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Clinical Medicine - Pulmonary > Ward Cases - Pneumonia, Pneumothorax, Effusions > Flashcards

Ward Cases - Pneumonia, Pneumothorax, Effusions Flashcards

1
Q

What does CURB-65 scoring help us with?

A

Deciding the best place of management for the patient (home, out-patient, in-patient) based upon risk

Risk is determined using
Confusion
Uremia
Respiratory Rate
Blood pressure
Age > 65
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2
Q

Community Acquired Pneumonia (CAP) category I

  • what defines this category
  • what is the likely source of infection
  • what antibiotics can be used
A

Outpatient, no cardiopulmonary disease, no modifying factors

S. pneumo
M. pnumo
Respiratory viruses
C. pneumo
H. flu

Macrolide
Doxycycline

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3
Q

Community Acquired Pneumonia (CAP) category II

  • what defines this category
  • what is the likely source of infection
  • what antibiotics can be used
A

Outpatient, cardiopulmonary disease or modifying factors

S. pnuemo
M. pneumo
C. pneumo
Respiratory viruses
Enteric GNR
Mixed infection

Fluoroquinolone
OR
B-lactam + Macrolide or Doxycycline

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4
Q

What are common cardiopulmonary disease/modifying factors?

A 
CHF
COPD
Cirrhosis
ESRD
DM
EtOH abuse
Malignancy
Asplenia
Immunosuppressed
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5
Q

Community Acquired Pneumonia (CAP) category III

  • what defines this category
  • what is the likely source of infection
  • what antibiotics can be used
A

Inpatient, non-ICU

S. pnuemo
M. pneumo
C. pneumo
H. flu
Legionella
Aspiration
Respiratory viruses

B-lactam + macrolide
OR
Fluoroquinolone

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6
Q

Community Acquired Pneumonia (CAP) category IVa

  • what defines this category
  • what is the likely source of infection
  • what antibiotics can be used
A

Inpatient ICU with NO risk factors for Pseudomonas

S. pneumo
Legionella
H. flu
GNRs
S. aureus
M. pneumo
Respiratory viruses

B-lactam + macrolide
OR
Fluoroquinolone

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7
Q

What are risk factors for community acquired pneumonia?

A

Previous pseudomonas infection
CF or bronchiectasis
Tracheostomy
Previous anti-pseudomonal antibiotic exposures

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8
Q

Community Acquired Pneumonia (CAP) category IVb

  • what defines this category
  • what is the likely source of infection
  • what antibiotics can be used
A

Inpatient ICU with risk factors for Pseudomonas

S. pneumo
Legionella
H. flu
GNRs
S. aureus
M. pneumo
Respiratory viruses
Pseudomonas

Antipseudamonal b-lactam +

(aminoglycoside + macrolide or fluoroquinolone_
OR Fluoroquinolone

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9
Q

Community Acquired Pneumonia (CAP) category IVb

–what antibiotics get added if the person is at risk for community acquired MRSA

A

Vancomycin or Linezolid

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10
Q

After influenza infection, prevalence of what infection goes up significantly?

A

S. aureus

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11
Q

What is the most likely bacterial cause of CAP?

A

S. pneumonia

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12
Q

What is the most likely cause of CAP in AIDs pts?

A

S. pneumonia

TRICK QUESTION!

  • -s. pneumo is still the main cause
  • -pneumocystis jiroveic is fourth or fifth on the differential now
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13
Q

What has the biggest impact on mortality for CAP?

A

Time to antibiotics

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14
Q

Pneumovax

  • Route of administration
  • Type of vaccine
  • Recommended groups
  • Revaccination
A

Route of administration - IM

Type of vaccine - bacterial cell wall

Recommended groups

  • age >/= 65
  • Smokers
  • High risk conditions

Revaccination - 1 time after 5 years

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15
Q

What are considered to be the high risk conditions/indications for pneumovax?

A 
Cardiopulm disease
DM
EtOH
Asplenia
Immunosuppressed
Long-term care facility
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16
Q

Inactivated Influenzae

  • Route of administration
  • Type of vaccine
  • Recommended groups
  • Revaccination
A

Route of administration - IM

Type of vaccine - killed virus

Recommended groups

  • Age >/= 50
  • Children > 6 mo
  • Health care pers.
  • High risk conditions and their contacts

Revaccination - Annual

17
Q

What are considered to be the high risk conditions/indications for pneumovax?

A 
Cardiopulm disease
DM
Renal disease
Immunosuppressed
Pregnancy
18
Q

Attenuated Influenzae

  • Route of administration
  • Type of vaccine
  • Recommended groups
  • Revaccination
A

Route of administration - Intranasal

Type of vaccine - live virus

Recommended groups

  • Age 2-49
  • Health care pers.

Avoid in high risk individuals

Revaccination - Annual

19
Q

Atypical pneumonia

A

Mycoplasma

20
Q

CF pt pneumonia

A

Pseudomonas

21
Q

Pneumonia, Birds

A

C. Psittaci

22
Q

Aspiration pneumonia

A

Anaerobes (e.g. peptostreptococcus)

23
Q

Pneumothorax

  • definition
  • symptoms
A

Air/gas in the pleural space

Asymptomatic
Pleuritic chest pain
Cough
Dyspnea

24
Q

Pathophysiology of pneumothorax

A

Pressure w/in the intrapleural space is negative

Any communication b/t the air filled lung parenchyma and pleural space will result in accumulation of air within the pleural space until the pressures are equalized (b/t of the gradient)

Result is a collapse of the lung and hyper-expansion of he hemi-thorax, leading to impairment

25
Q

What are the different types of pneumothorax

A

Spontaneous

  • primary
  • secondary

Traumatic
Iatrogenic

Tension!

26
Q

Explain about the diagnosis of tension pneumothorax

A

Clinical diagnosis

Hemodynamic instability secondary to poor venous return b/t everything is being pushed over (mass effect)

  • -hypotension
  • -tachypnea
  • -midline shift

EMERGENCY

27
Q

Pneumothorax findings on P/E

A

Diminished or absent breath sounds on affected side

Tactile fremitus is diminished or absent

Hyper-resonance to percussion

If large enough, tracheal deviation AWAY from pneumothorax

28
Q

How is a tension pneumothorax drained?

A

Needle decompression

2nd ICS midclavicular line

29
Q

What are the three goals of treating a pneumothorax? Give examples of how each is done.

A

Prevent death

  • aspiration
  • chest tube

Relieve symptoms

  • obs +/- O2
  • aspiration
  • chest tube

Prevent recurrence

  • pleurodesis (scars 2 pleural surfaces together)
  • surgical resection of affected area

Clinical Medicine - Pulmonary (8 decks)

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