Pneumonia

Question 1

What is pneumonia

Answer 1

Infection in the lungs caused by microbes.

Infection brings water in the lungs, making it hard to breathe

Question 2

Pneumonia symptoms

Answer 2

Fever, Chills, Pleuritic chest pain, hypoxemia, Productive cough

Rust colored sputum suggests streptococcal pneumonia (Gram positive diplococci)

Question 3

Defense mechanisms that prevent pneumonia in healthy individuals

Answer 3

Nasal hairs, mucosa and dynamics of airflow all act early to prevent inhalation of microorganisms

Epiglottis and cough reflex act to prevent particulate matter from traveling into the deeper airways

The respiratory tract is lined with mucus until the terminal bronchioles. Ciliated epithelium propels mucus upward eliminating foreign material as expectorant

The last line of defense is in and around the alveolar complex and is composed of macrophages, neutrophils, immunoglobulin and complement which become hyperactive during an infectious process.

Question 4

What do you know about aspiration pneumonia

Answer 4

infectious process caused by inhalation of oropharyngeal secretions that are colonized by bacterial pathogens

*elderly patients with dysphagia, people with poor dental care

any state that alters level of consciousness such as seizures, anesthesia, coma, sedation, intoxication predisposes to aspiration pneumonia due to suppression of the cough reflex.

Usually caused by anaerobes from the mouth or refluxed gastric contents

Question 5

Nosocomial pneumonia?

Answer 5

Same as hospital acquired pneumonia

Question 6

Most common pathogen causing nosocomial pneumonia

Answer 6

S. aureus

Question 7

Most common pathogens that cause CAP

Answer 7

S. pneumonia,
H. influenzae,
Legionella pneumophila and
Mycoplasma pneumoniae

Question 8

What do you know about atypical pneumonias

Answer 8

Atypical/Walking pneumonia has a more insidious onset.
Characterized by headache, myalgia, sore throat, nonproductive cough, low grade fever and a nonspecific diffuse interstitial infiltrate on x-ray

Generally caused by viruses, or intracellular bacteria such as Legionella pneumophila and Mycoplasma pneumoniae and Chlamydia

Bacterial causes can be treated with a macrolide or a tetracycline (Clindamycin)

Question 9

Lobar pneumonia?

Answer 9

Strep pneumonia (Gram positive, catalase negative) 
Opacification/Consolidation of a lobe on x-ray

Question 10

Klebsiella spp.

Answer 10

Gram negative rod
aspiration pneumonia
Red currant jelly sputum

Question 11

Group B strep

Answer 11

Gram positive chain

Cause of pneumonia in neonates

Question 12

Mycoplasma app

Answer 12

Doesn’t stain

Seen in atypical pneumonias

Question 13

Purpose of and tools for risk stratification with pneumonia

Answer 13

To decode which patients can be treated safely as outpatients with oral antibiotics, and which require hospitalization
PSI (Pneumonia Severity Index): uses 20 variables to identify patients at low risk for death
CURB-65 uses 5 variables

Question 14

CURB-65 variables

Answer 14

Confusion 
Urea greater than 20 mg/dl
Respiratory rate greater than 30 bpm
Blood pressure systolic less than 90 mmHG
Age greater than 65

Question 15

X-ray of infection with S. pneumoniae

Answer 15

Dense lobar consolidation

Question 16

outpatient CAP therapy

Answer 16

Good choices for treatment of S pneumoniae, Mycoplasma, and other common organisms

Minimum 5 day course of

macrolide antibiotics: azithromycin, doxycycline
antipneumococcal quinolones: moxifloxacin, levofloxacin