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PPC2 Exam 3 > Pulmonary 2 (begins with penumonia) > Flashcards

Pulmonary 2 (begins with penumonia) Flashcards

1
Q

Pneumonia

A

Lower respiratory tract infection with consolidation of the alveolar spaces involving the airways and parenchyma of the lung.

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2
Q

Lobar pneumonia (3)

A
  1. Lobar pneumonia involves infection of the alveolar space that results in consolidation; it is described as “typical” pneumonia
  2. Child will probably be sicker
  3. Involves entire lobe of the lung → results in consolidation of the lung
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3
Q

Intersitial Pneumonia (2)

A
  1. Atypical pneumonia describes patterns of consolidation that are not localized. In interstitial pneumonia, cellular infiltrates attack the interstitium, which makes up the walls of the alveoli, the alveolar sacs and ducts, and the bronchioles; this type of pneumonia is typical of acute viral infections, but may also be a chronic process.
  2. Since it is atypical, there is no localized area – not a clear X-Ray
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4
Q

Nonbacterial Pneumonia (2)

A
  1. Most common pulmonary infection in children and adolescents and includes atypical bacterial pneumonia caused by Mycoplasma pneumonia, Chlamydophilia pneumonia, and Chlamydia trachomatis which account for 23% of pneumonia in children
    * Chlamydia trachomatis is limited to newborns only
  2. Respiratory viruses account for 40% of acquired pneumonia
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5
Q

Pneumonitis

A

General term used to describe lung inflammation that may or may not be associated with consolidation.

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6
Q

Pneumonia history: age of child (2)

A
  1. Preschoolers → viral pneumonia
  2. Little infants get bacterial pneumonia
    * Must know age of child in order to treat properly
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7
Q

General info about pneumonia (5)

A
  1. 90% are viral
    a. Do not need to treat preschoolers with pneumonia, they should be sent home with supportive care (3 & 4 year olds most likely have viruses)
    b. RSV is frequently co-infected with bacteria, but pre-schoolers don’t get RSV frequently
  2. 10% are bacterial and are responsible for MUCH higher rate of complications
  3. Strep pneumoniae is the most common bacterial pathogen
  4. RSV is the most frequent viral cause
  5. Pneumocystis carinii most likely opportunistic infection
    a. Patients with HIV or on chemotherapy get this
    b. Will be very sick
    c. High fever, respiratory distress, and some fatal cases
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8
Q

3 months-17 years old treatment for bacterial pneumonia

A

Preferred: Amoxill

Alternate: amoxicillin/clavulanic acid levofloxacin for serious penicillin allergy

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9
Q

3 months-17 years old treatment atypical pneumonia

A

preferred: azithromycin
alternate: clarithromycin or erythromycin (Doxycycline if >7 years old)

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10
Q

3 months-17 years old treatment for infleunzae pneumonia

A

osteltamivir

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11
Q

3 months-17 years old treatment for viral pneumonia, not influenza

A

no antimicrobial

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12
Q

Viral Pneumonia (8)

A
  1. Gradual
  2. Associated with preceding upper airway symptoms (e.g., rhinorrhea, congestion).
  3. Non-toxic appearing
  4. Diffuse and bilateral finding.
  5. Wheezing was more frequent
  6. Rhinorrhea
  7. Myalgia
  8. Ill contacts
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13
Q

RSV Pneumonia (6)

A
  1. SINGLE LARGEST PATHOGEN Worldwide
  2. Negative double strand RNA virus
  3. Two subgroups A and B with multiple genotypes
  4. Bronchiolitis and pneumonia more in children Less than 1
  5. November through March
  6. RSV humanized monoclonal antibody (Synagis)
    * Given every 28 days
    * Synagis isn’t as effective as it used to be, only given for high risk children
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14
Q

Human Metapneumoviruses (4)

A
  1. Paramyxoviridae family includes RSV and metapneumovirus
  2. Upper and lower respiratory tract disease
  3. Greatest in Winter and early spring
  4. Lower respiratory tract disease
    a. Most before 12 month
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15
Q

Influenza: Epidemiology (8)

A
  1. Very contagious disease
  2. Person to person by direct contact
  3. Droplet contamination
  4. Fomites recently contaminated with infected nasopharyngeal secretions.
  5. Viremia is a rare occurrence.
  6. Temperate climates, epidemics
    * Winter months, last approximately 4 to 12 weeks
    * Peak 2 weeks after the index case.
  7. Children shed the virus longer
    * Good transmitters within a community
  8. Influenza tends to trump RSV – as RSV winds down, influenza flares
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16
Q

Incubation and Contagious Period of Influenza (3)

A
  1. Incubation period: 1 to 3 days.
  2. Infectious 24 hours before the onset of symptoms.
  3. Viral shedding for 7 days after the onset of illness.
    * Will still be contagious
17
Q

Clinical Findings in Influenza (14)

A
  1. Sick!
  2. Sudden onset of 102°F to 106°F
  3. Headache
  4. Chills
  5. Coryza
  6. Vertigo
  7. Sore throat
  8. Pain in the back and extremities
  9. Dry hacking cough that can resemble pertussis.
  10. Vomiting, diarrhea, and croup in young children.
  11. Conjunctival injection, epistaxis, and myocarditis (evident by weak heart sounds and rapid, weak pulse) are common.
    * Bright red eyes = flu
  12. Atelectasis or infiltrates in 10% of children.
  13. Severe myocardial involvement can cause distention of the right side of the
  14. Heart and congestive heart failure.
18
Q

Management of Influenza (5)

A
  1. Supportive
    a. Bed rest, fluids, antipyretics
  2. Antiviral therapy
  3. Amantadine diminishes the severity of type A illness but has no effect on type B
    a. Under 14 years of age
  4. Rimantadine > 14 years
  5. Do not give aspirin to influenza sufferers!
19
Q

Management of Influenza: Antiviral therapy (4)

A
  1. Should be started with 48 hours of symptom onset
  2. 2 to 5 days until the patient is asymptomatic for 24-48 hours.

Neuraminidase inhibitors:

  1. Tamiflu (oseltamir) > 1 year
    * Lowers period of contagiability!!
    * Lowers household transmission
    * May reduce sickness by one day
    * Prevents them from getting sicker
  2. Zanamivir (Relenza) >7 years
20
Q

Animal Associated Pneumonia (4)

A
  1. Histoplasma capsulatum
    * Eastern and central U. S. and Canada
    * Exposure to bird droppings and bat guano
  2. Hanta virus - Deer mouse exposure
  3. Chlamydophila (formerly chlamydia) psittacosis
    * Transmitted from birds
  4. Coxiella burnetii (Q fever)
    * Transmitted from sheep, goats, cattle and cats
21
Q

Mycoplasma Pneumoniae Signs and Symptoms (10)

A

Dermatologic manifestations

  1. Mild erythematous maculopapular rash
  2. Urticaria
  3. Stevens-Johnson syndrome

Extrapulmonary manifestations

  1. Hemolytic anemia
  2. Polyarthritis
  3. Pancreatitis
  4. Hepatitis
  5. Pericarditis
  6. Myocarditis
  7. Neurologic complications
22
Q

Clinical Presentation of Pneumonia (6)

A
  1. Inconsistent finding Pleuritic chest pain (pain with respiration) abdominal pain nuchal rigidity

Clinical Symptoms

  1. Can be non-specific
  2. No single symptom or sign is pathognomonic
  3. Fever and cough
  4. Can have leukocytosis
  5. More subtle in neonates and young infants; difficulty feeding, or restlessness
23
Q

Childhood Bacterial Pneumonia: Atypical Pneumonia (3)

A
  1. Mycoplasma pneumoniae
    * Most common cause of pneumonia
  2. Prodromal illness: headache, low grade fever and malaise
  3. Cough last 3-4 weeks
24
Q

Childhood Bacterial Pneumonia: Chlamydiaphilia Pneumoniae (4)

A
  1. Asymptomatic and mild
  2. SEVERE sore throat and hoarseness
  3. Complain of headache and presence of fever is variable
  4. Rare manifestation is myocarditis and erythema nodosum
25
Q

Childhood Bacterial Pneumonia: Treatment

A

Macrolide (Erythromycin, Azithromycin, Clarithromycin)

26
Q

How and when do they use microbiological testing (8)

A
  1. Use with severe disease
  2. For a community outbreak
  3. Unusual pathogen is suspected
    * S. aureus including methicillin-resistant strain
    * M. tuberculosis

Microbiologic diagnosis

  1. Culture
  2. Rapid diagnostic testing (enzyme immunoassay
  3. Immunofluorescence
  4. Polymerase chain reaction
  5. Serology
27
Q

Lung abscess complications (8)

A
  1. Accumulation of inflammatory cells, accompanied by tissue destruction or necrosis that produces one or more cavities in the lung
  2. Aspiration important predisposing factor for lung abscess
  3. S. aureus is the organism most frequently involved
  4. Clinical manifestations of lung abscess are nonspecific and similar to those of pneumonia
    * Fever, cough, dyspnea, chest pain, anorexia, dyspnea, hemoptysis, and putrid breath.
  5. Child will be sick!!
  6. High fever
  7. Chest pain
  8. Chest X –ray: Thick-walled cavity with an air-fluid level
28
Q

Pneumatocele complication (3)

A
  1. Thin-walled, air-containing cysts of the lungs,
  2. Classically associated with S. aureus pneumonia
  3. Association with empyema
29
Q

Hyponatremia complication (2)

A
  1. One-third of children hospitalized with pneumonia,

2. SIADH - inappropriate secretion of ADH is the most frequent cause

30
Q

Cystic Adenomatoid Malformation (6)

A
  1. Cysts communicate with main airway
  2. Vascular supply from bronchial circulation
  3. Terminal bronchiole proliferation
  4. Suppressed alveolar growth and development
  5. Will have a blood supply from the bronchioles
  6. Rare, but may see it in practice
31
Q

Chest CT with Pneumonia (2)

A
  1. Necrotizing pneumonia
  2. Not a pulmonary sequestration
    a. No separate blood supply
32
Q

Complications of Pneumococcal Pneumonia (3)

A
  1. Pleural effusion and empyema
  2. Necrotizing pneumonia
  3. Treat for total of four weeks or two weeks after the patient is afebrile and has improved clinically.
33
Q

Necrotizing Pneumonia (4)

A
  1. Clinically prolonged fever, sepsis, radiolucent lesion on chest X-ray
  2. Necrotizing pneumonia, necrosis and liquefaction of lung parenchyma, is a serious complication of Community Acquired Pneumonia.
  3. Necrotizing pneumonia usually follows localized lung infection with a particularly virulent pyogenic bacteria S. pneumoniae is the most common cause of necrotizing pneumonia
  4. Other organisms:
    i. S. aureus
    ii. Group A Streptococcus
    iii. M. pneumoniae
    iv. Legionella
    v. Aspergillus
34
Q

FUO workup in a child with fever for greater than 10 days (9)

A
  1. CBC with review of peripheral smear
  2. Blood culture
  3. UA, urine C&S
  4. Lytes, BUN, creat, LFTs, HIV serology
  5. LDH, uric acid
  6. ESR & CRP
  7. ANA
  8. PPD
  9. Chest x-ray

PPC2 Exam 3 (14 decks)

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