Pulm #3 Flashcards
MCC of typical Pneumonia
Strep Pneumo
Causes of atypical PNA
- Mycoplasma PNA
- Legionella PNA
Symptoms of Typical PNA
- Tachypnea
- Signs of consolidation: bronchial breath sounds, dullness to percussion, increased tactile fremitus, ego phony, inspiratory crackles/rales
- Fever, productive cough, pleuritic chest pain, dyspnea, rigors
Symptoms of Atypical PNA
- Fever, dry nonproductive cough, myalgias, malaise, nausea, vomiting, diarrhea
- Pulmonary exam often normal
- May have crackles and rales
Regarding Strep Pneumo PNA, what kind of sputum is associated with it?
Blood-tinged rusty sputum
On a gram-stain for Strep Pneumo, what is seen?
Gram-positive diplococci
Regarding H. Influenzae PNA (second MCC of CAP), what are the risk factors for this type?
- Extremes of age (young and old)
- Immunocompromised (DM, HIV, chemo)
- Underlying pulmonary disease (COPD, asthma, CF)
Staph Aureus PNA is associated with
A superimposed infection after a viral infection or hospital acquired pneumonia
What does a gram-stain for Staph A PNA show?
Gram-positive cocci in clusters
Klebsiella PNA is a severe illness in who?
Chronic alcoholism, sick patients, and patients with chronic illnesses (DM)
What kind of sputum is seem in patients with Klebsiella PNA?
-Purple-colored (currant jelly) sputum
For Klebsiella PNA, what is seen on CXR?
Cavitary lesions (especially right upper lobe) with bulging fissures
MCC of atypical PNA
Mycoplasma Pneumoniae
Risk factors for mycoplasma PNA
-Young and healthy (college students, military recruits)
Symptoms of Mycoplasma PNA
- Pharyngitis and URI symptoms (headache, fever, malaise)
- Persistent dry nonproductive cough
- Bullous myringitis (rare): fluid filled blisters in TM
What does a CXR for mycoplasma PNA show?
-Reticulonodular pattern most common (diffuse, patchy or interstitial infiltrates)
What is the test of choice for mycoplasma PNA?
-PCR: cold agglutinins
Treatment for Mycoplasma PNA
- Macrolides (Azithromycin) or Doxycycline
- Lacks a cell wall so resistant to beta-lactams
Legionella PNA is transmitted through
Outbreaks related to contaminated water sources (air conditioners, potable water, cooling towers)
-No person to person transmission
Symptoms of Legionella PNA
- GI symptoms prominent: watery diarrhea, nausea, vomiting
- Hyponatremia and increased LFT’s
- Neurologic symptoms: headache, confusion, AMS
Preferred diagnostic for Legionella PNA
-PCR or urine antigen
Treatment for Legionella PNA
-Macrolides or Levofloxacin, Moxifloxacin
What is the time frame regarding CAP and HAP
CAP: develops PNA within 48 hours of initial hospital admission or outside of the hospital
HAP: > 48 hours after hospital admission
Outpatient treatment for CAP
- Macrolide or Doxycycline first line
- Fluoroquinolones only used if comorbid conditions or recent ABX use
Inpatient treatment of CAP
-Ceftriaxone or Ampicillin/Sulbactam
OR
-Levofloxacin, Moxifloxacin
HAP treatment
-Piperacillin/Tazobactam, Ceftazidime, Cefepime;
Aminoglycosides (Amikacin, Gentamicin, Tobramycin);
or Levofloxacin/Moxifloxacin
With HAP:
- Add _____ or _____ if Legionella suspected
- Add _____ or _____ if MRSA suspected
- Levofloxacin or Azithromycin
- Vancomycin or Linezolid
What is the CURB-65 criteria regarding admission for PNA?
Admit if at least 2 points, each is worth 1 point
- Confusion
- Uremia (> 7 mg/dL)
- Respiratory rate > 30
- BP low (SBP < 90 or DBP < 60)
- Age > 65
Aspiration PNA is MCC by
Anaerobes (Peptostreptococcus, Fusobacterium)
Aspiration PNA is MC found in
The right lower lobe due to vertical angle of right mainstem bronchus
Treatment for aspiration PNA
-Ampicillin-Sulbactam or Amoxicillin-Clavulanate
Histoplasmosis PNA is transmitted through
Inhalation of soil containing bird and bat droppings in the Mississippi and Ohio River valleys
(also seen with demolition and spelunkers)
Most specific test for Histoplasmosis PNA
-Cultures
Treatment for mild-moderate disease in Histoplasmosis PNA
-Intraconazole 1st line
Pneumonia Vaccine Schedule
- Prevnar 13 to kids < 20 years old
- Prevnar 13 then Pneumovax 23 to people > 65
MCC of acute bronchiolitis
-RSV
Risk Factors for bronchiolitis
- Infants 2 months to 2 years
- Exposure to cigarette smoke
- Prematurity
- Crowded conditions (day care)
Symptoms of acute bronchiolitis
-Viral prodrome followed by respiratory distress
Management for bronchiolitis
-Supportive: humidified oxygen, IVF, nebulized saline, cool mist humidifier, antipyretics
How to prevent bronchiolitis in high risk patients
- Palivizumab during first year of life for children < 29 weeks, symptomatic lung disease, immunodeficiency
- Handwashing is preventative
Byssinosis is caused by
Cotton exposure in those employed in the textile industry
Symptoms of Byssinosis
- Dyspnea, wheezing, cough, chest tightness
- Symptoms get worse at beginning of week and improve later in the week (Monday fever)
Silicosis is pulmonary disease caused by
inhalation of silicon dioxide
Silicosis greatly increases the risk for
TB
Risk Factors for silicosis
- Coal mining
- Quarry work with granite
- Slate, quartz
- pottery makers
- Sandblasting
- Masonry
What do chest radiographs for silicosis show?
- Multiple small opacities in upper lobes
- Eggshell calcifications of hilar and mediastinal nodes
What is the diagnostic gold standard for silicosis?
Lung biopsy
Mainstay of treatment for silicosis?
Removal from exposure
