pneumonia + abscess + pleural effusion Flashcards
inflammation in alveoli
cause: bacteria, virus, fungi, aspiration from oropharynx (alcoholism, NG tubes, obtunded state)
pneumonia
categories of pneumonia
community-acquired pneumonia: G+
hospital-acquired pneumonia: G+, G- rods
clinical categories of pneumonia
typical pneumonia
atypical pneumonia
best to diagnose type based on clinical findings + CXR findings (not type of bug present)
what type of pneumonia is this: fever productive cough - purulent sputum malaise chest pain SOB ill-appearing CXR: lobar infiltrate (white, pus in lobe)
typical pneumonia
what do these cause? streptococcus pneumoniae S. aureus H. infuenzae group B streptococcus
typical pneumonia
nonproductive cough headache fatigue still feel ok CXR: diffuse patchy infiltrate (looks worse than patient)
atypical pneumonia (“walking pneumonia”)
less severe sx
what do these cause?
mycoplasma pneumoniae
legionella pneumophilia
chlamydophilia pnuemoniae
atypical pneumonia (“walking pneumonia”)
common cause of pneumonia in immunocompromised
pneumocystis jirovecii (used to be called PCP pneumonia)
most common cause of atypical/walking pneumonia
mycoplasma pneumoniae
common causative agent for pneumonia in alcoholics
aspiration (think anaerobes or G-)
klebsiella pneumoniae
can cause an interstitial pneumonia in bird handlers
chlamydia psittaci
often the cause of pneumonia in a patient with a history of exposure to bats and bat droppings
histoplasma
often cause of pneumonia in a patient who has recently visited south carolina, new mexico, west texas
coccidioides
pneumonia associated with “currant jelly” sputum
Klebsiella
Q fever
Coxiella burnetti
associated with pneumonia from air conditioner
Legionella pneumophila
most common cause of pneumonia in 1 yo or younger
RSV
most common cause of pneumonia in neonate (birth -28 days)
GBS, E.coli
most common cause of pneumonia in children and young adults (including college students, military recruits, prison inmates)
Mycoplasma pneumoniae
most common cause of viral pneumonia
RSV
causes wool-sorter’s disease (life-threatening pneumonia)
Bacillus anthracis
common pneumonia in ventilator patients and those with CF
think about aspiration → anaerobes or G-
Pseudomonas aeruginosa or
MRSA
pontiac fever
Legionella pneumophila
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
lung abscess
complication of aspiration pneumonia (caused by anaerobes in gingival crevices)
lung abscess
common organisms found in: anaerobes in ginginval crevices: peptostreptococcus prevotella bacteroides fusobacterium outside gingival crevices: s. aureus klebsiella pneumonia (ventilator) G- bacteria
lung abscesses (anaerobes)
treatment for lung abscess
empirical tx for aneorobes (since most often due to aspiration): clindamycin
fluid between 2 pleural layers → limit expansion of lung
CXR:
obliterated air space (white)
blunted costophrenic angle due to fluid in pleural space
pleural effusion
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
transudate pleural effusion
“TRANSudate is more TRANSparent”
high protein pleural effusion pleural/lung inflammation →↑ membrane permeability: cancer pneumonia, infection, TB uremia CT disease
exudate pleural effusion
thoracic duct injury → lymphatic fluid int pleural space
MILKY appearing: high TG content
lymphatic pleural effusion (=chylothorax)
absorb TG → enter lymphatic fluid as chylomicrons → digested as chylomicron remnants → liver
