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43 Cards in this Set
- Front
- Back
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what is the #1 cause of death from infectios disease in the US?
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pneumonia
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CAP has a greater prevalence in what groups?
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COPD
DM Renal Insufficiency CHF Chronic liver disease |
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What is involved in the cellular immnity in the lung?
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Alveolar macrophages
Neutrophils CD4 and CD8 lymphocytes NK cells B cells |
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What is the most common route of infection in CAP?
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Aspiration of nasopharyngeal secretions
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what is the most common organism involved in inhalation and getting CAP?
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Influenza
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What physiologic changes go along with CAP
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-Increased VO2, VCO2, and alveolar ventilation
-Increased shunt fraction bc of poor diffusion -V/Q mismatch because of vasoconstriction from inflammatory response -increased hypoxemia and hypocarbia -Decreased lung compliance -Increased cardiac output bc of hypercatabolic state but may become depressed later |
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What clinical symptoms occur?
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Fever/chills
Dyspnea Cough Pleuritic chest pain HA, N/V Abdominal pain, diarrhea myalgia athralgia |
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What might be an atypical pneumonia presentation?
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Elderly with vague symptoms like somnolence without a fever or cough
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What would be a typical CAP?
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Strep pneumo
-sudden onset, no viral prodrome, purulent sputum, signs of consolidation, response to B-lactam |
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What would be an atypical CAP?
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Mycoplasma, chlamydia, legionella
-no response to B-lactams, there is a viral prodrome, dry cough, absence of consolidation, no response to B-lactam |
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What might you find on physical exam?
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-crackles, rales
-consolidation -pleural friction rub sometimes -Bronchophony and whispered pectorioquey could be present |
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What diagnostic studies do you need for pneumonia
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CXR- this can differentiate pneumonias form other stuff.
It can identify more complicated forms and can tell the severity |
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What do atypical pneumonias look like on CXR
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Bilateral haziness
More interstitial infiltrates Less consolidation |
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What is the use of sputum gram stains?
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Debatable. They can be diagnostic for mycobacterium, endemic fungi, legionella, and PCP
Can ID pneumococcus in CAP |
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Would a CT scan help diagnose CXR?
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No they do not ad any info a CXR can't add
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What might you find on physical exam?
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-crackles, rales
-consolidation -pleural friction rub sometimes -Bronchophony and whispered pectorioquey could be present |
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What diagnostic studies do you need for pneumonia
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CXR- this can differentiate pneumonias form other stuff.
It can identify more complicated forms and can tell the severity |
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What do atypical pneumonias look like on CXR
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Bilateral haziness
More interstitial infiltrates Less consolidation |
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What is the use of sputum gram stains?
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Debatable. They can be diagnostic for mycobacterium, endemic fungi, legionella, and PCP
Can ID pneumococcus in CAP |
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Would a CT scan help diagnose CXR?
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No they do not ad any info a CXR can't add
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What workup do you do on a CAP patient?
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2 blood cultures
Thoracentesis if pleural effusion present CBC Electrolytes Liver lung function tests |
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Risk factors for mortality in CAP?
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Older than 65
Coexisting illness: COPD Bronchiectasis DM CHF Renal insufficiency Chronic liver disease Recent hospitalization AMS post-splenectomy Chronic alcohol abuse malnutrition malignancy |
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What physical findings predict mortality or bad course?
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RR >30
DBP <60 or SBP <90 Temperature either high or low Extrapulmonary sites of disease (meningitis or septic arthritis) HR > 125 AMS |
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Predictive labs of mortality
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Need mechanical ventilation
Abnormal renal function low hematocrit or hemoglobin low pH CXR with more lobes infolved, cavities, pleural effusion Evidence of sepsis like metabolic acidosis or DIC |
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What is the most common bacterial cause of CAP
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strep pneumo
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Describe strep pneumo CAP
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-Prototype of lobar pneumonia
-5% mortality overall |
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What is the most common cause of ARDS?
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Pneumonia. Trauma is second
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Who is at high risk for strep pneumo?
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-Post-splenectomy or Sickle Cell patients
-Immunodeficient This is because strep pneumo is encapsulated and they can't activate complement |
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You have a young patient with slow onset upper respiratory infection with dry cough and extrapulmonary complications (liver, cardiac, Joints). They had malaise leading up to it.
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Might be Mycoplasma pneumoniae
-this is the second most common CAP -Can diagnose with cold agglutins. difficult to culture. |
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How do you treat mycoplasma pneumonia
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macrolides, quinolones, doxycycline, tetracycline
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What pneumonia would cause multi-organ failure?
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Legionella
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Name some unique symptoms of legionella pneumonia
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Hyponatremia, increased liver transaminases, rhabdomyolysis, myocarditis
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How would you distinguish viral pneumonia from atypical pneumonia
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-Both have prodromes
-Influenza has shorter temporal profile though (a few days not a few weeks) -Commonly develop bacterial superinfection after 1-3 days with influenza |
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What would increase your risk for DRSP?
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-elderly
-Those on B-lactam therapy recently -steroid use -Multiple medical comorbidities -Exposure to child daycare |
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What puts you at risk for GN rods?
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Nursing home residents
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What increases risk for pseudomonas?
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-structural lung disease/dilated airways
-chronic steroid use -patients on broad spectrum antibiotics -malnourished |
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What organisms do you suspect in outpatient with no comorbities?
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Pneumococcus
Mycoplasma/Chlamydia H. influenza (smoker) Respiratory viruses |
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What organisms do you suspect in an outpatient with comorbidities?
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Pneumococcus
Mycoplasma/Chlamydia GNR Maybe legionella If sick, maybe staph |
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Inpatient organisms?
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Pneumococcus, H influenza, legionella
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ICU organisms?
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Pneumococcus, Legionella, H. Influenza, GNR, S. aureus
Possibly pseudomonas Mycoplasma/chlamydia not expected |
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What would you treat an outpatient with no comorbidities with?
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Macrolide like Azithromycin or Clarithromycin
Use doxycycline if they are allergic to the macrolide |
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Treat an outpatient with comorbidities with?
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Macrolide plus B-lactam for the GNR and DRSP
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Treat an inpatient or an ICU patient with?
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IV broad spectrum B-lactam
Macrolide |
