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Pneumonia, Pleural Effusion And Emphysema Flashcards

1
Q

What is pneumonia

A

Infection of the lung parenchyma caused by bacteria, viruses, fungi or rarely protozoa

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2
Q

What is the leading cause of ID rested morbidity and mortality

A

Pneumonia

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3
Q

Which bacteria which cause pneumonia are the leading cause of death from pneumonia

A

Streptococcus pneumoniae
Legionella pneumophila

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4
Q

What is pneumonitis

A

Inflammation of the lungs from a variety of non-infectious causes such as chemicals, radiation and autoimmune processes

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5
Q

Pneumonia may be classified based on

A

The setting of the acquisition of the infection
Mechanism of acquisition
Clinical presentation
Infecting pathogen
Radiographic pattern of the infiltrate
Immune status of the patient

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6
Q

What is the main reason for classification of pneumonia

A

To help predict etiology and guide diagnostic and initial empirical therapeutic interventions

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7
Q

Which setting of acquisition of pneumonia occurs prior contact to the health care system in the outpatient setting or within 48 hours of hospitalization

A

CAP

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8
Q

Which type of pneumonia occurs 48 hours after hospitalization with no signs of pulmonary infection on admission

A

HAP

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9
Q

Which type of pneumonia develops 48 hours or more on mechanical ventilation

A

VAP

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10
Q

Which type of pneumonia occurs in non-hospitalized patients with extensive health care contact

A

HCAP

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11
Q

What are the two common mechanisms of acquisition of pneumonia

A

Ventilator use
Aspiration

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12
Q

Which type of pneumoniae has a less abrupt course with constitutional and mild upper respiratory tract symptoms preceding the onset of a non-productive cough

A

Atypical pneumoniae

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13
Q

Which type of pneumonia is associated with an acute respiratory illness characterized by productive cough, pleuritic chest pain, fever and dyspnea

A

Typical pneumonia

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14
Q

What condition is interstitial pneumonia associated with

A

Reticulonodular opacities

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15
Q

What condition tends to have multifocal opacities

A

Bronchopneumonia

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16
Q

Absolute neutrophil count which suggests a patient is immunocompromised

A

Neutrophil count < 1000/mcL or 1.0x10^9/L

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17
Q

What is the pathogenesis of pneumonia

A

There is invasion and overgrowth of pathogenic organisms in the king parenchyma
The host defenses work to prevent proliferation of microorganisms in the lungs
A combination of defective host defenses, virulence of pathogen, high pathogen inoculum and patient’s overall health results in development of pneumonia
The Inflammatory response against the microorganisms causes the clinical manifestations of pneumonia

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18
Q

What are some risk factors for CAP

A

Alcoholism and smoking
Age greater than 65
Recent viral upper respiratory tract infection
Underlying pulmonary disease (COPD, bronchiectasis, lung cancer)
Proton pump inhibitor therapy for the last 30 days
Smoke
Sedating medications
Immunosuppression
Severity of underlying illness
Presence of invasive respiratory devices
Stress ulcer prophylaxis

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19
Q

List some bacteria which cause typical pneumonia

A

Streptococcus pneumoniae
Staphylococcus aureus
Klebsiella pneumoniae
Haemophilus influenzae and Moraxella catarrhalis
Pseudomonas aeruginosa

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20
Q

What is the most common pathogen for causing pneumonia

A

Streptococcus pneumoniae

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21
Q

Which bacteria can be seen in alcoholics and heavy smokers, and in association with aspiration and could lead to aggressive necrotising lobar pneumonia

A

Klebsiella pneumoniae

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22
Q

Which bacteria could cause pneumonia in the elderly and patients with COPD

A

Haemophilus influenzae and Moraxella catarrhalis

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23
Q

Which bacteria is an uncommon cause of CAP in healthy adults but may occur following an influenza infection. It could also cause a severe necrotizing pneumonia that often requires ICU admission

A

Staphylococcus aureus

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24
Q

What is a rare pathogen in CAP except in patients with structural lung disease such as cystic fibrosis and bronchiectasis

A

Pseudomonas aeruginosa

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25
What is the most common pathogen for atypical pneumonia
Mycoplasma pneumoniae
26
What is the result of aspiration of oropharyngeal contents
Anaerobic organisms
27
Mention some other bacteria that cause atypical pneumonia
Legionella spp Coxiella burnetii (Q fever) Chlamydophila pneumoniae
28
Aspiration pneumonia tends to be polymicrobial and may consist of some anaerobic species True or false
True
29
Give some examples of anaerobic species that cause aspiration pneumonia
Klebsiella Peptostreptococcus Bacteroides Fusobacterium Prevotella
30
What is the most common viral cause of pneumonia in patients at the extremes of age, with multiple comorbidities, and pregnant women
Influenza A and B
31
Which virus causes pneumonia only in immunocompromised patients
Cytomegalovirus
32
Which viral pathogens can cause pneumonia
RSV VZV EBV Coronavirus Parainfluenza virus Adenovirus
33
Fungal pathogens are rarely a cause for which type of pneumonia
CAP
34
Which bacteria is commonly associated with prolonged mechanical ventilation
Acinetobacter baumannii
35
Pneumonia is common in HIV patients True or false
True
36
Deactivation of which viruses can cause pneumonia in the IC host
HSV VZV CMV
37
Toxoplasma gondii and Strongyloides stercoralis may rarely cause pneumonia in the IC host True or false
True
38
What are some symptoms of CAP
Combination of cough with or without sputum production Fever, pleuritic chest pain Shortness of breath Respiratory distress Etc
39
Elderly and immunocompromised patients may present with subtle and non-respiratory symptoms such as
Lethargy or delirium Poor oral intake Decompensation of other comorbid medical conditions
40
What are some clinical manifestations of atypical CAP
It is characterized by a more insidious onset, a dry cough and constitutional and extrapulmonary symptoms such as headache, low-grade fever, malaise, myalgias, sore throat, etc Extra pulmonary symptoms are often more prominent than respiratory symptoms Chest radiograph tends to appear much worse than the clinical or auscultatory findings
41
Signs of CAP
Many patients appear acutely ill Common physical findings include fever or hypothermia, tachypnea, tachycardia, and arterial oxygen desaturation Dullness to percussion may be observed if lobar consolidation or a parapneumonic pleural effusion is present Chest auscultation often reveals inspiratory crackles and bronchial breath sounds *The clinical evaluation is less than 50% sensitive compared to chest imaging for the*
42
VAP may also manifest as an increased need for mechanical ventilator support and/or pulmonary suction requirements True or false
True
43
What is the most consistent presenting symptom for bacterial pneumonia
Cough productive of sputum
44
A red-colored sputum in pneumonia is characteristic of which bacteria
Streptococcus pneumoniae
45
A green-colored sputum in pneumonia is characteristic of which bacteria
Pseudomonas Haemophilus Pneumococcal species
46
A red currant jelly sputum In pneumonia is characteristic of which bacteria
Klebsiella species
47
A foul smelling sputum in pneumonia is characteristic of which type of infection
Anaerobic infection
48
The presence of rigors may suggest which type of pneumonia
Pneumococcal pneumonia more often than pneumonia caused by other bacterial pathogens
49
What are some aspiration risks
Alcoholism Altered mental status Dysphagia Seizure disorder GERD
50
Exposure to contaminated air conditioning or water systems can cause pneumonia. What bacteria is responsible for this
Legionella spp
51
Exposure to overcrowded instititions can cause pneumonia. What bacteria is responsible for this
S. pneumoniae Mycobacteria Mycoplasma Chlamydophilia
52
Exposure to cattle, cats, sheep and goats can cause pneumonia . What organism is responsible for this
C. burnetii
53
Exposure to cattle hide can cause pneumonia. What organism is responsible for this
B. anthracis
54
Exposure to turkeys, chicken, duck or other birds can cause pneumonia. What organism is responsible for this
C. psittachi
55
Exposure to rabbits and rodents can cause pneumonia. What organism is responsible for this
F. tularensis Y. pestis
56
What are some investigations for pneumonia
FBC (Leukocytosis with predominantly neutrophilia may be observed in any bacterial infection. Leukopenia may be an ominous clinical sign of impending sepsis) Blood culture (should be obtained before the administration of antibiotics. Positive in 40% in cases) Sputum gram stain and culture (should be performed before taking antibiotics) Serum chemistry panel (Blood urea, electrolytes and creatinine) Arterial blood gas determination (hypoxia and respiratory acidosis might be present) Inflammatory biomakers (ESR, C-reactive protein, Procalcitonin) Chest X-ray Ziehl-Neelsen stain for acid fast bacilli Silver stain for Pneumocystis jiroveci and fungal pathogens Antigen tests (Can be performed on urine, nasal aspirate, sputum, lower respiratory tract specimens and serum for various pathogens including L pneumophila, S pneumoniae, Pneumocystis jirovecii, Cryptococcus neoformans, Histoplasma capsulatum etc. PCR testing for M pneumoniae, Chlamydophila spp, common respiratory viruses. Immunohistochemistry can be performed on BAL specimen to detect viral infections such as CMV, VZV, or HSV. Histology from a transbronchial biopsy is useful for detecting endemic fungal and mycobacterial pathogens)
57
What is the the gold standard for diagnosis of pneumonia
The presence of an infiltrate in a chest x-ray
58
A normal x-ray does not exclude the diagnosis of pneumonia because X-rays may be normal, early in the course of disease True or false
True
59
Always consider the possibility of this infection, because delayed treatment significantly increases mortality. What bacteria is being referred to
Legionella
60
The episode of aspiration is usually not witnessed, thus a diagnosis is inferred when patient at risk of aspiration develops radiographic infiltrate in characteristic locations True or false
True
61
What are the non-infectious differential diagnosis for pneumonia
Pulmonary edema Pulmonary embolism Lung carcinoma Hypersensitivity pneumonitis Connective tissue disease involving the lung
62
What are some infectious differential diagnosis of pneumonia
Acute bronchitis Exacerbation of COPD TB Lung abscess
63
Differentiate pulmonary edema diagnosis from pneumonia
There is bilateral infiltration with central predominance and abnormal ECG is suggestive in pulmonary edema
64
Differentiate pulmonary embolism diagnosis from pneumonia
Pulmonary embolism rarely presents with productive coughs or infiltrations visible on chest x-ray
65
A history of smoking, constitutional symptoms (e.g. significant weight loss), or chronic cough may be suggestive. What differential diagnosis of pneumonia is this
Lung carcinoma
66
Most often, a prior diagnosis or symptoms of underlying disease is already present. Which differential diagnosis of pneumonia is this
Connective tissue disease involving the lung
67
Diagnostic criteria including a compatible exposure history. What differential diagnosis for pneumonia is this
Hypersensitivity pneumonitis
68
Once a diagnosis of CAP is made, the first management decision is to
Determine the site of care (Is it safe to treat the patient at home or does the patient require admission to the medical ward or intensive care unit?)
69
What are the two widely used clinical prediction rules available to guide admission and triage decisions
Pneumonia Severity Index (PSI-Preferred tool) Curb-65 (Alternative tool)
70
Curb-65 assesses 5 independent predictors of increased mortality. What are these
Confusion Urea Respiratory rate Blood pressure Age greater than 65
71
What is the use of the CURB-65 scoring system
It is used to help identify patients that may be candidates for outpatient treatment or require admission
72
In the Curb-65 system, one point is given in each of the predictors. What parameters of the predictors calls for points. List for each parameter (confusion, urea, respiratory rate, blood pressure, age greater than 65)
Confusion - altered mental state Urea - BUN levels > 7mmol/L RR - RR > 30bpm BP - Systolic pressure < 90mmHg or diastolic pressure < 60mmHg Age - 65 years or more
73
What does score of 0-1 mean in the Curb system
Outpatient treatment
74
What does score of 2 mean in the Curb system
Admission to medical ward
75
What does score of 3 or higher mean in the Curb-65 system
Admission to ICU
76
Which Curb-65 score range carries a low risk of mortality and which score range Carrie’s a high risk of mortality
0-1 - low risk of mortality 2-5 - high risk of mortality
77
What is the mainstay of treatment of bacterial pneumonia
Antibiotic therapy
78
List some supportive treatments for pneumonia
Supplemental oxygen with pulse oximetry monitoring Ventilators support if supplemental oxygen is not sufficient or patient cannot maintain the increased work of breathing Fluid resuscitation with intravenous crystalloids in patients with hypotension and/or tachycardia Analgesia and antipyretics Correction of electrolyte abnormalities Chest physiotherapy to assist in drainage of secretions Good nutrition and early mobilization of patients
79
What are some preventative measures for CAP
Pneumococcal vaccines Administration of influenza vaccine decrease the risk of viral influenza which decreases the risk of viral influenza which decreases the risk of bacterial superinfection
80
What is pleural effusion
It refers to the accumulation of fluid between the layers of the parietal and visceral pleura. It is the manifestation of a disease rather than a disease in itself
81
What are the classifications of pleural effusion
Transudative and exudative
82
What is emphysema
Pus in the pleural space. It is typically a complication of pneumonia
83
Emphysema may also arise from
Penetrating chest trauma Esophageal rupture Complication from lung surgery Inoculation of the pleural cavity after thoracentesis or chest tube placement Extension of a subdiaphragmatic or paravertebral abscess
84
What is the pathophysiology of pleural effusion
Pleural effusions represent a disturbance between pleural fluid production and lymphatic resorption. Pleural fluid is a product of Starling forces within the capillary bed of the parietal pleura and is absorbed by lymph vessels in the diaphragmatic and mediastinal surfaces of the parietal pleura The entire volume of pleural fluid normally turns over within 1 hour. The lymphatic vessels can handle flow of up to approximately 20 times more than the normal production rate → lymphatic resorption has a large reserve capacity
85
The normal mean rate of production and absorption of the pleural fluid is
0.2 mL/kg/hour

Medicine (38 decks)

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