Pneumonia (Peine) Flashcards
What factors influence disease penetrance
- host defenses (immune strength, genetics, past exposure)
- environmental factors during exposure
- pathogenic load
List 4 pathophysiologies of pathogenicity
- aspiration (micro vs macro)
- hematogenous spread (blood)
- direct extension (spread from adjacent organs/structures)
- direct inoculation (non-sterile procedure, etc.)
List some macro risks to aspiration
organisms gaining access to lower resp tract
- deep sleep/coma
- substance intox
- post-CVA dysphagia
- poor dentition
List some mechanical host defenses against pneumonia
- hairs/turbinates
- gag/cough
- normal flora
List the etiology/RF for community acquired pneumonia
List the sxs of community acquired pneumonia
List the pathognomonic sxs for pneumococcal pneumonia
(strep pneum): URI followed by bone shaking rigor, fever, cough, rust colored sputum
List the pathognomonic sxs for mycoplasma pneumonia aka walking pneumonia
indolent onset, nonproductive cough, myalgias/arthralgias, maculopapular or SJS rash, bullous myringitis
Describe the pathognomonic sxs for legionella pneumonia
insidious onset, dry cough, diarrhea, hyponatremia, confusion, rapidly progressive organ failure, exposure to fine mist
Describe the pathognomonic sxs for klebsiella pneumonia
currant jelly sputum, assoc with heavy alc use
describe the pathognomonic sxs for pneumocystis pneumonia
anorexia, weight loss, immunosuppression
what is this
bullous myringitis from mycoplasma pneumonia
Microbial association with alcohol overuse
klebsiella
microbial association with CF
pseudomonas
microbial association with milk
coxiella burnetti (Q fever)
microbial association with rabbit exposure
fancisella tularensis (tularemia)
microbial association with bird/bat droppings
histoplasmosis
microbial association with recent travel to the SW US
coccidiosis (valley fever)
microbial association with Mississippi/Ohio river valley
blastomycosis
Describe the PE & diagnostic testing for community acquired pneumonia
where is the pneumonia
right middle lobe
Define a conjugate vaccine
type of vaccine that joins a protein to part of the bacteria to improve the protection the vaccine provides
Define a polysaccharide vaccine
a type of vaccine that is made to look like the surface of certain bacteria in order to help the body build protection against that germ
When is the PCV 20 vaccine recommended to prevent pneumococcal pneumonia
once for all people 65+
19-64 with certain medical conditions or who smoke cigarettes
When should you get a flu vaccine and who can get it
- yearly
- starting at age 6 mos
- can get while pregnant
in an ambulatory patient what tests do you order to confirm pneumonia
CXR
For a pt who presents to the clinic and is dx with pneumonia, how do you determine if they need to be admitted to the hospital
CURB 65
Describe the treatment for community acquired pneumonia
Describe the scoring for CURB-65
- confusion
- BUN: abnormal
- RR 30+
- BP <90/<60
- age 65+
Describe the etiology of hospital acquired pneumonia
Describe the etiology of ventilator acquired pneumonia
Major cases occur in ICU, direct inoculation or aspiration from further up the tubing
Often multi-drug resistant pathogens
RF: mechanical ventilation, age 60+, pulmonary disease, coma, surgery, re-intubation, prolonged intubation
Describe the diagnostic testing for hospital acquired/ventilator acquired pneumonia
sputum culture and consult ID
