nursing home, cardiopulmonary disease
- aerobic gram negative bacilli
what pneumonia causing organisms are associated with loss of consciousness, swallowing dysfunction, poor dental hygiene, airway obstruction, neuromuscular weakness/stroke
- anaerobes
what pneumonia causing organisms are associated with COPD and smoking
- H. influenzae
what pneumonia causing organisms are associated with nursing homes, post influenza, IVDA, bronchiectasis
- S. aureus
what pneumonia causing organisms are associated with structural lung disease, recent broad spectrum antibiotics, malnutrition, chronic steroids
- P. aeruginosa
what pneumonia causing organisms are associated with age > 65, beta lactate therapy within 3 months, exposure to child in daycare, underlying medical co-morbidities
- drug resistant strep pneumonia
we use urine antigens for which organisms
- legionella
- strep pneumo
- histoplasma
what stain do you use for fungus on a culture?
- KOH
upper lobe cavitary infiltrate is indicative of which infection
- TB
exposure to outdoorsmen is indicative of which infection
- blastomycosis
exposure to the desert Southwest is indicative of which infection
- coccidioidomycosis
respiratory rate for severe vital sign
> 30
Systolic BP for severe vital sign
< 90
Temperature for severe vital sign
> 40 or <35
HR for severe vital sign
> 125
WBC numbers for severe vital signs
> 30 K or < 4K
initial treatment for pneumonia is always
- empiric
pathogenesis of hospital acquired pneumonia
- colonization of pharynx with pathogenic bacteria
- micro-aspiration of lower respiratory tract
is hospital acquired pneumonia based solely on a new culture result
- no
treatment of hospital acquired pneumonia based on
- local hospital flora
common pathogens in the hospital
- P. aeruginosa
- Enterobacter
- E. Coli
- Klebsiella
- Acetinobacter
- MRSA
- Anaerobes
KEEP AMA
neutropenic patients susceptible to infections by these organisms
- bacteria
- aspergillus
- candida
splenectomy patients susceptible to infections by these organisms
- encapsulated organisms
HIV or immunosuppressant patients susceptible to infections by these organisms
- fungi
- mycobacteria
- viruses (CMV, EBV)
- bacteria
important infection with a CD4 below 200
- PJP
what is the most likely diagnosis of a symptomatic HIV+ patient with an abnormal CXR
- bacterial pneumonia
treatment of PJP in patients with AIDS
- SMX/TMP
- IV pentamide
- Corticosteroids
most common causes of pnuemonia
- strep pneumo
- H. flu
- M. catarrhalis
what type of TB presentation do you see in patients with a higher CD4 count
- typical presentations
what type of TB presentation do you see in patients with a lower CD4 count
examples
- atypical
- lower zone infiltrates
- mediastinal adenopathy
- disseminated disease
