pneumonia Flashcards by zarieh Novela

Normal breath sound

Vesicular

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Breath sounds heard in pneumonia

Bronchial sound

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Tactile fremitus in pneumonia

Increased

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Adventitious lung sounds

Crackles
Wheezes or rhonchi
Stridor
Pleural rub
Mediastinal crunch

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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

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Adventitious sound:

It occurs when air flows rapidly thru bronchi that are narrowed nearly to the point of closure

Wheezes or rhonchi

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Adventitious sound:

Wheeze that is entirely or predominantly Inspiratory. It indicates partial obstruction of larynx or trachea.

Stridor

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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

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Adventitious sound:

Series of precordial crackles synchronous with heart beat, not with respiration

Mediastinal crunch

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Adventitious lung sound heard in pneumonia

Bacterial: crackles
Viral: wheezes

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Percussion note in pneumonia

Dull in airless area

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How to diagnose pneumonia

Epidemiological aspect: Classify if CAP or HAP
Age
X-ray
PE
History

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Acquiring infection in respiratory due to digestive bacteria

Aspiration

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Aspiration may be obtained thru / by

Unconscious person
Drug overdose
Sleeping
.4. Repeated vomiting
Lost of laryngeal/ pharyngeal muscle control

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Dense area in the lungs

Consolidation, diffused

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Most common COPD-associated pathogens in pneumonia

Haemophilus influenza

Moraxella catarrhalis

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Viruses that cause pneumonia

Parainfluenza virus
Adenovirus
Influenza virus
RSV

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Organisms that cause patchy infiltrates

SAMPLE
Staph aureus
Anaerobes
Mycoplasma pneumoniae
Pneumocystis jiroveci
Pseudomonas aeroginosa
Legionella pneumophila
E.coli

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Organisms that cause lobar consolidation

SHaKLaM
Strep.pneumoniae
H. influenza
Klebsiella pneumoniae
Mortadella catarrhal is

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Common responsible organism in organ transplant patient

CMV

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Most common alcohol-associated organism

Klebsiella pneumoniae

Strep. Pneumoniae

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Most common CAP organism

Strep. Pneumoniae

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Most common Atypical CAP organism

Mycoplasma pneumoniae

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Most common influenza-associated CAP organism

Staph. Aureus

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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