Term
| what is the first thing to consider when diagnosing a pt with pneumonia? |
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Definition
| determine where the pneumonia was contracted |
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Term
| what is the likely pathogen if the pneumonia was contracted outside by an other wise healthy pt? |
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Definition
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Term
| what is the likely pathogen if the pneumonia was contracted by a smoker? |
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Definition
| mycoplasma (esp in young adults), viral or legionella, (if truly sick) |
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Term
| what is the likely pathogen if the pneumonia was contracted in NYC? what is the common clinical presentation? |
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Definition
| pneumocystis (PCP) due to high HIV rates, drug use population. this will appear as diffuse inflitrate. |
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Term
| what is the likely pathogen if the pneumonia was contracted in a hospital (nosocomial)? |
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Definition
| HAP (haemophilus), staph and pseudomonas (the later 2 have some resistance to antibx) |
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Term
| what is the likely pathogen if the pneumonia was contracted by a pt with CF? |
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Definition
| staph and pseudomonas, which thrive in bronchiectasis, or destruction of the bronchial treee |
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Term
| what is the importance of the hx in pts w/pneumonia? |
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Definition
| the correct antibx need to be administered, and sometimes the cx can take longer than the pt has to come back |
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Term
| what does an abruptness of pneumonia onset point to in terms of pathogens? |
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Definition
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Term
| what do chills tell you about a pt w/pneumonia? |
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Definition
| the pt has likely become bacteremic and a blood cx needs to be performed/antibx need to be administered |
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Term
| what does pain upon breathing tell you about a pt w/pneumonia? |
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Definition
| pleuritis (stabbing pain w/breaths), which is commonly caused by the coxsackie virus in young women in the winter - known as bohr-holmes syndrome |
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Term
| what does a dry cough in a pnuemonia pt indicate? |
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Definition
| *viral cause or legionella/mycoplasma* |
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Term
| what does a yellow sputum mean if coughed up by a pneumonia pt? |
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Definition
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Term
| what does dyspnea/CXR with whited-out lungs indicate in a pneumonia pt? |
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Definition
| non-bacterial pneumonia, b/c a bacterial infection of that magnitude would be fatal |
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Term
| what needs to be r/o in a possible pneumonia pt? |
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Definition
| PE, sarcoid, CHF, ARDs, and noxious gasses |
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Term
| can animals pass on pneumonia? |
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Definition
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Term
| how might a pt contract pneumonia due to histoplasmosis? |
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Definition
| histoplasmosis is a fungus growing on feces of chickens, bats, etc - may be seen in pts traveling to developing countries |
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Term
| what needs to be done for every pneumonia pt? |
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Definition
| a sputum analysis - needs to be performed by the dr |
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Term
| what is seen in a sputum analysis of pneumonia pts? |
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Definition
| WBCs w/morphologically similar organisms (all gram + or -) and bronchial epithelial cells - should NOT see squamous cells (indicative of oral contamination) |
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Term
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Definition
| a suction device used for sputum analysis that attaches to the bronchoscope |
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Term
| what is likely if a sputum analysis shows both gram + and -? |
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Definition
| most likely mixed gram +/- is from elderly pts via aspiration |
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Term
| how is a sputum analysis performed? |
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Definition
| make sure the inside of the tube is sterile, have the pt expectorate into it, and take it directly to the lab (otherwise too many other organisms will grow) |
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Term
| how does sputum appear histologically? |
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Definition
| gram + diplococci being chewed apart by WBCs OR gram negative bacteria (larger, such as haemophilus) which are accompanied by many more WBCs |
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Term
| who are coccobacilli (such as diplococci haemophilus) common in? |
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Definition
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Term
| what pts are neisseria (m catarrhalis) common in? |
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Definition
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Term
| beyond a pt expectorating, what are other methods for getting a sputum sample? |
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Definition
| catheter to the cricothyroid membrane to suck out fluid (danger to thyroidema artery), and needle bx (danger in spreading infection) - but the best way is w/a clean & sterile bronchoscope |
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Term
| what are the 2 types of pneumonia patterns? |
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Definition
| alveolar (fluid surrounds alveolus, get rales) and interstitial (looks like congestive failure) |
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Term
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Definition
| when the infection surrounds an airway |
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Term
| what is seen in necrotizing pneumonia? |
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Definition
| cavitations and abscesses |
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Term
| what is general management of pneumonia? |
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Definition
| good bronchiodilatortherapy, *miller pump (done by family), O2 (if pt has high CO2, such as in COPD - helps pts breathe) |
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Term
| who needs to be monitored the most in terms of dehydration? |
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Definition
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Term
| how does empyema present? how is empyema treated? |
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Definition
| empyema presents as high WBC count as it is an infection between visceral and parietal pleura that needs to be tested with a 22 gauge needle and if pus, then followed by a chest tube |
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Term
| do viruses such as influenza commonly cause pneumonia? |
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Definition
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Term
| what pneumonia-causing bug are many elderly pts subject to? why? how is this treated? |
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Definition
| bordetella pertussis - b/c the vaccine wears off. this is treated with antibx effectively, but needs to be confirmed via a cx |
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Term
| what makes strep bacteria (gram positive) so lethal to humans? |
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Definition
| they have developed a mucopolyssachride capsule which inhibits WBCs - which is what PCN targets |
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Term
| what is the most common of all community acquired pneumonias? |
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Definition
| strep pneumoniae, which spreads in the lobar region to the pleural surface (can effuse) |
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Term
| what WBCs levels are consistent with a strep infection? |
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Definition
| ~20,000 - which if high enough and sustained = deranged liver and hypoxemia |
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Term
| what can result if breaks in the pleural surface are not treated? |
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Definition
| empyema, which often occurs w/delayed therapy |
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Term
| can strep pneumonia lead to meningitis, endocarditis, and pericarditis? |
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Definition
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Term
| what occurs if strep pneumonia isn't treated? |
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Definition
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Term
| what is the best treatment of strep pneumonia? |
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Definition
| prevention - recommend polyvalent pneumococcal vaccine (particularly if have predisposing condition) |
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Term
| what is the most concerning of the streptococci in terms of pneumonia? |
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Definition
| strep pyogenes - which is common w/influenza, increases ASO (anti-streptolysin O), affects the kidneys and causes empyema |
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Term
| do most antibx work on strep? |
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Definition
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Term
| what is the main issue with staph infections? |
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Definition
| staph has become resistant to PCN, methicillin, only vancomycin is left |
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Term
| what do staph infections do to the lungs? |
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Definition
| eats them, causes empyema, affects heart valves (IVDA), can cause a hematocoele (hole in lung wall) |
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Term
| how will pts with staph infections present? |
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Definition
| mild leukocytosis, hypoxemia, +blood cx 25% of the time, empyema, spontaneous pneumothorax, and heart effects |
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Term
| are gram negative pneumonia infections a large problem? when are they seen? |
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Definition
| yes, particularly pseudomonas - infections by gram negative bacteria are seen often in pts w/tracheal tubes |
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Term
| how does gram negative pneumonia present? what is the clinical resolution rate? |
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Definition
| as an acute toxic illness, even though the onset is insidious. if disease is only caught at acute stage: 80% mortality, if caught in insidious onset stage: 50-80% mortality. the clinical resolution rate is slow. |
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Term
| what is the most common cause of nosocomial pneumonia? |
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Definition
| pseudomonas - infections often due to broad spectrum antibx |
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Term
| what kind of pneumonia-causing pathogen is common in smokers? |
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Definition
| haemophilus - growth of bug favored with nicotine |
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Term
| how does haemophilus appear microscopically? |
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Definition
| as a pleomorphic rod w/a capsule |
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|
Term
| who does haemophilus generally affect? |
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Definition
| the elderly, pts with COPD, chronic alcoholics, smokers |
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Term
| is viral infection a common antecedent for haemophilus infection? |
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Definition
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|
Term
| what does haemophilus only grow on? |
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Definition
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Term
| what is the virulence factor for klebsiella? |
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Definition
| its capsule keeps phagocytes from consuming it |
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|
Term
| what pt populations commonly get klebsiella? |
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Definition
| diabetics, alcoholics and hospitalized pts |
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Term
| what characterizes a klebsiella pneumonia? |
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Definition
| a lot of sputum, mainly from the upper lobes. often there is a "bulging fissure" sign in the upper lobe, accompanied by leukopenia, cavitation, empyema, respiratory failure and shock |
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Term
| what pt population is most likely to get pneumonia due to pseudomonas? |
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Definition
| immunocompromised pts, those w/DM, the elderly and HIV pts |
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Term
| how are pts infected with pseudomonas? |
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Definition
| inhalation and colonization of the oropharynx (50% of hospital workers have pseudomonas in their body) |
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Term
| how is pneumonia due to e coli generally contracted? what part of the lungs are usually affected by e coli? |
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Definition
| instrumentation in the GI tract, pneumonia due to e coli is seen post cystoscopcy etc. this is more common in the lower lobes |
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Term
| why is mycoplasmic pneumonia so drug resistant? |
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Definition
| b/c mycoplasma doesn’t have cell wall but a triple membrane - need to kill the ribosomes with quinolones and macrolide (no penicillin because no cell wall) |
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Term
| what are the symptoms of pneumonia due to mycoplasm? |
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Definition
| sparse (dry) sputum (the only other causes of this are viral and legionella), lymphadenopathy, eruptions, increased in LFTs, and mild, scattered bronchopneumonia |
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|
Term
| when does mycoplasma affect philadelphia? |
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Definition
| between thanksgiving and easter, so do the lab test for it then! |
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Term
| what is the cause of most anerobic pneumonias? |
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Definition
| pts with poor dentition (large amounts of thick fluid in mouth) aspirating anerobic bacteria such as bacteroides/fusiform from the mouth. colonization is slow at first, but is followed by dyspnea and lung abscesses in 20% of affected pts |
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Term
| what is the best tx for viral pneumonia? |
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Definition
| prevention: influenza shot - esp healthcare workers. treatment: tamiflu/relenza |
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Term
| what are the symptoms of viral pneumonia? |
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Definition
| dry, unproductive cough, non-elevated WBC count |
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|
Term
| what are 2 important quesions to ask pts (life&death) suspected of pneumocystis carnii? |
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Definition
| do you use drugs? are you gay? |
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|
Term
| how do legionella pneumonia pts present? |
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Definition
| dry, non-productive cough, flu, overwhelming pneumonia, absent URI, high fever (106+), shaking, and chills |
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Term
| who does legionella commonly cause pneumonia in? |
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Definition
| immunocompromised pts, COPD pts, diabetics, alcoholics, and workers at excavation sites commonly get pneumonia due to legionella |
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Term
| what is the diagnosis of legionella presumptive until? |
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Definition
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Term
| what do you treat legionella w? |
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Definition
| zithromax and cephalosporins, need to target ribosomes. |
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Term
| *Young medical student comes in with good health, no HIV, nonsmoker, what bugs do you think would infect?* (exam question) |
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Definition
| *strep, diplococci, maybe mycoplasm -> all of which are responsive to the same antibx* |
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Term
| *80 year old lady in ICU, has infiltrating pneumonia what do you worry about?* (exam question) |
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Definition
| *nosocomial gram negatives, staph, pseudomonas -> all of which are responsive to the same antibx* |
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Term
| how can you test if a pt probably aspirated something? |
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Definition
| if the pt gags when a tongue blade is stuck in their mouth aspiration is not likely, however if they don't gag - aspiration needs to be investigated |
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