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9 Cards in this Set

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PPD Interpretation criteria


  • Highest risk group: >=5mm (immunocompromized, close contact with TB, abn CXR)
  • 'other' risk factors: >= 10mm (IVDU, homeless, hospital/prison/shelter/employees, recent immigrant, DM, malignancy, malnutrition, renal failure)
  • No risk factors: >= 15mm
Common clinical presentation of pneumonia
  • cough
  • fever
  • chest pain/discomfort
  • dyspnea
  • sputum production
  • inspiratory crackles & bronchial breath sounds

Pneumonia lab studies and Gold Standard


  1. Gold Standard: CXR

- ideally PA and lateral


- Look for consolidation, atelectasis, pleural effusion


2. bronchoscopy w/ biopsy/lavage


- PCP/TB


3. Percutaneous Needle Aspiration


- 5% risk of pneumothorax


4. Throacentesis


5. Pulse Ox?


6. ABG?




** if patient coughs up blood with fever, r/o PE STAT!

CAP (community acquired pneumonia):




BACTERIA (list most common),


demographics/predispositions,


CXR findings,


stains
  • Most Common: (Strep) Pneumococcal Pneumonia: elderly, chronically ill, alcoholism, smoking, nursing home, college dorm; gram: rust colored sputum, polls w/ gram+ lancet shaped cocci in singles; CXR: lobar w/i anatomical borders. CXR lags behind clinical picture

  • staphylococcal pneumonia: CAP during flu outbreak, post URI, IV drug use, pleuritic CP. Gram: many PMN's & gram+ cocci in clusters. CXR: patchy infiltrates w/ multiple areas of lung.

  • haemophilus influenza: smokers/COPD, nursing home, children <2y/o. gram: polls & gram- bacilli. CXR: broncho/lobar pattern.

  • klebsiella pneumonia: elderly, ETOH/DM/COPD, fever rigors, sputum +/- blood. gram: polls & gram- rods. CXR: upper lobe access, pleural effusion.

  • legionella pneumonia: common source of outbreaks, contaminated water from cooling/ventilation. gram: weak gram- bacilli. CXR: dense consolidation (50% have pl. effusion)

  • mycoplasma pneumonia: close quarters (50% college students, military). cold agglutinins+. gram: shows no bacteria. CXR: diffuse patchy infiltrates inv. entire lung.

CAP (community acquired pneumonia):
VIRUSES (list most common),
demographics/predispositions,
CXR findings,
stains
  • Hx: during flu season
  • CXR: patchy infiltrates
  • peribronchial thickening
  • pleural effusion
  • can do antigen testing, but mostly supportive (Tx Sx)

HAP (community acquired pneumonia): pathogens (list most common),


demographics/predispositions,


CXR findings,


stains

P aeruginosa


Klebsiella


E coli


S pneumoniae


H influenzae

sputum culture


blood culture


CBC


CXR


+/- ABG (SOB)

parameters for adequate sputum sample and differentiation against saliva on gram stain


  • <5–10 squamous epithelial cells (mouth)
  • > 25 leukocytes/lpf

Special stains for of sputum cultures


  • Acid-fast stain: Mycobacteria (TB)
  • Toluidine blue: PCP
  • Fluorescent antibody: Legionella

Croup classic X-ray findings

obstruction of upper airways by edema.


*STEEPLE SIGN (V. narrow sub-glottis)