Respiratory & Sleep Medicine\ Pneumonitis Flashcards
What is pneumonitis?
Inflammation of the lung parenchyma
What is pneumonia?
Pneumonitis due to infection
What are some common symptoms of pneumonia?
- Rigors
- fatigue
- cough (may be dry or productive)
- sputum production
- pleuritic chest pain
- dyspnea
What are the common physical signs of pneumonia?
- Fever
- tachypnea
- dullness to chest percussion
- tactile fremitus
- egophony
- bronchial breath sounds
- crackles or rales to auscultation
What is the pneumonia severity index?
A prognostic model that is used to help determine whether a patient with pneumonia should be treated as an inpatient or outpatient
What are the CURB-65 criteria?
- It is a clinical prediction rule that uses risk factors
- confusion
- uremia
- respiratory rate >30
- BP <90/60 mm Hg and
- age over 65
- Predicts mortality and need for hospitalization in pneumonia
- 0-1 factors treat as an outpatient
- >2 factors consider hospitalization.
Is a positive sputum culture necessary to make the diagnosis of pneumonia?
No
Clinical suspicion plus what diagnostic test result is necessary for a diagnosis of pneumonia?
- Pulmonary infiltrate on chest radiograph (obtain two views)
What purpose do radiographic studies serve in the management of pneumonia?
- Qualify pneumonia based on location (usually singular lobar consolidation but can be multilobar or diffuse)
- possible complications (eg, pleural effusion, pneumothorax, empyema, abscess)
A chest radiograph can be negative early in the disease course of pneumonia. True or false?
True
What is community acquired pneumonia (CAP)?
Pneumonia that is not acquired in hospital or long-term care facility
What is/are the first-line antibiotic(s) for CAP in the outpatient setting when no comorbidities are present, the patient has not been on antibiotics within the last 3 months, and there is a low local prevalence of drug-resistant strains?
- Macrolides (azithromycin, clarithromycin, or erythromycin) are strongly recommended.
- Doxycycline is an alternative.
What is/are the first-line antibiotic(s) for CAP in the outpatient setting when comorbidities (eg, heart/lung/liver/renal disease, diabetes, malignancy, alcoholism, asplenia, immune deficiency) are present and/or the patient has been on antibiotics within the last 3months and/or there is a high risk of drug-resistance?
A fluoroquinolone or macrolide plus β-lactum
What is the minimum duration of antibiotic therapy for uncomplicated CAP?
5 days (assuming the patient is stable and has been afebrile for more than 48 hours)
What is the most common bacterial cause of CAP in adults?
Streptococcus pneumoniae
What additional etiologies of pneumonia should you keep in mind for a patient with a history of the COPD and/or smoking
- Haemophilus influenzae
- Pseudomonas aeruginosa
- Legionella
- Moraxella catarrhalis
What additional etiologies of pneumonia should you keep in mind for a patient with a history of Immune suppression ?
- H. influenzae
- Pneumocystis jirovecii
- Cryptococcus
- Histoplasma
- Aspergillus
- P. aeruginosa
- Mycobacterium tuberculosis
- atypical mycobacteria
What additional etiologies of pneumonia should you keep in mind for a patient with a history of Seizures
- Aspiration:
- oral anaerobes
- gram-negative enteric pathogens
- Staphylococcus aureus
What additional etiologies of pneumonia should you keep in mind for a patient with a history of alcoholism?
- Aspiration
- Klebsiella
- Acinetobacter
- M. tuberculosis
What additional etiologies of pneumonia should you keep in mind for a patient with a history of recent animal exposure?
- Francisella tularensis (deer, rabbits)
- Hantavirus
- Yersinia pestis (rodents)
- Histoplasma capsulatum (bat and bird droppings)
- Q fever
- Brucellosis (some farm animals)
- H5N1 virus (poultry)
What additional etiologies of pneumonia should you keep in mind for a patient with a history of residence or travel to the Southwest United States?
- Coccidioides species
- Hantavirus
What patients are particularly prone to infection with S. pneumoniae?
Those with history of
- splenectomy
- sickle cell disease
- lung disease
- HIV, and/or
- renal failure
What are the most common causes of pneumonia in young, healthy adults?
- Mycoplasma
- Chlamydia
- viruses
What is pneumonia due to Mycoplasma/Chlamydia/Viruses called?
Atypical pneumonia
Is atypcial pneumonia more or less severe than typical pneumonia?
Generally the illness is mild
Do chest x-rays correlate well with the degree of illness in atypical pneumonia?
No. Chest x-rays often appear disproportionately “worse than the patient.”
What are the common causes of pneumonia in young children?
- RSV
- parainfluenza
- adenovirus
- enterovirus
What are some common causes of bacterial pneumonia in children?
- S. pneumoniae
- group A Streptococcus
- group B Streptococcus (in a neonate)
- M. pneumoniae
- Chlamydia trachomatis
- H. influenzae
- M. catarrhalis
What is the treatment for pneumonia due to influenza A?
- Give oseltamivir or zanamivir within 48 hours of symptom onset
- Consider empirical antibiotics for secondary bacterial pneumonia ( S. aureus, S. pneumoniae )
What are the risk factors for developing pneumonia due to S. aureus ?
- Viral pneumonia (eg, influenza)
- infection via hematogenous route (ie, IV drug users or patients with infective endocarditis)
- diabetes
- liver disease
Urinary antigen test exists for what pathogens?
- Legionella
- S. pneumoniae
What is the major water source for Legionella?
- Water distribution systems of large buildings (eg, hotels, hospitals)
What populations are most susceptible to Legionella pneumonia?
- Elderly
- smokers
- immunocompromised
- travelers
What symptoms are common in a patient with Legionella pneumonia?
- Dry cough
- fever
- headache
- confusion
- weakness
- GI disturbances (diarrhea)
What is the typical description for the sputum in Klebsiella infection?
Currant jelly sputum
Patients with what underlying diseases are at increased risk for Pseudomonas pneumonia?
- Patients with diabetes
- cystic fibrosis
What is the most common cause of pneumonia in an HIV patient?
- Pneumocystis pneumonia (PCP) caused by P. jirovecii
What is the treatment for PCP?
Trimethoprim-sulfamethoxazole and steroids
What is the most common opportunistic infection in HIV patients?
- S. pneumoniae (same as in the immunocompetent population)
What causes chemical pneumonitis?
Aspiration of sterile gastric contents
What are the typical signs and symptoms of chemical pneumonitis?
- Dyspnea,
- cough
- low-grade fever
- infiltrates on CXR involving dependent areas of lung
