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Clin Med2: Pulmonology > pneumonia - Eric > Flashcards

pneumonia - Eric Flashcards

1
Q

what is pneumonia

A

inflammation of the alveoli and bronchioles
#1 most deadly hospital acquired infection

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2
Q

what are the causes of pneumonia

A

infection (bacteria, viruses and fungi) or aspiration

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3
Q

what are the common bacterial pathogens of pneumonia

A

strep pneumoniae #1
H. Influenze B
S. aureus

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4
Q

what are the most common virus pathogens of pneumonia

A

influenza
RSV
Parainfluenza
adenovirus
COVID

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5
Q

what are the most common fungi pathogens of pneumonia

A

aspergillosis
histoplasma
coccidiomycosis
blastomycese
candida

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6
Q

what is the most rare type of pneumonia

A

fungal pneumonia

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7
Q

who is at risk of getting pneumonia

A

immunocompromised
children
CF
smoking - COPD
sickle cell disease
asthma
underlying lung disease
DM
intubated

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8
Q

who are considered immunocompromised in association with pneumonia

A

bone marrow transplant, organ transplant, cancer, immunosuppressive drugs, HIV, steroids

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9
Q

why are immunocompromised patients at increased risk of developing pneumonia

A

neutropenia and impaired granulocyte function which causes infection to happen

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10
Q

what pathogens are immunocompromised patients most likely to get

A

s. aureus
aspergillus
candida
gram-negative bacilli

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11
Q

what are the classifications of community acquired pneumonia

A

typical and atypical

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12
Q

what is typical community acquired pneumonia

A

caused by bacteria leading to alveolar inflammation and exudate
productive cough
lobar consolidation on CXR
S. pneumonia

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13
Q

what are atypical community acquired pneumonia

A

organisms invade and destroy interstitium of the lungs
lack of alveolar exudate
dry cough
patchy infiltrate on CXR
mycoplasma, chlamydia, viral

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14
Q

what causes typical community acquired pneumonia

A

aspiration + loss of cough/damage to cilia/impaired immunity / changes in flora
most common pathogen S. pneumonia

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15
Q

what are the symptoms of typical community acquired pneumonia

A

fever, chills, productive cough, crackles or absent lung sounds, malaise, chest pain

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16
Q

where are S. pneumonia antibodies created

A

within the spleen

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17
Q

what are the diagnostics for typical community acquired pneumonia

A

pt is ill appearing
crackles on exam
absent lung sounds
increased in whispered pectoriloquy
egophony e-a
bronchophony - 99
increased tactile fremitus
lobar consolidation

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18
Q

what are out patient treatment options for typical community acquired pneumonia

A

adult: Azithromycin OR Doxycycline OR levofloxacin
Peds: Amoxicillin 90mg/kg/day BID

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19
Q

what are inpatient treatments for typical community acquired pneumonia

A

adult: ceftriaxone + azithromycin OR levofloxacin
peds: ampicillin (if fully immunized) or ceftriaxone (if not fully immunized)

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20
Q

what is community acquired Atypical community acquired pneumonia

A

more common in children
known as bronchopneumonia = patchy infiltrate on CXR
cough is usually dry
crackles on exam
mycoplasma, chlamydia, influenza, adenovirus, RSV, parainfluenza

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21
Q

what is the most common pneumonia in children and young adults

A

mycoplasma Atypical community acquired pneumonia

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22
Q

what is mycoplasma Atypical community acquired pneumonia

A

damaged the epithelium allowing bacteria to over grow
fever, headache, dry cough, bullous myringitis (not common)
chlamydia pneumonia presents similarly (college aged, sore throat, koalas, no bullous myringitis)

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23
Q

what is the gram negative bronchopneumonia

A

legionnaires Atypical community acquired pneumonia

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24
Q

what is legionnaires disease (Atypical community acquired pneumonia)

A

not transmitted human-human
pathogen grown in water of ventilation systems
onset 2-10 days

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25
Q

what are the symptoms and tests used for legionnaires disease

A

fever, chills, malaise, dry cough, diarrhea
urine antigen or sputum fluorescent antibody tests

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26
Q

what is the treatment for legionnaires disease

A

levofloxacin
any delay in abx will increase risk of mortality

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27
Q

what are the common pathogens for hospital acquired pneumonia

A

pseudomonas, S. aureus, enterobacter, klebsiella, e. coli

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28
Q

what patients are at risk for hospital acquired pneumonia

A

intubation
tracheotomy
immunocompromised
chronic lung disease

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29
Q

what is the common college age person presenting with coughing with minimal production

A

mycoplasma or chlamydia

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30
Q

what is the most common ICU pathogen

A

pseudomonas - highest mortality rate

31
Q

what is the presentation time for hospital acquired pneumonia

A

presentation 48 hours after admission

32
Q

what is the treatment for hospital acquired pneumonia

A

no consensus on best abx treatment
cefepime
zosyn (pip+ tazo)
meropenem
levofloxacin
aspiration pneumonia - clindamycin OR metronidazole + ceftriaxone

33
Q

what is the leading cause of death for people with HIV worldwide

A

Pulmonary tuberculosis (TB)
aka HIV associated Pneumonia

34
Q

What is one of the first diseases seen in the AIDs pandemic

A

P, jirovecii (PJP)
fungal infection found in the soil

35
Q

what is the presentation of PJP

A

creates foamy exudates and cysts in lung
cough, fever, weight loss
CD4+ count < 200

36
Q

what is the treatment for PJP

A

treat first with prednisone and them TMP-SMX (Bactrim)
daily bactrim prophylaxis for CD4+ count < 200

37
Q

what is the presentation of TB

A

fever, night sweats and weight loss

38
Q

if a patient is hospitalized with HIV associated pneumonia what should they be treated with

A

Ceftriaxone and azithromycin

39
Q

what are sickle cell disease patients at risk for

A

S. penumonia due to poor spleen function from infarcts

40
Q

what is the vaccine for S. pneumonia

A

PCV 20 - all patients

41
Q

what patients are prone to pneumonia due to damaged ciliary bodies and thickened mucous

A

CF patients

42
Q

what is the most common pathogen associated with CF pneumonia

A

Pseudomonas aeruginosa

43
Q

how is CF pneumonia treated

A

aggressively inpatient with tobramycin + Pip-tazo
PCV 20
current studies recommended against prophylactic antibiotics

44
Q

what can pre-dispose to bacterial infections

A

viral infection pneumonia

45
Q

what is the treatment of viral pneumonia

A

antibiotics still - treated just the same

46
Q

what is fungal pneumonia

A

most infected pts are symptomatic but can turn fatal
HIV infxn and suppressed immunity make people more prone to fungal toxins
there are no fungal toxins - hypersensitivity reactions

47
Q

what is the presentation of fungal pneumonia

A

granulomas similar to TB on x-ray

48
Q

what are the phases of fungal pneumonia

A
  1. acute
  2. chronic pulmonary disease
  3. disseminated infection
49
Q

what is the presentation of acute fungal pneumonia

A

mild- flu like illness with fever

50
Q

what is the presentation of chronic pulmonary disease fungal pneumonia

A

creation of cavitary lesions
cough, fever and night sweats
very similar to TB

51
Q

what is the presentation of disseminated fungal pneumonia

A

hepatosplenomegaly
pancytopenia, elevated Alk Phos, elevated LDH
multi-organ failure, septic shock, death

52
Q

what is the fungus found in bird and bat droppings

A

Histoplasma capsulatum

53
Q

how quickly can disseminated histoplasmosis be fatal

A

within 6 weeks

54
Q

how do you confirm histoplasmosis

A

urine assay

55
Q

what is the treatment of hisotplasmosis

A

itraconazole
if patient is immunocompromised - itraconazole is used as lifelong prophylaxis

56
Q

what is the Valley Fever - Southwest U.S

A

coccidiomycosis
caused by coccidioides immitis

57
Q

what is the presentation of coccidiomycosis

A

fever, fatigue, cough, SOB and night sweats
symptoms onset is 1-3 weeks and can last several months

58
Q

how is coccidiomycosis diagnosed

A

skin test
<10% of cases become severe with long term effects

59
Q

how is coccidiomycosis treated

A

usually self limiting, but can treat with 3-6 months of Diflucan

60
Q

what is Cryptococcus found in

A

bird droppings and effects immunocompromised patients

61
Q

how do you treat cyrptococcus

A

fluconazole x 10 weeks
can start with amphotericin B x 2 weeks

62
Q

what are the ways to prevent pneumonia

A

PCV 20 and influenza vaccines

63
Q

what is the key feature about mycoplasma

A

children/young adults, dry cough, bullous myringitis

64
Q

what is the key feature about P jirovecii

A

HIV-related, slow onset, hypoxia worse than CXR findings

65
Q

what is the key feature about legionella

A

poor ventiltation, hyponatremia, diarrhea

66
Q

what is the key feature about chlyamdia

A

sore throat, dry cough, college age, koala

67
Q

what is the key feature about s. pneumonia

A

most common, sickle cell, rust colored sputum

68
Q

what is the key feature about klebsiella

A

currant jelly colored, alchol abuse

69
Q

what is the key feature about h flu

A

COPD

70
Q

what is the key feature about pseudomoas

A

ICU -related (worse prognosis), CF

71
Q

what is the key feature about RSV

A

Children <1

72
Q

what is the key feature about Parainflenza

A

children <2

73
Q

what is the key feature about histoplasma

A

Bats, caving diving

74
Q

what is the key feature about coccidiomycosis

A

southwest US

Clin Med2: Pulmonology (13 decks)

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