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pulmonology > Pneumonia Review > Flashcards

Pneumonia Review Flashcards

1
Q

Typical CAP?

A
  • Strep pneumoniae
  • H-flu
  • Staph aureus
  • Moraxella catarrhalis
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2
Q

Atypical CAP?

A
  • mycoplasma pneumoniae
  • Legionella
  • Chlamydophila pneumoniae
  • Pseudomonas
  • Viruses
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3
Q

Most common CAP?

A
  • Strep pneumoniae
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4
Q

H Flu is common in which pts?

A
  • elderly and pts with underlying pulmonary disease
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5
Q

What patients does mycoplasma pneumonia affect and what is this also known as?

A
  • also known as Walking Pneumonia

- affects scool aged childrem college students, and military recruits

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6
Q

Legionella is associated with what?

A
  • contaminated water

- associated with exposure to aerosol producing devices: air conditioners, shower, mist machine and whirlpool spas

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7
Q

Who is at risk for Klebsiella?

A
  • alcoholics
  • COPD pts
  • Diabetes pts
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8
Q

When does Chlamydia peak and who is it common in?

A
  • common in 65-79 y/o
  • peak rate in winter months
  • associated bronchitis
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9
Q

Who does pseudomonas affect?

A
  • the immunocompromised
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10
Q

Who does staph aureus affect?

A
  • elderly and young recovering from influenza virus
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11
Q

PCP is common in which patient group?

A
  • patients infected with HIV
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12
Q

Clinical presentation in patients with atypical CAP?

A
  • usually have less acute presentation than typical CAP
  • CAP due to atypical pathogens may have one or more extrapulmonary features
  • patients with Legionella infections may have a productive or nonproductive cough. Pts with mycoplasma pneumoniae or chlamydia pneumoniae usually present with a nonproductive cough
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13
Q

What antibiotics are ineffective for atypical pneumonia?

A
  • PCN and cephalosporins won’t be as effective because atypical bacteria lack a cell wall
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14
Q

What are predisposing host conditons/risk factors for pneumonia?

A
  • elderly and very young
  • pre-existing lung disease: COPD, cystic fibrosis, bronchiectasis
  • smoking
  • malnutrition
  • immunosuppressed
  • previous episodes of pneumonia or chronic bronchitis
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15
Q

Clinical features of pneumonia?

A
  • abrupt onset
  • fever
  • productive cough: purulent sputum
  • tachycardia
  • chills and rigors
  • HA
  • N/V
  • malaise (atypicals - flu like sxs)
  • dyspnea
  • consolidation
  • hypoxia
  • pleuritic chest pain
  • pleural effusion
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16
Q

Characteristic of strep pneumococcal pneumonia sputum?

A
  • bloody, rust colored sputum
17
Q

Characteristic of sputum of a pt with klebsiella pneumonia?

A
  • bloody, currant jelly, blood tinged
18
Q

Characteristics of pseudomonas pneumonia?

A
  • green sputum, and grape smelling
19
Q

Clinical presentation of strep pneumococcal pneumonia?

A
  • abrupt onset
  • shivering rigors and chills
  • rust colored sputum
20
Q

Clinical presentation of mycoplasma pneumonia?

A
  • slower onset
  • general malaise
  • HA
  • rash
  • diarrhea
  • sometimes the CXR isn’t conclusive
21
Q

What will you see on a CXR of pneumonia?

A
  • consolidation
  • interstitial infiltrates
  • air bronchograms
  • cavitary lesions and pleural effusions: H flu, observed with staph aureus, anaerobic and TB infection
  • legionella has a predilection for lower lung fields
  • Klebsiella: upper lobes
  • TB has a predilection for apex
22
Q

Lab indications for CAP?

A
  • not typically done in outpatient setting since empiric therapy is usually successful but inpatients require further dx
  • labs are always done in inpatient setting
    CMP: hyponatremia - associated with Legionella
    CBC: leukocytosis with left shift, and leukopenia (ominous sign of impending death, clinical absence shouldnt rule out possibility of bacterial infection)
    Sputum culture and gram’s stain: specimen should be a deep cough specimen obtained prior to abx
  • ABGs: hypoxia and respiratory acidosis (inpatient)
  • blood cultures
23
Q

How should you select a antimicrobial therapy?

A
  • for the most likely pathogen
  • clinical trials proving efficacy
  • risk factors for resistance
  • medical comorbidities
24
Q

Tx guidelines for ambulatory pts with CAP?

A
  • macrolides or newer flouroquinolones to provide coverage for both S. pneumoniae and atypical pathogens
  • macrolides are effective in absence of signifant RFs for macrolide resistant S. pneumo
  • tx: Azithro 500 mg pox day, 1, followed by 4 days of 250 mg a day
    clarithro: 500 mg po bid for 5 days
    doxy: 100 mg po bid for 7-10 days
25
Q

How common is HAP?

A
  • nosocomial pneumonia is 2nd most common cause of hospital acquired infection and is leading cause of death due to nosocomial infection (any contact with health care worker)
  • occurs more than 48 hrs after admission (especially common in pts requiring ICU or mechanical ventilation)
  • will present with at least 2 of the following:
    fever, cough, leukocytosis, purulent sputum
  • new or prgoressive parenchymal infiltrate on CXR
26
Q

How is HAP acquired?

A
  • colonization of pharynx
  • stomach bacteria: NG and ET tubes
    elevations in gastric pH (gastric microbial overgrowth), contamination by dirty hand and equipment, and drug resistant organisms
27
Q

What pts are at risk for HAP?

A
  • malnutrition
  • advanced age
  • altered consciousness
  • swallowing disorders
  • underlying pumlmonary and systemic disease
28
Q

Dx tests for HAP?

A
  • CXR
  • CBC
  • ABGs
  • sputum: gram stain and culture, fluorescent ab staining with suspected Legionella
  • blood cultures: from 2 different sites
  • thoracentesis: pleural effusion
29
Q

Common HAP bacteria?

A
  • pseudomonas
  • staph aureas
  • enterobacter
  • klebsiella
  • E-coli
30
Q

Tx for HAP

A
  • empiric like CAP

- may need to switch or add abx according to sputum and/or blood culture results

31
Q

Prevention of pneumonia?

A
  • PPV: 23 strains of S pneumo
    a single dose offers lifetime immunitiy
  • indications: 65 or older, any chronic illness that increases risk, and immunocompromised
  • one time revaccination after initial vaccination for:
    those at highest risk, those over 65 who received the vaccine 5 years or more previously and were under age of 65 at time of first vaccination
  • influenzae vaccine: for those at high risk for development of primary influenzae pneumonia and secondary bacterial pneumonias: age 65 and older, resident of long term care facilities, pts with pulmonary or cardiovascular disease
  • both vaccines can be given simultaneously and there are not CIs to use immediately after episode of pneumonia

pulmonology (20 decks)

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