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RRCCPA Clinical Medicine I > Pneumonia - Witwer Final > Flashcards

Pneumonia - Witwer Final Flashcards

1
Q

T/F: With evaluation of pneumonia, radiographic appearance is predictive of the causative organism

A

False - not predictive (non-specific)

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2
Q

Radiographic appearance can help determine what about pneumonia?

A
  • The presence of pneumonia
  • Extent
  • Possible complications

*Acts as a baseline study for future evaluations

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3
Q

Does the absence of radiographic findings of pnemonia exclude pneumonia as a Dx?

A

No! (dehydration)

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4
Q

Clinical Classification of pneumonia is based on ___ and ___ pneumonia is acquired.

A

Clinical Classification of pneumonia is based on how and where pneumonia is acquired.

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5
Q

What are the Clinical Classifications of pneumonia?

A
  1. Community Acquired (CAP)
  2. Nosocomial (Hospital Acquired, Healthcare Associated)
  3. Ventilator Associated
  4. Aspiration
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6
Q

What is the most common causative organism of CAP?

A

Streptococcus (Pneumococcus) pneumoniae (48%)

Viral is 2nd (19%)

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7
Q

What is the diagnostic strategy to confirm diagnosis in a CAP situation where a patient has a fever, cough, sputum, and coarse crackles?

A

Order CXR

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8
Q

If you see a segmental or lobar consolidation on CXR, there is a 90% chance of a CAP being caused by what 3 organisms?

A
  1. Pneumococcal
  2. Mycoplasma
  3. Viral
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9
Q

Nosocomial Pneumonia occurs after how many hours in the hospital?

A

48-72 hrs (or within 48 hrs of discharge)

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10
Q

What is the clinical presentation of typical bacterial pneumonia?

A
  • High fever
  • Rigors
  • Productive cough
  • Lobar consolidation
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11
Q

What is the clinical presentation of atypical bacterial pneumonia

A
  • Dry cough
  • Diffuse patchy infiltrates
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12
Q

What are the most common causative agents of Hospital Acquired Pneumonia?

A
  1. Aerobic Gram-Negative Bacilli (Enterobacter, E. coli, Pseudomonas, Aeruginosa)
  2. Gram positive cocci (Staph aureus - usually MRSA)
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13
Q

Does CAP or HAP have a higher mortality rate?

A

HAP

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14
Q

What is Health Care Associated Pneumonia (HCAP)?

A
  • Now under HAP
  • Patients who have extensive contact with health care -increasing the risk for virulent or drug resistant organisms
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15
Q

Intubation is a very high risk factor for what type of pneumonia?

A

Nosocomial (HAP)

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16
Q

What are the most common causative organisms of Ventilator Acquired Pneumonia (VAP)

A
  1. Pseudomonas aeruginosa is MC
  2. Klebsiella pneumoniae
  3. Serratia marcescans
  4. Enterobacter
17
Q

What are examples of other radiographic findings in pneumonia that often complicate the evaluation of the radiographic studies?

A
  • Atelectasis
  • Pulmonary infarction
  • Pulmonary edema
  • Pleural effusions
  • ARDS

*All of these are “water” density

18
Q

Pneumococcal classically presents with what symptoms?

A
  • Sudden onset of chills, fever, rigors
  • Productive cough
  • Pleuritic CP
  • Focal pulmonary infiltrates
19
Q

Staphylococcus aureus pneumonia can be rapidly ____ with destructive changes

A

Staphylococcus aureus pneumonia can be rapidly progressive with destructive changes

20
Q

Haemophilus pneumonia in adults is found in smokers with ____

A

COPD

21
Q

Mycoplasma and Chlamydia pneumonias often have insidious presentation with what symptoms?

A
  • Dry cough
  • Scattered infiltrates
22
Q

Legionella pneumonia is often preceded by what?

A

GI complaints - presenting with hyponatremia, elevated LAD, delirium, or a very sick patient

23
Q

An HIV patient presenting with strandy appearance (hazy) on CXR should make you think of what specific Dx?

A

Pneumocystis jiroveci (PJP)

*Note these pts could also present with subtle or absent findings

24
Q

Tuberculosis causes what symptoms and is seen in what parts of the lungs?

A
  • Chronic cough
  • Weight loss
  • Fevers
  • Night sweats

Seen in upper lobes of lungs

25
Q

What type of pneumonia is usually found bilaterally in the posterior lower lobes of the lungs?

A

Aspiration pneumonia

26
Q

What would you expect to see during the PE of a pneumonia patient if there is consolidation?

A
  • Fluid in the lungs may transmit sounds better than air
  • Sounds created in vocal cords and trachea will be heard better and may be altered
  • Tactile fremitus is augmented by fluid consolidation
  • Normal spoken words heard clearer and louder
  • Whispered words heard clearer and louder
  • Spoken “E” will be altered to “A”
27
Q

A CXR with diffuse alveolar infiltrate, enlarged hilar lymph nodes, and upper lung lobe changes should make you think of what specific Dx?

A

Primary Tuberculosis

*Note TB has a non-specific pattern

28
Q

Ghon or Ranke complexes on CXR should make you think of what specific Dx?

A

TB - after the primary infection, there is healing with scar formation, usually in the upper lobes or upper portion of the lower lobes. The scar can contain viable bacteria

29
Q

Primary Tuberculosis is associated with?

A
  • Hilar adenopathy
  • Pleural Effusions
30
Q

What is Postprimary TB and what would you expect to see on CXR?

A

Reactivation TB or Secondary

  • Cavitation is common (destroyed lung tissue in cave like manner)
  • Thin walled
  • Strandy fibrotic densities
  • In upper lobes
31
Q

What would you see on CXR for Miliary TB?

A

Multiple small tuberculomas scattered throughout the lungs

32
Q

Viral pneumonias are radiographically ___-___

A

Viral pneumonias are radiographically non-specific - however tends toward interstitial, nodular, or patchy air-space consolidation, but can be segmental or lobar

33
Q

What are the viral organisms that cause Viral Pneumonia?

A
  • Influenza, Adenovirus
  • Measles, Varicella-Zoster, Cytomegalovirus
  • Beware more virulent forms such as Hanta virus
34
Q

What is Non-Resolving Pneumonia?

A

Persistence of radiographic findings for more than a month in a clinically improved patient

*Beware of chronic underlying TB, fungal pneumonia, inflammatory pneumonitis, sarcoid or malignancy

35
Q

What are these CXRs showing? Dx?

A

Peribronchial/Bronchial Cuffing –thickened bronchi secondary to inflammation and or mucus

Dx: Bronchopneumonia

36
Q

What is this CXR showing?

A

Air bronchograms

*Note air in bronchi, airways are open and surrounded by alveolar consolidation of the lung

37
Q

What is Bronchiolitis?

A

Diffuse inflammatory process involving the bronchioles

38
Q

How does Bronchiolitis usually present in children?

A
  • Usually seen in children < 18 months
  • 2/2 to Respiratory Syncytial Virus (RSV), Adenovirus or others
  • Diffuse hyperinflation of lungs - usually without pneumonia
  • Child taking deep breaths in (children normally do not take deep breaths)

*Do not be fooled by a clear CXR - hyperinflation of lungs = difficulty moving air

39
Q

In adults, Bronchiolitis can present as what?

A
  • Can be a chronic inflammatory process
  • Bronchiolitis Obliterans
  • Bronchiolitis Obliterans with Organizing Pneumonia (BOOP) with diffuse interstitial/alveolar infiltrates

RRCCPA Clinical Medicine I (49 decks)

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