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PANCE/EOC > Pulm #3 > Flashcards

Pulm #3 Flashcards

1
Q

MCC of typical Pneumonia

A

Strep Pneumo

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2
Q

Causes of atypical PNA

A
  • Mycoplasma PNA

- Legionella PNA

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3
Q

Symptoms of Typical PNA

A
  • 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
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4
Q

Symptoms of Atypical PNA

A
  • Fever, dry nonproductive cough, myalgias, malaise, nausea, vomiting, diarrhea
  • Pulmonary exam often normal
  • May have crackles and rales
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5
Q

Regarding Strep Pneumo PNA, what kind of sputum is associated with it?

A

Blood-tinged rusty sputum

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6
Q

On a gram-stain for Strep Pneumo, what is seen?

A

Gram-positive diplococci

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7
Q

Regarding H. Influenzae PNA (second MCC of CAP), what are the risk factors for this type?

A
  • Extremes of age (young and old)
  • Immunocompromised (DM, HIV, chemo)
  • Underlying pulmonary disease (COPD, asthma, CF)
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8
Q

Staph Aureus PNA is associated with

A

A superimposed infection after a viral infection or hospital acquired pneumonia

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9
Q

What does a gram-stain for Staph A PNA show?

A

Gram-positive cocci in clusters

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10
Q

Klebsiella PNA is a severe illness in who?

A

Chronic alcoholism, sick patients, and patients with chronic illnesses (DM)

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11
Q

What kind of sputum is seem in patients with Klebsiella PNA?

A

-Purple-colored (currant jelly) sputum

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12
Q

For Klebsiella PNA, what is seen on CXR?

A

Cavitary lesions (especially right upper lobe) with bulging fissures

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13
Q

MCC of atypical PNA

A

Mycoplasma Pneumoniae

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14
Q

Risk factors for mycoplasma PNA

A

-Young and healthy (college students, military recruits)

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15
Q

Symptoms of Mycoplasma PNA

A
  • Pharyngitis and URI symptoms (headache, fever, malaise)
  • Persistent dry nonproductive cough
  • Bullous myringitis (rare): fluid filled blisters in TM
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16
Q

What does a CXR for mycoplasma PNA show?

A

-Reticulonodular pattern most common (diffuse, patchy or interstitial infiltrates)

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17
Q

What is the test of choice for mycoplasma PNA?

A

-PCR: cold agglutinins

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18
Q

Treatment for Mycoplasma PNA

A
  • Macrolides (Azithromycin) or Doxycycline

- Lacks a cell wall so resistant to beta-lactams

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19
Q

Legionella PNA is transmitted through

A

Outbreaks related to contaminated water sources (air conditioners, potable water, cooling towers)
-No person to person transmission

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20
Q

Symptoms of Legionella PNA

A
  • GI symptoms prominent: watery diarrhea, nausea, vomiting
  • Hyponatremia and increased LFT’s
  • Neurologic symptoms: headache, confusion, AMS
21
Q

Preferred diagnostic for Legionella PNA

A

-PCR or urine antigen

22
Q

Treatment for Legionella PNA

A

-Macrolides or Levofloxacin, Moxifloxacin

23
Q

What is the time frame regarding CAP and HAP

A

CAP: develops PNA within 48 hours of initial hospital admission or outside of the hospital

HAP: > 48 hours after hospital admission

24
Q

Outpatient treatment for CAP

A
  • Macrolide or Doxycycline first line

- Fluoroquinolones only used if comorbid conditions or recent ABX use

25
Q

Inpatient treatment of CAP

A

-Ceftriaxone or Ampicillin/Sulbactam

OR

-Levofloxacin, Moxifloxacin

26
Q

HAP treatment

A

-Piperacillin/Tazobactam, Ceftazidime, Cefepime;

Aminoglycosides (Amikacin, Gentamicin, Tobramycin);

or Levofloxacin/Moxifloxacin

27
Q

With HAP:

  • Add _____ or _____ if Legionella suspected
  • Add _____ or _____ if MRSA suspected
A
  • Levofloxacin or Azithromycin

- Vancomycin or Linezolid

28
Q

What is the CURB-65 criteria regarding admission for PNA?

A

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
29
Q

Aspiration PNA is MCC by

A

Anaerobes (Peptostreptococcus, Fusobacterium)

30
Q

Aspiration PNA is MC found in

A

The right lower lobe due to vertical angle of right mainstem bronchus

31
Q

Treatment for aspiration PNA

A

-Ampicillin-Sulbactam or Amoxicillin-Clavulanate

32
Q

Histoplasmosis PNA is transmitted through

A

Inhalation of soil containing bird and bat droppings in the Mississippi and Ohio River valleys

(also seen with demolition and spelunkers)

33
Q

Most specific test for Histoplasmosis PNA

A

-Cultures

34
Q

Treatment for mild-moderate disease in Histoplasmosis PNA

A

-Intraconazole 1st line

35
Q

Pneumonia Vaccine Schedule

A
  • Prevnar 13 to kids < 20 years old

- Prevnar 13 then Pneumovax 23 to people > 65

36
Q

MCC of acute bronchiolitis

A

-RSV

37
Q

Risk Factors for bronchiolitis

A
  • Infants 2 months to 2 years
  • Exposure to cigarette smoke
  • Prematurity
  • Crowded conditions (day care)
38
Q

Symptoms of acute bronchiolitis

A

-Viral prodrome followed by respiratory distress

39
Q

Management for bronchiolitis

A

-Supportive: humidified oxygen, IVF, nebulized saline, cool mist humidifier, antipyretics

40
Q

How to prevent bronchiolitis in high risk patients

A
  • Palivizumab during first year of life for children < 29 weeks, symptomatic lung disease, immunodeficiency
  • Handwashing is preventative
41
Q

Byssinosis is caused by

A

Cotton exposure in those employed in the textile industry

42
Q

Symptoms of Byssinosis

A
  • Dyspnea, wheezing, cough, chest tightness

- Symptoms get worse at beginning of week and improve later in the week (Monday fever)

43
Q

Silicosis is pulmonary disease caused by

A

inhalation of silicon dioxide

44
Q

Silicosis greatly increases the risk for

A

TB

45
Q

Risk Factors for silicosis

A
  • Coal mining
  • Quarry work with granite
  • Slate, quartz
  • pottery makers
  • Sandblasting
  • Masonry
46
Q

What do chest radiographs for silicosis show?

A
  • Multiple small opacities in upper lobes

- Eggshell calcifications of hilar and mediastinal nodes

47
Q

What is the diagnostic gold standard for silicosis?

A

Lung biopsy

48
Q

Mainstay of treatment for silicosis?

A

Removal from exposure

PANCE/EOC (63 decks)

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