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Pulmonology - OMS 2 > Pneumonia - clinical approach > Flashcards

Pneumonia - clinical approach Flashcards

1
Q

2 places where you can catch pneumonia?

A
  1. community (MC)
  2. hospital (acute care & long-term acute care)

nosocomial (hospital)

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2
Q

Key clue in history that suggests pneumonia?

A

pleuritic CP

cough, sputum, dyspnea, fever, malaise

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3
Q

What is pneumonia?

A

infection in alveoli

(terminal bronchioles)

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4
Q

physical exam findings of pneumonia (4)

A
  1. crackles (alveoli opening during inspiration)
  2. bronchial breath sounds
  3. egophony (only in pneumonia)
  4. dullness to percussion

(alveoli should always be open)

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5
Q

Where can you evaluate alveoli on CXR?

A

between the ribs

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6
Q

Patterns of pneumonia are categorized by which features?

A
  1. density
  2. location
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7
Q

bronchopneumonia involves which areas?

A

patchy over entire lung (air spaces)

lobar is just a lobe

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8
Q

define cavitary pneumonia

A

wall surrounding infection

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9
Q

key finding on CXR that suggests empyema

A

meniscus of fluid

must be confirmed by fluid purulence & pH
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10
Q

What causes CAP in healthy hosts?

A

lung microbiome dysbiosis

(62% of patients don’t have a microbe that can be isolated)

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11
Q

CAP in host w/co-morbidities have which predisposing factors

A

different microbes within their lungs

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12
Q

3 step approach to tx pneumonia

A
  1. normal host or co-morbidities?
  2. risk factors for MRSA or pseudomonas?
  3. exposures?

rule in/out influenza, COVID-19

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13
Q

co-mordities that predispose to pneumonia (5)

A
  1. age>65
  2. chronic diz
  3. asplenia/immunosuppressed
  4. smoking, alcohol
  5. recent abx
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14
Q

CAP initial tx

normal host

A

amoxicillin or doxycylcine

(z-pac not used b/c pneumococcal is resistant)

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15
Q

CAP w/co-morbidities initial tx

A

beta-lactam + z-pac

(z-pac used here bc it is broader spectrum due to co-morbidities)

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16
Q

CAP w/co-morbidities initial tx in patients w/penicillin allergy

A

fluoroquinolone

(they are over used and there is now resistance)

17
Q

when would you do dx testing for pneumonia?

A
  1. if they have COVID or flu
  2. sick enough to be admitted

only if tthe results will change management

18
Q

major risk factors for MRSA/pseudomonas (R-GNB)

(step 2 in determining pneumonia tx)

A
  1. prior colonization or infection w/one of these organism
  2. hospitalization < 3 months + received IV abx

colonization means bacteria is there, but no diz

19
Q

Which patients are at risk for MSRA/psudeomonas (R-GNB)

step 2 evaluation

A
  1. bronchiectasis
  2. CF
  3. COPD
  4. repeated abx or steroid use
20
Q

Which 6 exposures pre-dispose to pneumonia?

step 3 in tx assessment

A
  1. farm animals
  2. cats/dogs
  3. birds
  4. camels
  5. rodens
  6. human: Covid, virus, tb
21
Q

Which geographic regions pre-dispose to fungal pneumonia?

step 3 in tx assessment

A

SW: coccidioidomycosis
NE: blastomyces
SE: histoplasma

must ask patients where they have been the last 6 months

22
Q

How do you know if a patient needs inpatient care?

A
  1. medical issues
  2. common sense issues: socioeconomic determinants

can they care for themselves?

23
Q

clinical prediction rules used for pneumonia (2)

A
  1. Pneumonia severity index (PSI)
  2. CRB-65 (+O2 sat)

bedside

24
Q

What is included in the CRB-65 assessment?

A
  • Confusion
  • RR >30/min
  • BP < 90mmHG
  • 65 > 65
  • O2 < 92%

(0= outpatient, 1-2 = inpatient, 3-4 = ICU)

MUST use clinical judgement, look at social determinants

25
Q

8 lab dx tests (POC) for pneumonia

A
  1. Rapid Niral NAATs (Ag detection)
  2. sputum stain & culture
  3. blood culture
  4. UA (pneumococcal or legionella)
  5. Nasal PCR
  6. Serology (retrospective)
  7. Procalcitonin
  8. Multi-plex PCR

use only if they have been admitted

26
Q

What is procalcitonin used for in pneumonia patients?

A

tial end of pneumonia, to decide when to stop abx

positive correlation w/bacterial pneumonia

27
Q

Multi-plex PCR will miss which causative microbe of pneumonia?

A

coccioides

28
Q

Initial therapy for CAP inpatient ward w/co-morbidities

B-

A
  1. IV abx
  2. add MRSA coverage if needed
  3. sub B-lactame for pseudomonas coverage

**once they’ve been admitted, you can test to de-escalate abx use by day

Pulmonology - OMS 2 (28 decks)

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