Pneumonia (Nassar)

Question 1

what is the most common way that people develop pneumonia?

Answer 1

microaspiration of oropharyngeal contents (ie, streptococcus, haemophilus)

Question 2

how are mycobacterium and viral infections like influenza most commonly acquired?

Answer 2

inhalation of aerosolized particles that contain microorganisms

Question 3

these chemokines lead to the release and migration of neutrophils to the lung

Answer 3

IL-8 and GCSF

Question 4

what is responsible for triggering the clinical syndrome of pneumonia?

Answer 4

host inflammatory response

Question 5

what are the inflammatory mediators responsible for producing fever?

Answer 5

IL-1 and TNF alpha

Question 6

increased respiratory drive in response to systemic inflammation leads to this condition

Answer 6

respiratory alkalosis (decreased levels of CO2 in the blood)

Question 7

A 60 year old male patient presents to your clinic with fevers. This started a week ago and is associated with cough productive of yellow phlegm. He is a smoker and was recently told he has COPD. On physical exam, his temperature is 102; respiratory rate of 24; O2 saturation of 90%.

What would you order to confirm your diagnosis?

a) urine streptococcus antigen
b) blood culture
c) PCR for mycoplasma
d) Chest radiograph

Answer 7

D. This is the most important tool in establishing diagnosis of pneumonia.

Question 8

mycoplasma pneumoniae, chlamydia pneumoniae and legionella are all ____ organisms that may be present in community acquired pneumonia.

Answer 8

atypical

Question 9

S. pneumonia, H. influenza, and staph aureus are ____ organisms present in community acquired pneumonia

Answer 9

typical

Question 10

what are the main limitations of a sputum gram stain for obtaining a diagnosis of pneumonia?

Answer 10

1. 30% of patients have a non-productive cough
2. only 14% of patients can provide an adequate sample
3. 15-30% of patients have already received antibiotics

Question 11

what is the main limitation of a blood culture for obtaining a diagnosis of pneumonia?

Answer 11

while blood cultures are almost always positive in hematogneous pneumonia like S. Aureus, they are only positive in 25% of cases in which inhalation or aspiration is reponsible for the community acquired pneumonia

Question 12

what are the two pneumococcal vaccines indicated for elderly patients or those with chronic lung disease?

Answer 12

pneumovax and prevnar