Pulmonary Clinical Medicine II: Pneumonia, PE, and ARDS Flashcards
What is the most common etiologic agent in community acquired pneumonia?
(Highlighted in his slides)
Streptococcus pneumoniae
What are important considerations when determining the treatment of community acquired pneumonia?
(Highlighted in his slides)
1) Patient history
2) Patient comorbidities
What comorbidity is associated with Step. pneumonia and H. influenzae as a cause of community acquired pneumonia?
Alcoholism
What comorbidity is associated with Step. pneumonia, M. catarrhalis, and H. influenzae as a cause of community acquired pneumonia?
COPD
What comorbidity is associated with P. aeruginosa, Burkholderia cepacia, and Staphylococcus aureus as a cause of community acquired pneumonia?
Structural lung disease (e.g. bronchiectasis)
What comorbidity is associated with CA-MRSA, oral anaerobes, endemic fungi, and M. tuberculosis as a cause of community acquired pneumonia?
Lung abscess
Travel to what region is associated with Histoplasma capsulatum as a cause of community acquired pneumonia?
Ohio or St. Lawrence river valley
Travel to what region is associated with Hantavirus and Coccidioides spp. as a cause of community acquired pneumonia?
SW U.S.
Travel to what region is associated with Burkholderia pseudomallei and avian influenza virus as a cause of community acquired pneumonia?
SE Asia
What factor is associated with Legionella spp. as a cause of community acquired pneumonia?
Recent stay in hotel or cruise ship
Exposure to what animals is associated with H. capsulatum as a cause of community acquired pneumonia?
Bats or birds
Exposure to what animal is associated with Chlamydia psittaci as a cause of community acquired pneumonia?
Birds
Exposure to what animal is associated with Francisella tularensis as a cause of community acquired pneumonia?
Rabbits
Exposure to what animals is associated with Coxiella burnetii as a cause of community acquired pneumonia?
Sheep or goat
What comorbidity is associated with Pseudomonas aeruginosa as a cause of community acquired pneumonia?
Immunocompromised
What comorbidity is associated with Staph aureus (MRSA and MSSA) as a cause of community acquired pneumonia?
Injection drug use
Amoxicillin or Doxycycline are given to which patients when treating community acquired pneumonia?
1) No comorbidity
2) No risk factor for P. aeruginosa or MRSA
Amoxicillin-clavulanate, Cefpodoxime, Cefuroxime, Azithromycin, Clarithromycin, or Levofloxacin are given to which patients when treating community acquired pneumonia?
Comorbidity present
What types of pneumonia follow the same consideration in treatment?
(Highlighted in his slides)
Hospital acquired pneumonia and ventilator acquired pneumonia (HAP and VAP respectively)
What are the early onset etiologies of VAP and HAP?
1) Step pneumonia
2) H. influenzae
3) Enteric gram negative bacilli
What are the late onset etiologies of VAP and HAP?
Staph aureus (often MRSA)
It is common to still give broad spectrum antimicrobial plus metronidazole when
empirically covering for?
Aspiration pneumonia
Clindamycin and moxifloxacin are used in the treatment of aspiration pneumonia in what setting?
Primary outpatient
Ceftriaxone + metronidazole or Ampicillin-sulbactam are used in the treatment of aspiration pneumonia in what setting?
Parenteral regimens
What are some causes of transudative pleural effusion?
1) HF
2) Cirrhosis with ascites
3) Nephrotic syndrome
4) Hypoalbuminemia
What are some causes of Exudative pleural effusion?
1) Malignancy
2) PE
3) Viral infection
When is thoracentesis indicated for pleural effusions?
When do you combine diuresis with thoracentesis?
When should thoracentesis be done ASAP?
(Highlighted in his slides)
1) All effusions with > 1 cm layering in decubitus view
2) Effusion from HF
3) Effusion from infection
What is used to differentiate exudate and transudate effusions?
(Highlighted in his slides)
Light’s Criteria
What is Light’s Criteria?
Highlighted in his slides
At least one of the following:
1) Pleural fluid/serum protein ratio > 0.5
2) Pleural fluid LDH greater than two-thirds of the laboratory normal upper limit
3) Pleural/serum LDH ratio > 0.6
For which type of effusion should pleural fluid also be tested for pH, glucose, CBC with differential, microbiologic studies, and cytology?
Exudative effusions
Acute respiratory distress syndrome (ARDS) develops rapidly and includes what symptoms?
(Highlighted in his slides)
1) Severe dyspnea
2) Diffuse pulmonary infiltrates
3) Hypoxemia
What is the key diagnostic criteria for ARDS?
Highlighted in his slides
PaO2 / FIO2 ≤ 300 mmHg
Arterial partial pressure of oxygen in mmHg) / (Inspired O2 fraction
What is the exudative phase of ARDS characterized by?
There is subsequent development of hyaline membranes from?
What does CXR reveal?
(Highlighted in his slides)
1) Alveolar edema and neutrophil inflammation
2) Diffuse alveolar damage
3) Bilateral opacities consistent with pulmonary edema
In the exudative phase of ARDS, the alveolar edema, which is most prominent in the dependent portions of the lung, causes?
(Highlighted in his slides)
1) Atelectasis
2) Reduced lung compliance
In the proliferative phase of ARDS, although most patients recover, some will develop?
(Highlighted in his slides)
1) Progressive lung injury
2) Pulmonary fibrosis
What body position may improve oxygenation when a patient is on mechanical ventilatory support?
(Highlighted in his slides)
Prone
In ARDS, alveolar collapse can occur due to alveolar/interstitial fluid accumulation and loss of surfactant which worsens hypoxemia, therefore how is this prevented with mechanical ventilatory support?
(Highlighted in his slides)
Low tidal volumes are combined with the use of positive end-expiratory pressure at levels that strive to minimize alveolar collapse and achieve adequate oxygenation with the lowest required FIO2
Pts with ARDS have increased pulmonary vascular permeability leading to?
Therefore, what should they receive only as needed in order to achieve adequate cardiac output and tissue O2 delivery?
What do most patients require as an ancillary therapy?
What should be avoided in the treatment of ARDS?
(Highlighted in his slides)
1) Interstitial and alveolar edema
2) IV fluids
3) Sedation and even paralytic agents
4) Glucocorticoids
What are used for treatment of influenza A and B viruses?
When does it need to be started?
(Highlighted in his slides)
1) Neuraminidase inhibitors
2) Within 48 h of infection
What is the most frequent serious manifestation of both COVID-19 and influenza?
Pneumonia
How does ARDS present in high risk patients?
Highlighted in his slides
Deteriorate rapidly
