pneumonia Flashcards
Normal breath sound
Vesicular
Breath sounds heard in pneumonia
Bronchial sound
Tactile fremitus in pneumonia
Increased
Adventitious lung sounds
Crackles Wheezes or rhonchi Stridor Pleural rub Mediastinal crunch
Adventitious sound:
It results from series of tiny explosions when small airways pop open, or air bubbles flowing thru the secretions or lightly closed airways during respiration
Crackles
Adventitious sound:
It occurs when air flows rapidly thru bronchi that are narrowed nearly to the point of closure
Wheezes or rhonchi
Adventitious sound:
Wheeze that is entirely or predominantly Inspiratory. It indicates partial obstruction of larynx or trachea.
Stridor
Adventitious sound:
Inflamed and roughened pleural surfaces grate against each other as they momentarily and repeatedly delayed by increased friction. Movement produce creaking sound
Pleural rub
Adventitious sound:
Series of precordial crackles synchronous with heart beat, not with respiration
Mediastinal crunch
Adventitious lung sound heard in pneumonia
Bacterial: crackles
Viral: wheezes
Percussion note in pneumonia
Dull in airless area
How to diagnose pneumonia
- Epidemiological aspect: Classify if CAP or HAP
- Age
- X-ray
- PE
- History
Acquiring infection in respiratory due to digestive bacteria
Aspiration
Aspiration may be obtained thru / by
- Unconscious person
- Drug overdose
- Sleeping
.4. Repeated vomiting - Lost of laryngeal/ pharyngeal muscle control
Dense area in the lungs
Consolidation, diffused
Most common COPD-associated pathogens in pneumonia
Haemophilus influenza
Moraxella catarrhalis
Viruses that cause pneumonia
Parainfluenza virus
Adenovirus
Influenza virus
RSV
Organisms that cause patchy infiltrates
SAMPLE Staph aureus Anaerobes Mycoplasma pneumoniae Pneumocystis jiroveci Pseudomonas aeroginosa Legionella pneumophila E.coli
Organisms that cause lobar consolidation
SHaKLaM Strep.pneumoniae H. influenza Klebsiella pneumoniae Mortadella catarrhal is
Common responsible organism in organ transplant patient
CMV
Most common alcohol-associated organism
Klebsiella pneumoniae
Strep. Pneumoniae
Most common CAP organism
Strep. Pneumoniae
Most common Atypical CAP organism
Mycoplasma pneumoniae
Most common influenza-associated CAP organism
Staph. Aureus
HAP organisms
Pseudomonas aeroginosa
E.coli
Klebsiella pneumoniae
Staph. Aureus
With characteristic rusty colored sputum
Step pneumoniae
With characteristic foul smelling sputum
Anaerobes
Mechanical and structural host defenses
Cough/gag reflex Airway branching Mucociliary clearance Nose Normal oropharyngeal flora
Cellular host defense
Macrophage
Epithelial cells
Neutrophils
Humoral/molecular/inflammatory host defense
IgG,IgA
Cytokines
Colony stimulating factor
Lobes are heavy, red and boggy, contains proteinaceous exudates, neutrophils and bacteria.
Edema, congestion
Infected lobe is liver-like in consistency. Packed with neutrophil, red cells and fibrin.
Red hepatization
Lobe is gray, dry and firm because red cells are listed. Fibrin deposition is abundant
Gray hepatization
Macrophages are dominant, inflammatory debris are cleared
Resolution
Type of CAP. It is an infection by bacteria that multiply extracellularly in the alveoli and cause inflammation and exudation of fluid into air-filled spaces of alveoli
Typical pneumonia
Type of CAP: Caused by viral and mycoplasma infections Less striking symptoms and findings No alveolar infiltration No purulent sputum No lobar consolidation
Atypical pneumonia
Infection that begins outside the hospital or is diagnosed within 48 hrs after admission to the person who has not resided on a long term care facility for 14days or more before admission
CAP
Typical CAP organisms
PSSHaKe Pseudomonas aeroginosa Strep. Pneumoniae Staph. Aureus H.influenza Klebsiella pneumoniae
Atypical CAP organisms
CaLMeR Chlamydophila pneumoniae Legionella pneumophila Mycoplasma pneumoniae RSV
Diagnostic tests that use antigen tests in urine
Legionella and strep
Low risk CAP
CHEMMS Chlamydophila pneumoniae H. Influenza Enterics Mycoplasma pneumoniae Moraxella catarrhalis Strep.pneumoniae
Moderate risk CAP
CHEMMS + legionella and anaerobes
High risk CAP
CHEMMS + anaaerobes, staph.aureus, p.aeroginosa
HAP patients usually requires mechanical ventilation
True
Use of accessory respiratory muscles
Nasal flaring
Chest and sub costal retractions
Shoulder elevation
Signs and symptoms
Fever, cough, chest pain, shortness of breath, tachypnea, tachycardia, joint and muscle pain, headache, fatigue
With characteristic abdominal pain, diarrhea and confusion
Legionella pneomonia
With characteristic bloody (currant jelly) sputum
Klebsiella pneumoniae
Fungi that cause pneumonia
BCCPH blastomyces - found on soil and rotten wood Coccidioides immitis Cryptococcosis neoformans - encap.yeast Pneumocystis jiroveci Histoplasma encapsulatum
Empiric treatment, first line for CAP
Amoxicillin
Encap.
NF of URT
Lobar consolidation
Optochin sensitivity
Strep pneumoniae
Treatment for strep.pneumoniae
Pen G
Encap.
Type B
Lobar consolidation
Chocolate agar (factor X, V)
H. Influenza
Treatment for h. Influenza
Ampicillin
Catalase (+) coagulate (+)
Patchy infiltrates
Blood agar
Staph.aureus
Treatment for staph.aureus
Nafcillin
If resistant, vancomycin
Fecal-oral route Alcohol abuse Lobar consolidation EMB, Macconkey agar Currant jelly sputum
Klebsiella pneumoniae
Treatment for klebsiella
Cephalosporin
Fecal oral route
Indole (+)
EMB, Macconkey agar
E.coli
Treatment for e.coli
3rd gen cephalosporin
Oxidase (+)
In immunocompromised pts
Resistant to many antimicrobial drugs
Patchy infiltrates
P.aeroginosa
Treatment for p. aeroginosa
Anti pseudomonas cephalosporin
Aspiration pneumonia
Mixed flora
Patchy infiltrates
Anaerobes
Treatment for anaerobes
Clindamycin
“Walking pneumonia”
Extensive patchy infiltrates
Complement fixation and cold agglutinin
Most common atypical CAP
M.pneumoniae
Treatment for m.pneumoniae
Erythromycin
Tetracycline
Catalase (+) oxidase (+)
Aerosolized water source, air conditioner
Patchy and lobar consolidation
High risks in smoking, immunocompromised and old age
BCYE agar
L.pneumophila
Treatment for legionella
Erythromycin
Rifampin
TWAR
Likes columnar epith cells
Elementary body, initial body
Infant pneumonia
C.pneumoniae
Treatment for c.pneumoniae
Erythromycin
Doxycycline
Treatment for moraxella catarrhalis and pneumocystis jiroveci
Trimethoprim-sulfamethoxazole
Associated with cystic fibrosis and immunocompromised
P.aeroginosa
