pneumonia + abscess + pleural effusion

Question 1

inflammation in alveoli

cause: bacteria, virus, fungi, aspiration from oropharynx (alcoholism, NG tubes, obtunded state)

Answer 1

pneumonia

Question 2

categories of pneumonia

Answer 2

community-acquired pneumonia: G+

hospital-acquired pneumonia: G+, G- rods

Question 3

clinical categories of pneumonia

Answer 3

typical pneumonia
atypical pneumonia
best to diagnose type based on clinical findings + CXR findings (not type of bug present)

Question 4

what type of pneumonia is this:
fever
productive cough - purulent sputum
malaise
chest pain
SOB
ill-appearing
CXR: lobar infiltrate (white, pus in lobe)

Answer 4

typical pneumonia

Question 5

what do these cause?
streptococcus pneumoniae
S. aureus
H. infuenzae
group B streptococcus

Answer 5

typical pneumonia

Question 6

nonproductive cough
headache
fatigue
still feel ok
CXR: diffuse patchy infiltrate (looks worse than patient)

Answer 6

atypical pneumonia (“walking pneumonia”)

less severe sx

Question 7

what do these cause?
mycoplasma pneumoniae
legionella pneumophilia
chlamydophilia pnuemoniae

Answer 7

atypical pneumonia (“walking pneumonia”)

Question 8

common cause of pneumonia in immunocompromised

Answer 8

pneumocystis jirovecii (used to be called PCP pneumonia)

Question 9

most common cause of atypical/walking pneumonia

Answer 9

mycoplasma pneumoniae

Question 10

common causative agent for pneumonia in alcoholics

Answer 10

aspiration (think anaerobes or G-)

klebsiella pneumoniae

Question 11

can cause an interstitial pneumonia in bird handlers

Answer 11

chlamydia psittaci

Question 12

often the cause of pneumonia in a patient with a history of exposure to bats and bat droppings

Answer 12

histoplasma

Question 13

often cause of pneumonia in a patient who has recently visited south carolina, new mexico, west texas

Answer 13

coccidioides

Question 14

pneumonia associated with “currant jelly” sputum

Answer 14

Klebsiella

Question 15

Q fever

Answer 15

Coxiella burnetti

Question 16

associated with pneumonia from air conditioner

Answer 16

Legionella pneumophila

Question 17

most common cause of pneumonia in 1 yo or younger

Answer 17

RSV

Question 18

most common cause of pneumonia in neonate (birth -28 days)

Answer 18

GBS, E.coli

Question 19

most common cause of pneumonia in children and young adults (including college students, military recruits, prison inmates)

Answer 19

Mycoplasma pneumoniae

Question 20

most common cause of viral pneumonia

Answer 20

RSV

Question 21

causes wool-sorter’s disease (life-threatening pneumonia)

Answer 21

Bacillus anthracis

Question 22

common pneumonia in ventilator patients and those with CF

Answer 22

think about aspiration → anaerobes or G-
Pseudomonas aeruginosa or
MRSA

Question 23

pontiac fever

Answer 23

Legionella pneumophila

Question 24

necrosis of pulmonary parenchyma
collection of pus in lung
highest risk: alcoholics, drug abusers, general anesthesia
caused by aspiration (anaerobes) or bronchial obstruction
AIR-FLUID levels on CXR: pus levels in cavity

Answer 24

lung abscess

Question 25

complication of aspiration pneumonia (caused by anaerobes in gingival crevices)

Answer 25

lung abscess

Question 26

common organisms found in:
anaerobes in ginginval crevices:
peptostreptococcus
prevotella
bacteroides
fusobacterium
outside gingival crevices:
s. aureus
klebsiella pneumonia (ventilator)
G- bacteria

Answer 26

lung abscesses (anaerobes)

Question 27

treatment for lung abscess

Answer 27

empirical tx for aneorobes (since most often due to aspiration): clindamycin

Question 28

fluid between 2 pleural layers → limit expansion of lung
CXR:
obliterated air space (white)
blunted costophrenic angle due to fluid in pleural space

Answer 28

pleural effusion

Question 29

low protein, high electrolyte content pleural effusion (watery): fluid leaks from vessels to pleural space
↑ hydrostatic pressure: CHF, fluid overload
↓ plasma oncotic pressure: cirrhosis, nephrotic syndrome

Answer 29

transudate pleural effusion

“TRANSudate is more TRANSparent”

Question 30

high protein pleural effusion
pleural/lung inflammation →↑ membrane permeability: 
cancer
pneumonia, infection, TB
uremia
CT disease

Answer 30

exudate pleural effusion

Question 31

thoracic duct injury → lymphatic fluid int pleural space

MILKY appearing: high TG content

Answer 31

lymphatic pleural effusion (=chylothorax)

absorb TG → enter lymphatic fluid as chylomicrons → digested as chylomicron remnants → liver