Pneumonia Flashcards

Question

What are some risk factors for nosocomial pneumonia?

Answer 1

Neurologic disease or altered consciousness Age Functional status Lung disease, smoking history Severity of underlying illness Time (risk is cumulative, but daily risk decreases with time). Surgery, type of surgery Position (sitting reduces aspiration risk) Endotracheal intubation Antacid therapy Transmission by HCW’s; failure to handwash

Answer 2

Coliforms (E. coli etc.) Staphylococcus aureus including MRSA Pseudomonas especially in ICU, after antibiotics Acinetobacter, Stenotrophomonas Other (Legionella endemic in some hospitals) RSV epidemics common in Pediatrics

Answer 3

New radiologic infiltrate & compatible clinical features, e.g. fever, ↑ wbc, hypoxia, ↑ respiratory secretions

Answer 4

A) Empiric broad spectrum therapy based on “best guess”, local epidemiology and upper airway gram stain and cultures OR B) Guidance based on respiratory specimen obtained non-invasively with semi-quantitative culture OR C) “Invasive”diagnosis: bronchoscopy with sheathed brushes or quantitative bronchoalveolar lavage

Answer 5

``` Early and mild: “respiratory” fluoroquinolone 3rd generation cephalosporin Late or severe: Piperacillin/tazobactam or carbapenem Plus Vancomycin if evidence or likelihood of MRSA Duration: Usual recommendation: 7 days depending on clinical/radiologic response. ```

Answer 6

Recognize patients @ risk (decreased level of consciousness, altered swallowing, gastro-esophageal reflux) Minimize aspiration risk Position, feeding, airway management Hand washing ``` Oral care Semirecumbent position Limit antacid use Enteral feeding Hand washing Minimize intubation; use non-invasive ventilation, oral tube preferred to nasal Adequate pressure in ET tube cuff Prevent gastric overdistention Scheduled drainage of condensation from circuits ```

Answer 7

Inflammation of the lung, usually of infectious etiology | --> Lung parenchyma inflammation/injury +/- filling of alveolar spaces with inflammatory gunk (consolidation)

Answer 8

The development of CAP indicates either a defect in host defenses (local and/or global), exposure to an overwhelming inoculum, or a particularly virulent microorganism

Answer 9

``` Fever Dyspnea Cough Sputum production Pleuritic chest pain Mental status changes ```

Answer 10

Toxic appearance Increased temperature Increased respiratory rate/heart rate [most sensitive sign] In severe cases respiratory failure & septic shock Asymmetric movement of chest wall Increased tactile fremitus Dullness to percussion Bronchial breath sounds on auscultation Crackles, wheezes, egophony, whispering pectoriloquay +/- signs of a “parapneumonic effusion”

Answer 11

CHEST XRAY: Posterior-anterior and lateral views If pleural effusion is present, do a lateral decubitus view with the involved side down BUT CT has higher sensitivity and specificity

Answer 12

F: Testing for a microbial diagnosis is usually not performed in outpatients because empiric treatment is almost always successful. HAPs do not need the bloodwork.

Answer 13

Bacteria are the most common cause of CAP: - “Typical” organisms include S. pneumoniae, H. influenzae, S. aureus, Group A strep, M. catarrhalis, anaerobes, and aerobic gram-negative bacteria - “Atypical” refers to pneumonia caused by Legionella spp, M. pneumoniae, C. pneumoniae, and C. psittaci

Answer 14

``` (c) ABC O2 to keep SpO2 > 90%; wean if > 95% IV fluids (early goal directed therapy) Lab work, septic workup (sputum, blood, +/- urine, +/- CSF) PA and Lateral CXR +/- CT, Bronchoscopy +/- Isolation precaution ```

Answer 15

Initial antibiotic selection for pneumonia is almost always empiric; if/when a likely organism is identified, focus antimicrobials accordingly - no comorbidity: macrolide OR doxycycline - comorbidity: fluoroquinolone OR beta-lactam + macrolide

Answer 16

Score to determine if patient should be admitted to the hospital: Class I/II- Outpatient treatment Class III- Clinical Judgement Class IV/V- Hospitalize

Answer 17

Most patients under 50 with CAP should be screened for HIV infection and IgG deficiency

Answer 18

``` Alterations in the level of consciousness Smoking tobacco Alcohol consumption Malnutrition Being elderly Cystic fibrosis Bronchiectasis Chronic obstructive pulmonary disease (COPD) Previous episode of pneumonia Immunocompromised ```

Answer 19

produce proteases that can split secretory IgA

Answer 20

Mycoplasma pneumoniae

Answer 21

ciliostatic factor

Answer 22

Mycobacterium spp, Nocardia spp, and Legionella spp

Answer 23

Influenza virus markedly reduces tracheal mucus velocity within hours of onset of infection and for up to 12 weeks postinfection

Answer 24

Pneumocystis jirovecii

Answer 25

Pneumonia Severity Index | Pneumonia Severity Index for Adult CAP estimates mortality for adult patients with community-acquired pneumonia.