pneumonia

Question 1

what is pneumonia?

Answer 1

inflammation of alveoli or interstitium of lung cause my microorganism (bacteria, viral, fungal)

Question 2

how is pneumonia classified and what are the 4 types we went over?

Answer 2

by source of infection
major groups: - CAP: community acquired 
-HAP: hospital acquired 
minor groups: -HIV associated (immunocompromised) 
-Flu associated MRSA pneumonia

Question 3

how long must you have been at the hospital for it to be classified as HAP?

Answer 3

48 hrs after admission

Question 4

3 risk factors for CAP

Answer 4

extremes of age, alcoholism, other medical conditions (i.e. DM)

Question 5

3 types of CAP

Answer 5

bacterial (worse symptoms, 85% of cases) viral (milder symptoms) fungal (only in immunocompromised people)

Question 6

3 typical bacterial organisms that cause CAP

Answer 6

Strep Pneumo, H flu, M catarrhalis

Question 7

which bacterial organisms for CAP are penicillin sensitive and penicillin resistant

Answer 7

Strep pneumo- sensitive
H flu- somewhat resistant- txt w/ Beta Lactamase inhib
M cattarrhalis- resistant

Question 8

3 atypical bacterial organisms that cause CAP

Answer 8

legionella, mycoplasma, C pnemoniae

-usually less acute symptoms w/ less productive cough

Question 9

rare bacterial pathogens that cause CAP and what are they assosciated with?

Answer 9

klebsiella (w/ alcoholism)
staph aureus (w/ flu)
* recent reports of recent fatal CA-MRSA pneumonia

Question 10

inoculation of pneumonia

Answer 10

microaspiration

Question 11

clinical presentation of pneumoniae, how are these different if its viral?

Answer 11

symptoms come on rapidly, early onset cough (if productive it is purulent), pleurisy (localized chest pain w/ breathing), maybe SOB and dec. pulse ox
*viral: same symptoms but more mild

Question 12

respiratory rate w/ pneumonia

Answer 12

commonly increased

Question 13

PE for pneumonae

Answer 13

• bronchial breath sounds in periphery (consolidation, fluid filled causes transmitted sounds to travel)
• dull to percussion (effusion)
• crackles (pus in alveoli)

Question 14

Dx for simple pneumonia (no hospital admission)

Answer 14

chest x ray (gold standard) : shows interstitial infiltrates (pus in lung tissue) or consolidation (pus in airways- alveoli)

Question 15

txt for pneumoniae: abx?

Answer 15

tripack > Zpack

azithromycin: 1 pill/day for 3 days

Question 16

if Dx with CAP and considering hospitalization, what two further tests will you run?

Answer 16

deep cough sputum culture before giving abx and gram stain

Question 17

additional tests for CAP and hospitalizing… to evaluate severity..

Answer 17

pulse ox (if not as sick), ABG (if very sick) 
procalcitonin to evaluate severity (elevated w/ sepsis)

Question 18

6 signs that pt should be admitted with CAP

Answer 18

neutropenia, multilobar infection, 50+yo and other med. problems, altered mental status, low BP

Question 19

if CAP and hospitalized, what drugs (in general) are you giving?

Answer 19

IV Abx, multi-drug therapy

Question 20

4 requirements to give oral abx and discharge

Answer 20

able to take PO, WBC decreasing, afebrile, improving cough and SOB

Question 21

when txt considered failed?

Answer 21

if not better in 72 hours: this might mean you gave the wrong drug, the bug was resistant or there are other complications (i.e. empyema)

Question 22

what is empyema?

Answer 22

collection of pus in pleural cavity (abx cant reach these) (might need thoracentesis and drainage)

Question 23

symptoms get better before _____ gets better

Answer 23

chest xray (for longterm followup)

Question 24

klebsiella pneumoniae has what as a risk factor?

Answer 24

alcoholism

Question 25

“walking pneumonae” usually refers to what?

Answer 25

viral pneumonia (same symptoms but more mild)

Question 26

mortality for HAP

Answer 26

high: 20-50%

Question 27

HAP is usually from what source?

Answer 27

bacterial

Question 28

clinical presentation for HAP

Answer 28

change in clinical status: those in hospital should be improving NOT declining

Question 29

labs and Dx test for HAP

Answer 29

chest Xray
procalcitonin
*sputum
*blood cultures (helpful if positive)

Question 30

w/ HAP, there is a risk with _____

Answer 30

treating empirically- overtreating

start with broad spectrum then narrow based on culture results (risk of bug resistance in hospital)

Question 31

when did we see flu assosciated pnumonaie and who did it effect?

Answer 31

young healthy people

2008: very severe mortality from flu–>MRSA–>pneumonae
2014: –> strep pneumoniae

Question 32

index of suspicion of post-flu pneumonia is elevated by…

Answer 32

Hx of skin infection, recent flu, multilobar disease, lack of txt response, no flu vaccine

Question 33

SARS and MERS cause by what virus?

Answer 33

mutated coronavirus - very high mortality

Question 34

what is the most common opportunistic infection in HIV?

Answer 34

pneumocystitis jiroveci

Question 35

low CD4 counts mean what?

Answer 35

low immune system (HIV pts have this)

Question 36

many AIDs pts receive prophylactic azithromycin until their CD4 counts are up to avoid what kind of pneumonia?

Answer 36

mycobacterium (fungal)

Question 37

most common types of mycobacterium pneumoniae

Answer 37

histoplasmosis- midwest from bird droppings

occidiomycosis- southwest

Question 38

old people have less or more severe signs and symptoms of infection

Answer 38

less- dont mount immune response as well. Be wary of old people whose vitals are bad- this means the infection must be really bad.

Question 39

major clinical presentation in elderly with pneumonia

Answer 39

tachypnea

Question 40

what is BOOP?

Answer 40

bronchial obliterans organizing pneumoniae : bronchial and alveolar fibrous plugging
–> looks like pneumonia but isnt infectious

Question 41

etiology of BOOP

Answer 41

immune hypersensitivity and resulting fibrosis

Question 42

txt for BOOP

Answer 42

steroids - but hard to taper off b/c signs recur once you start lowering