Pulm III - PNA...

Question 1

Pneumonia - PNA

Answer 1

*acute infxt of the pulmonary parynchema

Question 2

Community Acquired PNA - (CAP)

Answer 2

*PNA outside of the healthcare setting

Question 3

Hospital Acquired PNA - (HAP)

Answer 3

*PNA >48 hrs after hospital admin

Question 4

Ventilator Acquired PNA - (VAP)

Answer 4

*Subset of HAP; >48 hrs after ET tube

Question 5

Patho of CAP

Answer 5

1. Microaspiration
2. Defect in host system
3. Organism virulence

Question 6

Microbiology of PNA

Answer 6

50% of time, don't know pathogen
#1 - BACTERIA; antbx mainstay of tx 
2. Viruses
IMC host + opportunistic infxn:
3. Fungal
4. Parasites

Question 7

Prevention of PNA

Answer 7

1 - SMOKING CESSATION

2. Pneumococcal vaccines @ risk pts
   prevnar 13: (4 vaccine series, under 2 yrs old) pneumovax 23: (repeat 5-10 yrs, older adults >65)
3. Influenza vaccine for ALL patients

Question 8

Epi of CAP

Answer 8

4.5 million visits
MC infectious cause of death
8th MC cause of mortality (PNA + Flu)
Winter, M>F, B>W
2nd MC cx of hospitalizeation

Question 9

RF’s for CAP

Answer 9

**Age >70; recommend all pts >65 get vaccine
**Chronic CoMbs -
`COPD, Chronic lung dz, heart dz, CVA, DM
- Viral respiratory infxn
- Impaired airway protection
- Smoking
- ETOH
- Crowded living, low income residence, air toxins

Question 10

Typical Bacteria

Answer 10

[Organism list]
#1 - Streptococcus pneumoniae; 65%, MC, Rust Colored sputum
2. Haemophilus influenzae; COPD, smoker, ETOH
3. Moraxella catarrhalis; COPD
- Staph Aureus; seen after viral illness (flu), IVDU - lung abscesses
- Group A Strep
- Aerobic GN bacteria
**Klebsiella pneumoniae; currant jelly hemptysis - ETOH, COPD, bed bound, assoc w/ cavitary lesions
- Microaerophillic bacteria + anaerobes (aspiration)

[Presentation]

• Acutely sick, coughing a bunch of sputum
• Myalgia, weakness, SOB, fever, pleuritic
• Lobar consolidation!!

Question 11

Atypical Bacteria

Answer 11

[Organism]

• *Mycoplasma pneumoniae; walking PNA - young college students, bullous myringitis (TM buldging)
• *Legionella species; contaminate water, air conditioner, hot tubs, cruise, travel, GI sx
• Chlamydia pneumoniae
• Chlamydia psittaci - birds*
• Coxiella burnetii - exposure to farm animals (sheep) Q fever

[Presentation]

• Slowly, indolently feeling sick
• Non productive cough, normal vitals and labs
• Interstitial patchy infiltrates
• WONT cx

Question 12

Respiratory Viruses

Answer 12

• **#1 - Influenza A & B viruses - MC adults
  2. Rhinoviruses
  3. Respiratory syncytial virus (RSV) - MC in infants/children
• Adenoviruses
• Human metapneumovirus
• Coronaviruses
• Human bocaviruses

Question 13

Symptoms…

Answer 13

• Fever
• Chills
• Cough: prod v.s nonprod
  Green (Pseudo), Rust (Strept P), Currant (Klebs)
• Hemoptysis
• Pleuritic pain
• Dyspnea
• HA
• Myalgias
• Nausea
• Infants/children; Poor feeding, restless
• AMS; older adults

Question 14

Signs…

Answer 14

• Fever
• Tachypnea
• Hypoxemia
• Tachycardia
• Hypotension: (SIRS + hypoT = sepsis)
• Rales/Crackles
• DEC Breath sounds (consolidations)
• Asymm BS
• Expiratory wheezing

Question 15

Imaging…

Answer 15

**CXR - preferred
`may have to repeat if still suspicious & after pt has been volume restored
- chest CT
- US

Question 16

CXR findings

Answer 16

1. Lobar consolidations - (whole lob lights up, in alveoli itself, DEC bs, adv bs)
2. Interstitial infiltrates - (Atyp, not w/i alveoli, around them)
3. Bronchopneumonia - (worse, patchy infiltrates)
4. Cavitations - (lesions w. empty center, surr necrotic tissue)

Question 17

Labs…

Answer 17

• *CBC; dec PLTs, RBCs
• *BMP; TXs - check creatine clearance for Kid, look at electrolytes
• Flu
• Lactic acid, CRP, ESR, pro-calcitonin
• Urine antigens (strep pneum, legionella)
• PCR NP swabs for viruses
• Sputum gram stain & cx; expectorated, induced, bronchial lavage
• Blood Cx (2 sets) - b/f anx