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16 Cards in this Set
- Front
- Back
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what are 3 routes of entry into pulmonary parenchyma
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- endogenous aspiration (aspirating oropharyngeal contents while asleep)
- inhalation of aerosolized bacterial particles (ie. legionella) - hematogenous spread ( ie. endocarditis) |
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how do you evaluate pts for lower resp tract infections? in other words, what's the best way to dx 1) clinically and 2) lab wise?
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-history and physical most important
-CXR - GRAM STAIN is most important initial lab test to obtain |
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whats the appropriate ratio PMN:epithelial cell for a GOOD gram stain
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20 PMNs:1 epithelial cell
note: specimens that don't fulfill this criteria ==> throw out!! |
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etiology of community-acquired lower resp infections
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S. pneumoniae, non-typeable H influenza, M. catarrhalis
less common: c. pneumoniae, influenza virus (during outbreaks), legionella, M. pneumoniae ALL DEPENDENT ON GEOGRAPHY AND PT POPULATION |
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how do you assess risk for pneumonias
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PORT algorithm
class I: <50 y/o, no serious comorbid condition, no serious abnormalities on physical exam (like altered mental status, tachypnea, tachycardia, etc) all others are assigned to class II - V based on point system (the higher the class, the higher risk of mortality and recommendation for inpatient care) |
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common etiologies (4) for nosocomial infections leading to lower resp infections (like pneumonia)
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S. aureus
P. aeruginosa Enterobacter Klebsiella |
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what are some predisposing factors to getting nosocomial infection leading to lower resp infection?
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-host factors
-surgery -medications -invasive devices -respiratory therapy equipment |
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most common etiologies (2 gram positives and 2 gram negatives) for aspiration/anaerobic infections leading to lower resp illness (like pneumonia)
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gram pos: peptostreptococcus, microaerophilic streptococci
gram neg: bacteriodes, fusobacterium |
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what is the Dx of choice for aspiration/anaerobic infections
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sputum gram stain!! when you see gram stain with a variety of bacterial morphologies ==> you know its an aspiration pneumonia!!
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name 3 aspiration syndrome
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- chemical pneumonitis (secondary to gastric acid burns)
- bronchial obstruction (secondary to particular matter - like chicken!) - bacterial aspiration |
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is aspiration pneumonitis more likely to occur on right or left lung? why?
where does inflammation tend to localize? |
right lung bc right mainstem bronchus is less of an acute angle - things are more easily lodged down there
localizes in posterior segment of upper lobe or apical segment of lower lobe |
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necrotizing pneumonia would show up as _______.
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multiple cavities < 1cm in diameter
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a lung abscess would show up as a ________.
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cavity > 1cm in diameter
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aspiration pneumonia is associated with what type of patients?
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pts with poor dental hygiene
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what 1 of 3 analysis criteria do you need to Dx pleural exudate?
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-ratio of protein to serum fluid protein > 0.5
- ratio of LDH to serum fluid LDH > 0.6 - WBC count > 1000/mm^3 |
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if pH of pleural fluid is less than ___, this means it could be an empyema (accumulation of pus in the pleural cavity)
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7.3 (could be from hepatic abscess, trauma ==> you have to think about where's it coming from and its source)
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