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001 Respiratory Therapy > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

What is the basic definition of pneumonia

A

Infection in the lung

Also known as a respiratory tract infection

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2
Q

Lobar Pneumonia

A

Involvement of entire lung lobe

Typically is the end result of severe or chronic bronchopneumonia that has spread of one lung segment to another until the entire lung is involved

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3
Q

Double Pneumonia

A

Involvement of both lungs

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4
Q

Walking Pneumonia

A

Mild case of pneumonia where the patient remains ambulatory

Often caused by mycoplasma pneumoniae

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5
Q

What are the different causes of pneumonia

A

Bacteria

Viruses

Fungi,

Protozoa,

Parasites,

TB,

anaerobic organisms,

aspirations

Inhalation of irritating chemical like chlorine

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6
Q

Bronchopneumonia

A

Patchy pattern of infection limited to segmental bronchi and surrounding lung parenchyma

Usually involves both lungs

Seen more often in lower lobes

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7
Q

polymorphonuclear leukocytes

A

Will go into the alveoli with bacterial pneumonia in order to clear out the infection

Will not travel into the alveoli for interstitial pneumonia

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8
Q

Interstitial pneumonia

A

Diffuse and often bilateral inflammation that primarily involves the alveolar septa (separates adjacent alveoli) and the interstitial space

Mycoplasma pneumonia and other viruses cause interstitial pneumonias.

Most interstitial pneumonias cause only minor permanent alveolar damage and usually resolve without consequences.

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9
Q

CURB-65

A

CURB-65, is used to help predict mortality for CAP and guide where the patient shout be treated

C-Confusion

U-Blood urea >20 mg/dl

R-RR >30

B-Blood pressure with systolic <90 or diastolic <60

65-Is the patient greater than 65

If any of the above questions are answered yes, then it is considered to be one point

1 or 2 risk criteria-outpatients

2 criteria-wards

three or more risk factor should be treated in ICU

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10
Q

The risk factors for the development of HAP and VAP

A
  • Factors that interfere with hosts immunity
    • Underlying illness
    • Certain interventions (intubation or trach)
    • Meds such as sedative and corticosteroids
  • Factors the encourage exposure to pathogenic micro-organisms
    • Endotracheal or nasogastric tube
    • Contaminated equipment
    • Prior antibiotic therapy
    • Neutralization of gastric pH
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11
Q

Non-ventilated patient mortality risk with pneumonia increased when there is

A

Bilateral infiltrates

Respiratory Failure

Infection with high risk organism

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12
Q

Ventilated patient mortality risk with pneumonia increased when there is

A

Infection with high-risk organisms such as P. aeruginosa, Acinetobacter species, and Stenotrophomonas maltophilia

Multisystem organ failure

Nonsurgical diagnosis

Therapy with antacids or histamine-2 (H2)-receptor antagonists

Transfer from another hospital or ward

Renal failure

Prolonged mechanical ventilation

Coma or shock

Inappropriate antibiotic therapy

Hospitalization in a noncardiac ICU

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13
Q

Empiric anti-microbial therapy and Pneumonia

A

Empiric anti-microbial therapy is used while a definitive microbiologic diagnosis is awaited

Empiric therapy is treatment that is initiated based on the most likely cause of infection when the specific cause is unknown

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14
Q

In ~50% of patient a microbiologic diagnosis has not been made which can be attributed to

A

Inability for patient to produce sputum

The sputum acquisition is done after antibiotics has been started

There is a failure to perform routine serologic studies in all patients

Many different organisms (viruses and anaerobic bacteria) are not routinely tested for

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15
Q

fomites

A

Objects capable of transmitting infection through physical contact with them

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16
Q

what is VAP

A

VAP stands for Ventilator-Associated Pneumonia and is basically pneumonia that develops 48 hours or longer after mechanical ventilation is initiated on a patient.

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17
Q

What are the three most common gram-negative organisms associated with VAP?

A

(1) Pseudomonas aeruginosa, (2) klebsiella pneumoniae, and (3) E. Coli

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18
Q

What is the most common gram-positive organism associated with VAP?

A

Methicillin-Resistant Staphylococcus Aureus

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19
Q

What kind of secretions typically does a diagnosed VAP patient have?

A

Strong smell (purulent)

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20
Q

What fungi can cause VAP in immunocompromised patients?

A

Aspergillus

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21
Q

What is pneumonia?

A

Pneumonia is an inflammatory condition of the lungs primarily affecting the alveoli which may fill with fluid and pus. It is an acute infection of the lung parenchyma.

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22
Q

What is the assessment of viral pneumonia?

A

Low-grade fever, non-productive cough, WBC normal to low elevation, less severe than bacterial.

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23
Q

What can be assessed on patients with bacterial pneumonia?

A

High fever, productive cough, WBC elevated, chest X-ray show infiltrates more severe.

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24
Q

What medication therapy can be used for pneumonia?

A

Antibiotics, bronchodilator, and corticosteroids.

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25
Q

What type of pneumonia is frequently undiagnosed?

A

Nonbacterial Pneumonia.

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26
Q

What are the three key signs of bacterial pneumonia?

A

Expectoration of yellow sputum, increased white blood cell count, and the presence of fever.

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27
Q

What type of anatomic alteration leads to aspiration pneumonia?

A

Alveolar consolidation – atelectasis – inflammation of the alveoli.

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28
Q

What term applies to the filling of alveolar spaces as a result of pneumonia?

A

Effusion.

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29
Q

The expression “walking pneumonia” is generally applied to patients with what type of pneumonia?

A

Mycoplasma pneumonia

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30
Q

What is the most commonly found bacterial cause of pneumonia?

A

Streptococcus pneumonia

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31
Q

What are some of the viruses that can cause pneumonia?

A

Influenza A or B, respiratory syncytial virus, rhinovirus, and coronavirus (SARS, MERSCoA).

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32
Q

What are some of the fungi that can cause pneumonia?

A

Cryptococcus, histoplasma, coccidioides, aspergillus and mucor.

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33
Q

What are some of the non-infectious etiologies of pneumonia?

A

Carcinomas, lymphomas, vasculitis, sarcoidosis, heart failure and pulmonary embolism.

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34
Q

What is the problem with pneumonia?

A

Even with antibiotics, patients with pneumonia have a high morbidity and mortality rates with the highest incidence in 1-4-year-olds or over 65.

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35
Q

What is hospital-acquired pneumonia?

A

This type of pneumonia is a ventilator associated and health care associated and happens at least 48 hours – 72 hours or more after admission to the hospital.

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36
Q

What is the pathophysiology of pneumonia?

A
  1. Trigger inflammatory response-Increase blood flow and vascular permeability
  2. Neutrophil activation
  3. Microorganism enter alveoli
  4. Extotxin produced by bacteria or cell lysis caused by viruses
  5. Increased vascular permeability
  6. Macrophage recruitment
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37
Q

What is the inflammatory response?

A

More neutrophils are activated (cascade effect) resulting to edema of the airways and fluid leaks from the capillaries to the alveoli. This affects normal oxygen transport.

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38
Q

What are the mechanical barriers from a bacterial infection?

A

Mechanical barriers include air filtration, epiglottis, cough reflex, and mucociliary response; reflex bronchoconstriction; and, secretion of immunoglobulins A and G and alveolar macrophages.

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39
Q

Why is antibiotic therapy beneficial for pneumonia?

A

Macrophages break down the bacteria and process the debris, lung tissue is allowed to recover and gas exchange returns to normal. They help to result in homeostasis and healing occurs if there are no other complications.

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40
Q

What type of pneumonia is more common in children and young adults?

A

Viral pneumonia.

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41
Q

What type of pneumonia is more common in adults and elderly?

A

Strep pneumonia.

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42
Q

What type of pneumonia is commonly found in people with HIV?

A

Pneumocystic jiroveci (FUNGAL).

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43
Q

What are the most common forms of pneumonia in neonates (0-1 month)?

A

Group B Strep and HSV.

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44
Q

What is the most common cause of pneumonia in infants (1-6 months)?

A

Bordetella pertussis and chlamydia trachomatis.

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45
Q

What is the most common cause of pneumonia in children (6 months – 5 years old)?

A

RSV and influenza.

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46
Q

What is the most common pathogen found on a young, healthy adult contracting pneumonia?

A

Mycoplasma.

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47
Q

What is the most common cause of pneumonia in older adults?

A

Strep pneumonia and H. flu.

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48
Q

What chest x-ray finding would indicate that the pneumonia will be difficult to treat and is life threatening?

A

Lung abscess (pus in the lung).

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49
Q

What are the atelectasis findings on a chest x-ray?

A

Collapse or incomplete expansion of the lung, loss of volume, Dyspnea or respiratory failure if severe and apex will usually be at the hilum.

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50
Q

What chest x-ray finding is usually associated with empyema (pus in the lung)?

A

Parapneumonic effusion.

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51
Q

What is a bronchogram on chest x-ray?

A

Air filled bronchi made visible by opacification of surrounding alveoli and peribronchial cuffing/thickening.

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52
Q

What will you usually see on a CBC with pneumonia?

A

Leukocytosis and L shift.

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53
Q

What should true sputum show when trying to find the cause of pneumonia?

A

An abundance of inflammatory cells, no squamous epithelial cells and large numbers of a single organism.

54
Q

What pattern of pneumonia will have entire lobe consolidation and is commonly caused by Klebsiella?

A

Lobar. It can usually be seen in bronchograms too.

55
Q

What pattern of pneumonia is multifocal and patchy and usually seen with staph, strep, and h. flu pneumonia?

A

Bronchopneumonia

56
Q

What pattern of pneumonia is caused by viruses?

A

Interstitial that is characterized by a ground glass appearance.

57
Q

What are the four most common symptoms of pneumonia?

A

Productive cough, shortness of breath, chest pain, fevers and chills.

58
Q

What are the typical and atypical organisms associated with community-acquired pneumonia?

A

Typical involves S pneumoniae (pneumococcus), which is the most common cause requiring hospitalization, Haemophilus and Staphylococcus species. While atypical is caused by legionella, mycoplasma, chlamydia species and pneumocytis jiroveci (associated with HIV diagnosis).

59
Q

What factors impair pulmonary clearance of pneumonia?

A

Viral upper respiratory tract infection, smoking, alcohol, uremia (raised levels of urea and other nitrogenous waste compounds in the blood), and bronchial obstruction.

60
Q

What is the difference between typical (virulent) and atypical pneumonia?

A

Typical has an abrupt onset characterized productive cough with purulent sputum, pleuritic chest pain, impressive physical findings, leukocytosis with left shift or leukopenia, abdominal pain and high fever. This type responds to beta-lactams.

While atypical has a gradual onset that presents nonproductive/dry cough, sub-sternal chest pain, unimpressive physical exam, WBC count normal (no left shift), and nonspecific symptoms (headaches, malaise, nausea, vomiting, diarrhea, interstitial or patchy infiltrate). This type responds to macrolides and quinolones.

61
Q

What indications are observed to determine the type of organism that caused the pneumonia infection?

A

Patients are observed by their chills, relative bradycardia and sputum.

For chills, a single chill suggests S. pneumoniaewhile multiple chills suggest S. aureus or K. pneumoniae. For relative bradycardia, association with viral infection, mycoplasma pneumonia, psittacosis, tularemia, and legionella spp.

Sputum is identified if rust-colored sputum or currant-jelly. Rust-colored sputum suggests association with infection by S. pneumoniae while currant-jelly sputum is associated with infection by Klebsiella species. Foul-smelling or bad-tasting sputum is often produced by anaerobic infections.

62
Q

Pneumonia Definition

A

Pneumonia is the result of an inflammation process that primarily affects the gas exchange of the lungs

In response to inflammation fluid (serum) and RBC from adjacent pulmonary capillaries will pour into the alveoli (this fluid transfer is known as effusion)

8th leading cause of death

63
Q

Consolidation in the Lungs

A

When an infection is overwhelming the alveoli will become filled with fluid , RBC, leukocytes, and macrophages

When this happens the lungs are considered to be consolidated

When this happens the alveolar structure will be maintained meaning that after the pneumonia has been resolved there will be minimal residual destruction to the parenchyma

64
Q

Pneumonia as a Insidious Disease

A

Pneumonia is an insidious disease as symptons depend upon underlying condition and organism causing pneumonia

65
Q

High Risk Groups for Pneumonia

A

Seen in the hospital with other co-morbidities, but anyone can get pneumonia

High-risk groups for pneumonia

  • COPD
  • HIV
  • Altered LOC/dyspnea/dementia
  • Patient undergoing chemotherapy
  • Intubated
  • Recent Surgery
  • Paraplegic
  • Pregnant
  • Alcoholics
66
Q

Anatomical Alterations of the Lungs

A

Inflammation of Alveoli

Alveolar Consolidation-Blocks alveoli

Atelectasis-E.g. Aspiration pneumonia

Increased Alveolar Capillary Membrane Thickness

Excessive Bronchial Secretions-During resolutions phase

67
Q

Bronchopneumonia

A

Inflammation in the bronchi

Bilateral

68
Q

Lobar Pneumonia

A

Involvement of entire lung lobe

Widespread in the alveoli

69
Q

Double Pneumonia

A

Involvement of both lungs

Bilateral

70
Q

Walking Pneumonia

A

Mild case of pneumonia

Typically mycoplasma pneumonia

Patient remains ambulatory

71
Q

Gram-Negative Organism

A
  • Haemophilus Influenzae
  • Klebsiella
  • Pseudomonas Aeruginosa
    • 1st degree killer
      • Primary killer in hospital pneumonia
        *
72
Q

Gram-Positive Organism

A

Streptococcus-Most common community pneumonia

Staphylococcus-Most common hospital acquired (E.g. MRSA)

73
Q

Bacterial Causes

A

Alveolar exudates will be mainly composed of neutrophils

It is important to promptly get a gram stain and culture analysis

Can be gram positive or gram negative

74
Q

Atypical Organism

A

Organism escapes standard identification from bacterial test

Moderate sputum

Absence of alveolar consolidation

Only moderate WBC elevation

Lack of alveolar extubate

75
Q

Atypical Organism Types

A
  • Myocoplasma Pneumoniae
    • Most common acquired atypical pneumonia
    • Walking pneumonia
  • Legionella Pneumonia
    • Found in hot tubes
    • Middle age smokers
  • Chamydia Osittaci
    • School aged children
  • Chlamydia Pneumoniae
76
Q

Viral Causes

A

Viral cases account for 50% of pneumonia cases

Influenza A and BVirus

Respiratory Syncytial Virus (RSV)-Tends to affect children younger than one year, with a seasonal presentation

Parainfluenza Virus-Affects all ages and will spread quickly

Adenovirus-Affects all ages with a high morbidty in children

Coronavirus (SARS)

H1N1 (Swine Flu)

77
Q

Other Causes of Pneumonia

A

Rickettsial Infections

Varicella

Rubella

Aspiration Pneumonitis

Lipoid Pneumonitis

Immuno-comprimised Patients

AIDs Patients

Tuberculosis

Fungal infections

Avian Influenza A

78
Q

Cryptogenic Organizing Pneumonia (COP)

A

Unknown cause

No consolidation

Appear with history of dry cough

Inflammatory process

Treated with steroids

Rare and very severe

Can reoccur

79
Q

Acquired Pneumonia Classifications

A

Community-Acquired Pneumonia (CAP)

Nursing home acquired pneumonia

Hospital-Acquired Pneumonia

Ventilator-Associated Pneumonia

80
Q

Community Acquired Pneumonia-Typical Acute Forms

A

Streptococcus Pneumoniae

Haemophilus Influenza

Moraxella Catarrhalis

Staphylococcus Aureus

81
Q

Community Acquired Pneumonia-Chronic Forms

A

Mycobacterium tuberculosis

Histoplasma capsulatum

Coccidiodes Immitis

Blastomyces Dermatiditis

82
Q

Immuno-Comprimised Host

A

Pneumocystic Carinii

Cytomegalovirus

Aspergillus Species (Fungal)

Cryptococcus Neoformans (Yeast)

Re-Activation of Tuberculosis or Histoplasmosis

83
Q

Aspiration

A

Not always nosocomial

Patients with GERD (asthma, pregnant) will be more acidic when they aspirate which also puts them at greater risk for ARDS

Trach patients will have difficultly swallowing which will put them at a higher risk for aspiration pneumonia (especially when the cough is inflated)

Mixed aerobic and anaerobic species

Enteric-Normal gram negative

Staph Aureus

84
Q

Mendelson’s Syndrome

A

Clinical picture of aspiration pneumonitis in pregnant women

Include tachypnea, dyspnea, and cyanosis

85
Q

Silent aspiration

A

Aspiration that does not evoke observable adverse symptoms

86
Q

Ventilator Associated Pneumonia

A

Most common nosocomial infection

Pseudomonas Aeruginosa-1 Degree Killer

Acinetobacter Species

Enterobacter Species

Klebiella

Staphylococcus Aureus

Moraxella Catarrhalis

87
Q

Typical Process of Pneumonia

A
  1. Begins with alveoli filled with exudate and pathogen (edema)
  2. Early consolidation RBC and neutrophils
  3. Severe consolidation, phagocytation by polymorpho-nuclear neutrophils, PMNS
  4. Resolution macrophages replace neutrophils, debris clean up
88
Q

Lung Exudate

A

Exudate: A fluid rich in protein and cellular elements that oozes out of blood vessels due to inflammation and is deposited in nearby tissues.

89
Q

Streptococcal Pneumonia Treatment

A

Most strains are sensitive to pencillin and its derivities

90
Q

Streptococcal Pneumonia Onset

A

Will tend to begin in the upper airway (URT infection) and then move down

Will have an abrupt onset with a cough, shaking, and chills

91
Q

Streptococcal Pneumonia

A

Gram positive

Accounts for over 80% of bacterial pneumonia

The bacteria is enclosed in a sugar jacket (polysaccharide) which accounts for their virulence (how fast and aggressive they spread)

Splinting (immobilization) causes a low tidal volme and tachypnea

Mixed red and grey hepatization

Fibrinous pleural exudate

92
Q

Streptococcal Pneumonia Sputum

A

Rusty color sputum from hemorrhagic caps

93
Q

Streptococcal Pneumonia Transmission

A

Aerosol

Cough, Sneeze

94
Q

Streptococcal Pneumonia Breath Sounds

A

Fine crackles, pleural rub,

95
Q

Staphylococcal Pneumonia Breath Sounds

A

Coarse and medium crackles

96
Q

Staphylococcal Pneumonia Clinical Presentation

A

High fever

Hemoptysis

Pleuriti adhesions

Etiology has a definite respiratory componenet

97
Q

Staphylococcal Pneumonia

A

Gram positive

The patient will often need to be intubated

Will often be nosocomial as it is the main hospital acquired pneumonia

Origin on normal flora of humans

Half the population are carrier, but it is rare to see this as a community acquired disease unless there is a influenze outbreak, as it often follows a predisposing viral infection (super infection after a viral insult)

Can cause emphysema, cavitation, abscess, potential pneumothorax on the lung and endocarditis and tri cuspid lesions and the heart

Often seen in children and immunosuppressant adults

There is a high mortality rate due to the complexity of the disease

98
Q

Staphylococcal Pneumonia Types

A

Staphylococcal Aureus-Most virulent

Staphylococcus Epidermidis-In the normal flora of the skin

99
Q

Staphylococcal Pneumonia Treatment

A

Methicillin-Susceptible Strains-Nafcillin

Methicillin-Resistant Strains-Vancomycin

This is very difficult to treat and often we need to conslt a specialist

100
Q

Staphylococcal Pneumonia Transmission

A

Aerosol-Cough

On any surface after a viral infection

101
Q

Klebseiella (Friedländer’s)

A

Gram Negative

Commonly seen in diabetics, the homeless, alchoholics, trach pt. and men over 40

Sudden onset

Hemptyosis

There is a significant mortality rate as it can lead to septicemia

Often nonsocomial

Can be misdiagnosed as TB due to abscess formation

1st or 2nd super infection pathogen

looks like currant jelly sputum

102
Q

Klebseiella (Friedländer’s) Transmission

A

Can be aerosol but more likely is contact from food and unclean hands

103
Q

Klebseiella (Friedländer’s) Origin

A

Fecal/oral route

Normal flora of GI tract

Aerosol

104
Q

Klebseiella (Friedländer’s) Treatment

A

3rd or 4th Generation Cephalosporins (ceftazidime, ceftriaxone)

Aminoglycoside

Antipseudomonal

Penicillin

Monobactam (aztreonam)

Quinolone

105
Q

Klebseiella (Friedländer’s) Resolution

A

Resolution

Will have a large number of organisms such as necrotizing and fibrin (scar) producing elements during the resolution

106
Q

Pseudodomas Aeruginosa

A

Gram negative

Can be confused with flesh eating disease

Can be seen in ICU with pt. who are immuno comprimised

107
Q

Pseudodomas Aeruginosa Tranmission

A

Aerosol or freshly contaminated surfaces

Often will be nosocomial and due to respiratory equipment (ex. Trachs)

Often cultured especially in aquesouns solution (loves dampness)

108
Q

Pseudodomas Aeruginosa Origin

A

Normal GI flora

Meaning wash your hands after you use the bathroom

109
Q

Pseudodomas Aeruginosa Treatment

A

Trobramycin

110
Q

Pseudodomas Aeruginosa Sputum

A

Copious production

Greenish

Sweet smelling sputum

111
Q

Pseudodomas Aeruginosa Clincal Presentation

A

Fever

Rigors

Abscesses

112
Q

Pseudodomas Aeruginosa Mortality Rate

A

High Mortailty rate

113
Q

Haemophilus Influenza

A

Smallest gram negtaive

often seen secondary to a viral infection

With a severe infection there is a 30% mortality rate

114
Q

Haemophilus Influenza Transmission

A

Aerosol

Recently contaminated surfaces-It does not liek the cold and will not last long out side of the body (not easy to transmit)

The above are also the origin of the disease

115
Q

Haemophilus Influenza Treatment

A

Ampicillin

116
Q

Haemophilus Influenza Affected Populations

A

Commonly seen in small children where it can cause acute epiglottitis

Also seen in pt. with COPD, alchoholics,

117
Q

Haemophilus Influenza Clinical Presentation

A

Low leve cough

Fever

Will grow to dyspnea-Not a fast acting disease

Purulent spurum

Patchy infiltrates on x-ray

118
Q

Viruses

A

Non-living pathogens

Parasites that are dependent upon living cells for nutrition and replication

Have protein spikes on their surface which will match to receptor sites on specific cells (designation H and N)

These spikes can facilitate penetration of the usually intact cell membrane and allow viruses to either inject RNA or the entire viral packet into the cell

Once inside the cell the viral RNA will force copes of itself to be made

Viruses will often kill the host cell through using up all the cells nutrients and proteins and initiating over production of RNA packets which will lead to burst of the cell membrane

119
Q

Influenza Viral Pneumonia

A

Severe parencyma congestion, hemorrhage, edema, consolidation, and emphysema

The A/C membrane will thicken by the edema, capillaries will engore, alveoli filled with type I and II cells leukocytes, and macrophages (fibrin producing)

Can be diagnosed though symptons and a rapid antigen test will can produce results in 15 min but is high in false negatives

120
Q

Criteria for Severe Designation

A
  1. RR over 30 at rest
  2. PaO2 less than 60 on 30% or more O2
  3. Multiple lob involment
  4. Shocky;
  5. Low BP; systolic under 90 and diastolic under 60
  6. Low Urine Output-Less than 20 ml/hr
121
Q

General Physical Examination

A

Vital signs-Tachycardia, tachypnea, increase blood pressure

Chest pain and decreased chest expansion-Moved to pleural space and painful

cyanosis

cough, sputum, hemoptysis

Confusion and mood change (may mean septic shock)

Nausea and vomitting

122
Q

Chest Assessment

A

Incresed tactile and vocal fremitus

dull percussion

bronchial bretah sounds throughout

crackles and wheezes

pleural friction rub-if in pleural space

increased whispered pectoriloquy

123
Q

Pulmonary Function Test

A

Restrictive

124
Q

Arterial Blood Gases- Severe Stages

A

Acute Alveolar Ventilation with hypoxemia

Acute Respirtory Acidosis

125
Q

Arterial Blood Gases- Mild to Moderate Stages

A

Acute Alveolar hyperventilation with hypoxemia

Acute Respirtory Alkaslosis

126
Q

Oxygenation Indices

A

Pulmonary shunt (Qs/Qt)

127
Q

Chest Radiograph

A

Increased density (from consolidation and atelectasis)

Air Bronchograms

Pleural Effusion

128
Q

General Mangement of Pneumonia is Based Upon

A

Specific etiology of the Pneumonia-Bacteria, Virus, Aspiration

Severity of Symptons

129
Q

Fungi-Causes

A

Aspergillus Species

Cryptococcus Neoformans

Cardida Species

130
Q

Bacterial Causes- Types

A

Streptococcus Pneumonia

Staphylococcus Aureus

Hemophilius Influenza

Pseudomonas Aerginosa

Kledsiella Pneumonia

Legionella Species

Mycoplasma Pneumonia

Chalmydia Species

131
Q

Types of Protozoa

A

Pneumocystis Carinii

001 Respiratory Therapy (53 decks)

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