Term
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Definition
| an inflmmation, usually caused by an infection, involving the alveoli of the lungs |
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Term
| Predisposing factors for community acquired pna (10) |
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Definition
| COPD, renal insufficiency, CAD, neurologic dz, Etohism, immunosuppresion, DM, heart failure, asthma, >60 yo |
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Term
| Predisposing factors for hospital acquired pna? (6) |
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Definition
| mechanical vent, LOS >4d, surgery, compromised condition, shock, coma |
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Term
| What is the most common cause of pna? |
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Definition
| aspiration of oropharyngeal secretions |
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Term
| What bacteria is most likely to colonize in healthy people? |
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Definition
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Term
| What type of bacteria is more prevalent in debilitated and hospitalized pts? |
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Definition
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Term
| What time of the year is CAP most prevalent? What age range? |
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Definition
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Term
| What is the most common pathogen in CAP? |
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Definition
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Term
| How long /p admission does HAP occur? |
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Definition
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Term
| Which patients are most susceptible to HAP? |
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Definition
| ICU pts on vents, AMS from intoxication or metabolic states, stroke pts, decreased gag reflex |
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Term
| What are the most common presenting sx in a pt w/ pna? |
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Definition
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Term
| What are other clinical presentations of pna? |
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Definition
| increased respiratory rate, increased HR, CO and BP, cyanosis if severe, cough, sputum production, and hemoptysis, +/- fever |
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Term
| Name 5 physical finding assoc. w/ increased mortality. |
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Definition
| (1) RR > 30 (2) Diastolic BP < 60 and systolic BP < 90 (3) Pulse > 125 (4) Temp <35C/95F or >40C/104F (5) Confusion or ALOC |
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Term
| What findings would you expect on chest physical exam? (7) |
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Definition
| Increased tactile fremitus, dullness on percussion, bronchial breath sounds, crackles/rhonchi, whispered pectoriloquy, pleural friction rub, possible pleural effusion |
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Term
| What s/sx are seen in a local inflammatory response? (5) |
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Definition
| cough, sputum, dyspnea, rales, pulmonary infiltrates |
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Term
| What s/sx are seen in a systemic inflammatory response? (5) |
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Definition
| fever, tachycardia, malaise, anorexia, leukocytosis w/ left shift |
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Term
| Sx of lower reapiratory tract infection? |
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Definition
| fever or hypothermia, chills, CP, rigors, sweats, new cough w/ or w/o sputum, change in sputum color if chronic cough, onset of dyspnea |
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Term
| Name 6 nonspecific sx that a pt w/ pna may also c/o. |
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Definition
| fatigue, myalgia, abd pain, flank/back pain, anorexia, HA |
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Term
| Name 6 signs of acute lower respiratory infxn. |
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Definition
| Fever, altered breath sounds (rales or diminished), tachypnea, dullness, fremitus, tachycardia |
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Term
| What is the most common presenting sign in a pt w/ pna? |
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Definition
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|
Term
| What is considered the gold standard for dx of pna? |
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Definition
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Term
| When can a false negative CXR occur in a pt w/ pna? |
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Definition
| severe dehydration or too early in course of illness |
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Term
| Which pts are recommended to have CXR? Do they need a f/u CXR? |
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Definition
| all pts >40yo, all smokers or former smokers, f/u in 4-6 wks |
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Term
| Name 4 common patterns of pna on CXR. |
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Definition
| Bronchopneumonia, lobar consolidation pna, interstitial infiltrates pna, miliary pna |
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Term
| Which type is the most common? |
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Definition
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Term
| What is seen on CXR in bronchopneumonia? |
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Definition
| lesions in lower lungs, multiple foci lookred then gray-associated w/ pus, granulation tissue |
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Term
| Which parts of the lungs are affected by lobar pna? What is it worsened by? |
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Definition
| Complete lobe or lobes affected, worsened by smoking |
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Term
| Name the 4 stages of lobar pna. |
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Definition
| 1) Congestion, 2) Red hepatization 3) Grey hepatization, 4) resolution-resorption and restoration of pulmonary lung |
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Term
| Describe characteristics of the lobe in stage 1. what are the associated sx? |
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Definition
| lobe is heavy, boggy, and red. fever and cough d/t multiplying bacteria |
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Term
| Describe the lobe in stage 2. What are associated sx? |
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Definition
| lobe is firm, airless, and red. Pain on breathing, productive cough |
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Term
| Describe the lobe in stage 3. |
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Definition
| Lobe is gray-brown to yellow, and dry. Weeks to full recovery. |
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|
Term
| what is interstitial pna? What does it affect? |
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Definition
| d/o w/ patchy or diffuse inflammation that results in thickening and stiffness and normal elastic tissue, involves the interstitium |
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Term
| How does intersttial pna affect normal breathing? |
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Definition
| Causes shallow, rapid breaths |
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Term
| Describe the appearance of CXR of interstitial pna. |
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Definition
| fluffy appearance - not globular or focused lesion |
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Term
| What is miliary pna? How are the pathogens spread to the lungs? |
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Definition
| Causes multiple discrete lesions, possible acute necrotizing lesions. Spread via the bloodstream |
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Term
| What are predisposing factors to developing miliary pna? |
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Definition
| immunocompromise, TB, environmental (histoplasmosis) can manifest as granulomas |
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Term
| Describe appearance of miliary pna on CXR. |
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Definition
| Globular lesions, "cotton ball" appearance |
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Term
| When is it indicated to check pulse ox in a pna pt? (5) |
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Definition
| respiratory distress, dyspnea at rest, tachypnea, multilobar infiltrate or pleural effusion on CXR, underlying cardiac or pulmonary dx |
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|
Term
| Which labs can be checked in pna? When would they need to be checked? |
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Definition
| CBC, lytes and GLUC, LFTs, RFTs, blood cultures X 2 (b/f and /p abx). CHeck if considering hospitalization, >65 yo, comorbidities |
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Term
| What is the CURB-65 test? what does a score > 3 indicate? |
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Definition
| Determines if pt needs to be hospitalized, 1 pt each for confusion, urea > 20, RR > 30, BP <90/60, Age > 65. Score > 3 high risk for mortality. |
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Term
| What are risk factors for penicillin resistance in pneumococcal infxn? (6) |
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Definition
| > 65yo, <5yo, Etohism, beta-lactam w/i last 3 mths, immune suppression, multiple comorbidities |
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Term
| Name 4 risk factors for enteric gram (-) infxn |
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Definition
| 1) NH or LTC, 2) cardiopulmonary dz, 3) multiple comorbidities, 4) recent abx |
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Term
| Name 5 risk factors for pseudomonas aeroginosa. |
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Definition
| 1) Structural lung dz (bronchiectasis), 2) Corticosterois (>10mg/d), 3) Broad spectrum abx X 7d in last mth, 4) Malnutrition, 5) Leukopenic immune suppression |
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Term
| Name 8 etiologic agents most likely responsible in outpatients w/ no cardiopulmonary dz or modifying factors. |
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Definition
| S. pneumo, Mycoplasma, Chlamydophila, H. influ, respiratory viruses, legionella, mycobacterium TB, endemic fungi |
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Term
| What is the recommeneded pharmacologic therapy in oupatients w/ no cardiopulmonary dz or modifying factors? |
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Definition
| One of 3 macrolides: azithromycin, clarithromycin, doxycycline |
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Term
| What are considered other modifying factors? (8) |
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Definition
| >65 yo, Etohism, beta-lactam w/i 3 mths, multiple comorbidities, NH, underlying cardiopulmonary dz, recent abx |
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Term
| what pathologic agents are most likely responsible in outpatients w/ modifying risk factors? (10) |
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Definition
| drug-resistance s. pneumo, mycoplasma, chlamydophila, mixed infxn, enetic gram (-), anerobes, respiratory viruses, M cat, legionella, mycobacterium TB, endemic fungi |
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Term
| What meds are used to tx outpatients w/ modifying risk factors? |
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Definition
| Beta lactam (IV or oral) PLUS macrolide OR doxycycline |
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Term
| What bacterias are found in inpatients but not typically outpatients? |
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Definition
| H influ and pneumocystic carinii |
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Term
| What meds are used to tx inpatients? |
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Definition
| same as for oupatient w/ modifying risk factors |
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Term
| What are alternative meds to tx inpatients w/ modifying risk factors and inpatients? |
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Definition
| Anti-pneumococcal fluoroquinolone (levofloxacin, gatifloxacin, or ciprofloxacin) |
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Term
| what meds are used to tx ICU pts w/ no risk for pseudomonas? |
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Definition
| IV beta-lactam PLUS IV macrolide or IV fluoroquinolone |
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|
Term
| What are risk factors for pseudomonas infxn? |
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Definition
| Vent, underlying chronic lung condition (COPD, Lung CA) |
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|
Term
| What meds are used to tx ICU pts at risk for pseudomonas? |
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Definition
| IV anti-pseudomonas beta-lactam (imprenem, meropenem, piperacillin/tazobactam) PLUS IV anti-pseudomonas fluoroquinolone |
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|
Term
| How long should you tx pts w/ CAP? |
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Definition
| Min of 5 days, afebrile for 48-72hrs, no more than one sign of clinical instability |
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|
Term
| When should you switch from IV to PO therapy? |
|
Definition
| Improvement in cough, dyspnea, afebrile <100F X 2, WBC decreasing, adequate p.o. intake |
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|
Term
| What are 4 prevention measures against pna? |
|
Definition
| smoking cessation, avoidance of illicit drug/etoh, improve nutritional status, pneumococcal vaccine |
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|
Term
| Name 3 predisposing factors for streptococcal pna. |
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Definition
| URI, malignancy, chronic bronchitis |
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Term
| What are s/sx of streptococcal pna? (10) |
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Definition
| sudden onset fever, rigors, hemoptysis, pleuritic CP, malaise, anorexia, back/flank pain, dyspnea, increased RR, increased HR |
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|
Term
| What is seen on CXR in streptococcal pna? |
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Definition
| usually singular infiltrate/lobar, patchy infiltrate in elderly and infants |
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|
Term
| What meds are used to tx streptococcal pna? |
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Definition
|
|
Term
| What is the second most common bacteria that causes pna? What groups does it appear in most commonly? |
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Definition
| H influ. In elderly and non-vaccinated children |
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|
Term
| What is the most virulent strain of H influ? |
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Definition
| H influenzae type B (Hib) |
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|
Term
| What are s/sx associated w/ H influ infxn? |
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Definition
| Increased temp, HR, RR, rales w/o signs of consolidation, WBC frequently normal |
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|
Term
| What is seen of CXR of H influ infxn? |
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Definition
| patchy alveolar infiltrates, lobar consolidation, poss multilobar involvement |
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|
Term
|
Definition
| Augmentin Plus Clarithromycin |
|
|
Term
| what pts are high risk for staphylococcal pna? What is the prognosis? |
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Definition
| CF, IVDU. 30-40% mortality rate |
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|
Term
| What are s/sx of staphylocccal pna? |
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Definition
| recurrent rigors, cough, tissue necrosis w/ abscess formation, pleural effusion, elevated WBC, poss empyema |
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|
Term
| What is seen on CXR in staphylococcal pna? |
|
Definition
| bronchopneumonia, abscess |
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|
Term
| What are s/sx of klebsiella pna? |
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Definition
| SOB, malaise, sudden cough, rigors, pleuritic CP, red currant jelly sputum |
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Term
| What is seen on CXR of klebsiella pna? |
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Definition
| segmental consolidation, poss abscess formation |
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|
Term
| What is the most common cause of atypical (walking) pna? |
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Definition
|
|
Term
| What groups is mycoplasma infxn common in? What time of the year? |
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Definition
| School children, yound adults, military recruits. Summer and fall |
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Term
| What are predisposing factors for mycoplasma infxn? |
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Definition
|
|
Term
| What are s/sx of mycoplasma infxn? |
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Definition
| low-grade fever, dry cough, h/o pharyngitis |
|
|
Term
| What is seen on CXR of mycoplasma? |
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Definition
|
|
Term
| Vaccines are availble for which types of pna? |
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Definition
|
|
Term
| What are risk factors for legionnaire's disease? |
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Definition
| middle-aged to elderly males, smoking, Etoh, immunosuppression |
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|
Term
| Where do outbreaks of legionnaire's dz tend to occur? |
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Definition
| buildings, hotels, hospitals, air conditioning |
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|
Term
| What sx occur in legionnaire's dz? |
|
Definition
| HA, high fever, chills, N/V/D, possible delirium |
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Term
| How is legionnaire's dz dx? |
|
Definition
| urinary antigen for legionella, sputum culture |
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|
Term
| Name 4 complications of legionnaire's dz. |
|
Definition
| respiratory failure, shock, DIC, renal failure |
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|
Term
| What type of pathogen is pneumocystic jiroveci? Who is it typically seen in? |
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Definition
| Protozoa, immunosuppresion |
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|
Term
| Who is chlamydophila most often seen in and what conditions is it seen along with? |
|
Definition
| 65-79 yo, seen with arthritis, asthma, and Alzheimer's |
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|
Term
| What viruses can cause pna? Is there a vaccine available? |
|
Definition
| influenza, RSV, rhinovirus, parainfluenza, coronavirus. Yes, yearly |
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