Bacterial Pneumonia

Front 1

Difference btn Pneumonia and Pneumonitis

Back 1

Pneumonia = infection of the pulmonary parenchyma
Pneumonitis = inflammation of the pulmonary parenchyma; may be non-infectious

Front 2

criteria for Hospital-acquired (HAP)

Back 2

onset of symptoms >48 after admission

Front 3

Risk factors for pneumonia (4 of them)

Back 3

• Disruption of anatomical or mechanical barriers (smoking, CHF, COPD)
• Increased exposure to pathogens(crowding, aspiration)
• Immune deficiencies
• Iatrogenic bypass of host defenses (bronchoscopy and intubation

Front 4

acute CAP presentation symptoms

Back 4

Fever
productive cough
pleuritic chest pain

also less specific such as fatigue, anorexia, sweats, chills( the elderly are notorious for non specific symptoms)

Front 5

acute CAP signs

Back 5

-Tachypnea
-rales
-Only 1/3 have consolidation (fairly specific to pneumonia)
-Leukocytosis with left shift (more neutrophils and bands)

Front 6

Bacteiral etiologies of CAP in adults

Back 6

S. Pneumoniae, Hemophilus, Moraxella, S. Aureus,

Front 7

Clinical Variations of CAP (4)

Back 7

1) Aspiration – occurs in dependent lobes, often anaerobic
2) Elderly often have non-specific complaints
3) Atypical syndrome (walking) – chlamydia, mycoplasma, legionella
4) Post-obstructive – distal to bronchial obstruction, more likely to be gram neg

Front 8

Which agent is common cause of pneumonia for all ages above three weeks?

Back 8

S. Pneumoniae

Front 9

Three classic atypical

Back 9

C. pneumoniae, M. pneumoniae, Legionella sp.

Front 10

1) Strep colonizes the___
2) major virulence factor

Back 10

1) nasopharyna
2) polysaccharide capsule; elicits an intense inflammatory response

Front 11

1) is H. influenzae usually acute or chronic
2) most dangerous type

Back 11

1) chronic
2) type B

Front 12

common Moraxella catarrhalis infections

Back 12

middle ear, sinuses or lower tract
(Gram negative diplococcus, indistinguishable from Neisseria on gram stain)

Front 13

1) Staphylococcus aureus importance
2) cavitation and nectosis is caused by

Back 13

1) CA-MRSA, initial treatment with vancomycin
2) PVL toxin

Front 14

3 organisms associated with atypical CAP

Back 14

Legionella, chlamydia, and mycoplasma

Front 15

% of patients w/ pneumonia who will develop pleural effusions

Back 15

40%

Front 16

an effusion should be evaluated by thorocentesis
1)
2)

Back 16

1) thickness > 1 cm on lateral decubitus film
2) persistant unexplained fever

Front 17

1) empyema
2) management?

Back 17

1) presence of pus in pleural space
2) chest tube drainage

Front 18

other considerations for chest tube drainage

Back 18

pleural fluid pH <7
glucose <40
gram stain is positive

Front 19

When should you consider induced sputum

Back 19

M. tuberculosis, P. carinii

Front 20

What is generally reserved for non resolving pneumonia or for patients who end up in the ICU

Back 20

Fiberoptic bronchoscopy