Pneumonia Lecture Powerpoint

Question 1

Pneumonia definition

Answer 1

Acute infection of the lung tissue/parenchyma (lower respiratory tract infection) can be preceded by a URI typically bacteria, viral, or fungal in origin that causes consolidation/exudate accumulation where air exchange would normally occur

Question 2

Pneumonitis

Answer 2

Broad term referring to any inflammation of lung tissue from any etiology, ranging from hypersensitivity, infection (pneumonia), smoking, drugs, occupational exposure, etc.

Question 3

2 types of pneumonia

Answer 3

• Community acquired (patient not in or recently in care facility)
• Nosocomial (hospital acquired pneumonia or ventilator associated if develop symptoms >48 hrs after admission/intubation)

Question 4

Why the fissures of the lung help differentiate what lobe the consolidation is occurring in on a chest x ray

Answer 4

-Can see infiltrates ending at the fissures sharply being separated

Question 5

Age groups at increased risk for pneumonia (2)

Sex and race associated with increased risk for pneumonia

Answer 5

-Adults >65
-children <5
(This is why pneumococcal vaccine is so important in these 2 groups!!!)

Male African Americans

Question 6

Pneumonia risk factors (3)

Answer 6

• smoking
• recent antibiotic therapy or resistance
• crowded living conditions

Question 7

Influenza and pneumonia are the combined ___ leading cause of death

Answer 7

8th

Question 8

Pneumonia pathways of infection (3)

Answer 8

• Most common microaspiration due to inhalation of microdroplets
• direct spread from other part of body
• macroaspiration of secretions from pharynx into larynx

Question 9

Most common causes of pneumonia (4)

Answer 9

• S. pneumoniae (most common bacterial cause)
• H influenza
• Mycoplasma
• Viruses

Question 10

Typical vs atypical pneumonia

Answer 10

Typical is seen in young and old predisposed populations caused by common infectious agents with classic presentation and rapid onset, while atypical is more prone to affect young adults and is caused by less common bugs with abnormal presentation and slower onset with less severe symptoms and other systems commonly being affected

Question 11

Atypical pneumonia types (3)

Answer 11

• legionella
• pneumocystis jirovici (immunocompromised patients)
• walking pneumonia (mycoplasma pneumoniae) (more chronic)

Question 12

Predisposing factors for pneumonia development (4)

Answer 12

• lung pathology such as COPD or cystic fibrosis
• loss of airway protection (any form of immune dysfunction)
• irritants
• infectious agents

Question 13

Alcoholism induced pneumonia causes ____ sputum characteristic of ___ organism

Answer 13

current jelly sputum,klebsiella pneumoniae

Question 14

4 stages of lobar pneumonia

Answer 14

1) 24 hours of infection seeing vascular congestion and alveolar edema, many bacteria and few neutrophils
2) 2-3 days, many erythrocytes, neutrophils, and fibrin placed in alveoli (red hepatization stage), symptomatic
3) 3+ days, tissue is gray brown to yellow because of fibropurulent exudate, disintegration of red cells and hemosiderin (grey hepatization sttage)
4) resolution, absorption and restoration of pulmonary architecture

Question 15

clinical signs and symptoms of typical pneumonia (4)

Answer 15

• cough
• fever
• chills
• dsypnea/SOB

Question 16

Clinical signs and symptoms of atypical pneumonia (3)

Answer 16

• headache
• myalgia
• GI symptoms

Question 17

Physical exam pneumonia findings (5)

Answer 17

• fever
• tachypnea
• increased tactile fremitus on affected side (exudate in lungs increases vibration)
• dullness to percussion
• crackles and rales on auscultation

Question 18

Differential diagnosis of pneumonia (6)

Answer 18

• bronchitis
• congestive heart failure
• pulmonary edema
• asthma
• PE
• MI

Question 19

Diagnostic tests for pneumonia (3)

Answer 19

• history and physical exam
• PA and lateral CXR visualizing lobar consolidation and bilateral diffuse infiltrates
• high degree of suspicion consider CT

Question 20

3 subtypes of pneumonia based on their locatoin

Answer 20

• Bronchopneumonia (diffusely spread)
• Lobar (only affecting one lobe)
• Interstitial pneumonia (surrounding alveoli in interstitial tissues of lung)

Question 21

Lab tests for pneumonia (3)

Answer 21

• Leukocyte count
• sputum sample gram stain and culture and sensitivity (need to get sample first thing in morning because SPIT does not work and also get before starting antibiotic)
• blood cultures

Question 22

Initial pharmacotherapy for pneumonia is at least initially typically…

Answer 22

….empiric (prior to culture results)

Question 23

Criteria for severe community acquired pneumonia

Answer 23

• minor criteria such as confusion or leukopenia

- Major criteria such as invasive mechanical ventilation or septic shock requiring vasopressors

Question 24

How to determine whether to treat pneumonia inpatient vs outpatient (3)

Answer 24

• Clinical judgement
• PSI (pneumonia severity index)
• CURB 65

Question 25

PSI vs CURB 65

Answer 25

PSI looks at comorbidities when considering overall treatment and is thus a better studied tool that is more often used to determine hospitalization than CURB 65 status

Question 26

PSI values for risk class (5)

Answer 26

I = 0
II = 70
(above here outpatient)
III = 71-90 (short inpatient)
(below here high risk inpatient)
IV = 91-130 
V >130

Question 27

Goal principles for treatment of pneumonia (4)

Answer 27

• eradicate causative pathogen
• resolve clinical signs/symptoms
• minimize hospitalization
• prevent reinfection

Question 28

Empiric outpatient therapy for pneumonia (2)

Answer 28

• macrolides (azithro, clarithro, erythro)

- fluorquionlones (cipro, levo, moxi)

Question 29

Empiric inpatient therapy for pneumonia (2)

Answer 29

• fluoroquinolone

- B lactam + azithro or fluorquinolone