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General Medicine & Family Medicine > Respiratory & Sleep Medicine\ Pneumonitis > Flashcards

Respiratory & Sleep Medicine\ Pneumonitis Flashcards

1
Q

What is pneumonitis?

A

Inflammation of the lung parenchyma

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2
Q

What is pneumonia?

A

Pneumonitis due to infection

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3
Q

What are some common symptoms of pneumonia?

A
  • Rigors
  • fatigue
  • cough (may be dry or productive)
  • sputum production
  • pleuritic chest pain
  • dyspnea
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4
Q

What are the common physical signs of pneumonia?

A
  • Fever
  • tachypnea
  • dullness to chest percussion
  • tactile fremitus
  • egophony
  • bronchial breath sounds
  • crackles or rales to auscultation
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5
Q

What is the pneumonia severity index?

A

A prognostic model that is used to help determine whether a patient with pneumonia should be treated as an inpatient or outpatient

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6
Q

What are the CURB-65 criteria?

A
  • 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.
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7
Q

Is a positive sputum culture necessary to make the diagnosis of pneumonia?

A

No

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8
Q

Clinical suspicion plus what diagnostic test result is necessary for a diagnosis of pneumonia?

A
  • Pulmonary infiltrate on chest radiograph (obtain two views)
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9
Q

What purpose do radiographic studies serve in the management of pneumonia?

A
  • Qualify pneumonia based on location (usually singular lobar consolidation but can be multilobar or diffuse)
  • possible complications (eg, pleural effusion, pneumothorax, empyema, abscess)
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10
Q

A chest radiograph can be negative early in the disease course of pneumonia. True or false?

A

True

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11
Q

What is community acquired pneumonia (CAP)?

A

Pneumonia that is not acquired in hospital or long-term care facility

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12
Q

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?

A
  • Macrolides (azithromycin, clarithromycin, or erythromycin) are strongly recommended.
  • Doxycycline is an alternative.
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13
Q

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

A fluoroquinolone or macrolide plus β-lactum

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14
Q

What is the minimum duration of antibiotic therapy for uncomplicated CAP?

A

5 days (assuming the patient is stable and has been afebrile for more than 48 hours)

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15
Q

What is the most common bacterial cause of CAP in adults?

A

Streptococcus pneumoniae

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16
Q

What additional etiologies of pneumonia should you keep in mind for a patient with a history of the COPD and/or smoking

A
  • Haemophilus influenzae
  • Pseudomonas aeruginosa
  • Legionella
  • Moraxella catarrhalis
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17
Q

What additional etiologies of pneumonia should you keep in mind for a patient with a history of Immune suppression ?

A
  • H. influenzae
  • Pneumocystis jirovecii
  • Cryptococcus
  • Histoplasma
  • Aspergillus
  • P. aeruginosa
  • Mycobacterium tuberculosis
  • atypical mycobacteria
18
Q

What additional etiologies of pneumonia should you keep in mind for a patient with a history of Seizures

A
  • Aspiration:
    • oral anaerobes
    • gram-negative enteric pathogens
    • Staphylococcus aureus
19
Q

What additional etiologies of pneumonia should you keep in mind for a patient with a history of alcoholism?

A
  • Aspiration
  • Klebsiella
  • Acinetobacter
  • M. tuberculosis
20
Q

What additional etiologies of pneumonia should you keep in mind for a patient with a history of recent animal exposure?

A
  • Francisella tularensis (deer, rabbits)
  • Hantavirus
  • Yersinia pestis (rodents)
  • Histoplasma capsulatum (bat and bird droppings)
  • Q fever
  • Brucellosis (some farm animals)
  • H5N1 virus (poultry)
21
Q

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?

A
  • Coccidioides species
  • Hantavirus
22
Q

What patients are particularly prone to infection with S. pneumoniae?

A

Those with history of

  • splenectomy
  • sickle cell disease
  • lung disease
  • HIV, and/or
  • renal failure
23
Q

What are the most common causes of pneumonia in young, healthy adults?

A
  • Mycoplasma
  • Chlamydia
  • viruses
24
Q

What is pneumonia due to Mycoplasma/Chlamydia/Viruses called?

A

Atypical pneumonia

25
Q

Is atypcial pneumonia more or less severe than typical pneumonia?

A

Generally the illness is mild

26
Q

Do chest x-rays correlate well with the degree of illness in atypical pneumonia?

A

No. Chest x-rays often appear disproportionately “worse than the patient.”

27
Q

What are the common causes of pneumonia in young children?

A
  • RSV
  • parainfluenza
  • adenovirus
  • enterovirus
28
Q

What are some common causes of bacterial pneumonia in children?

A
  • S. pneumoniae
  • group A Streptococcus
  • group B Streptococcus (in a neonate)
  • M. pneumoniae
  • Chlamydia trachomatis
  • H. influenzae
  • M. catarrhalis
29
Q

What is the treatment for pneumonia due to influenza A?

A
  • Give oseltamivir or zanamivir within 48 hours of symptom onset
  • Consider empirical antibiotics for secondary bacterial pneumonia ( S. aureus, S. pneumoniae )
30
Q

What are the risk factors for developing pneumonia due to S. aureus ?

A
  • Viral pneumonia (eg, influenza)
  • infection via hematogenous route (ie, IV drug users or patients with infective endocarditis)
  • diabetes
  • liver disease
31
Q

Urinary antigen test exists for what pathogens?

A
  • Legionella
  • S. pneumoniae
32
Q

What is the major water source for Legionella?

A
  • Water distribution systems of large buildings (eg, hotels, hospitals)
33
Q

What populations are most susceptible to Legionella pneumonia?

A
  • Elderly
  • smokers
  • immunocompromised
  • travelers
34
Q

What symptoms are common in a patient with Legionella pneumonia?

A
  • Dry cough
  • fever
  • headache
  • confusion
  • weakness
  • GI disturbances (diarrhea)
35
Q

What is the typical description for the sputum in Klebsiella infection?

A

Currant jelly sputum

36
Q

Patients with what underlying diseases are at increased risk for Pseudomonas pneumonia?

A
  • Patients with diabetes
  • cystic fibrosis
37
Q

What is the most common cause of pneumonia in an HIV patient?

A
  • Pneumocystis pneumonia (PCP) caused by P. jirovecii
38
Q

What is the treatment for PCP?

A

Trimethoprim-sulfamethoxazole and steroids

39
Q

What is the most common opportunistic infection in HIV patients?

A
  • S. pneumoniae (same as in the immunocompetent population)
40
Q

What causes chemical pneumonitis?

A

Aspiration of sterile gastric contents

41
Q

What are the typical signs and symptoms of chemical pneumonitis?

A
  • Dyspnea,
  • cough
  • low-grade fever
  • infiltrates on CXR involving dependent areas of lung
42
Q
A

General Medicine & Family Medicine (150 decks)

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