Pneumonia

Front 1

List the different Pneumonia syndroms.

Back 1

Community-acquired pneumonia
Hospital-acquired/nosocomial pneumonia
Atypical pneumonia
Aspiration pneumonia
Pneumonia in the immunosuppressed host
Chronic pneumonia

Front 2

What is the pathophysiology of pneumonia?

Back 2

Infection of the lung parenchyma by particular organism
Neutrophils migrate out of the pulmonary capillaries into the air spaces
After phagocytosis, neutrophils kill ingested microbes
Inflammation results in neutrophilic exudate in the alveolar spaces

Front 3

How can acute pneumonia develop?

Back 3

Aspiration of upper airway flora into lower respiratory tract
Inhalation of aerosolized micobes
Metastatic seeding from blood
Invasion of infection in contiguous structures
Direct inoculation
Reactivation

Front 4

What does development of acute pneumonia signify?

Back 4

Impairment of host defenses
Exposure to a particularly virulent organism
Overwhelming inoculum of low-virulence organism

Front 5

What are the defense mechanisms for the nasopharynx?

Back 5

nasal hair, nasal turbinates, aerodynamic filtration and impaction, mucociliary epithelium

Front 6

What are the defense mechanisms for the oropharynx?

Back 6

flow of saliva, sloughing of epithelial cells, bacterial interference of resident flora, local production of complement

Front 7

What are the defense mechanisms for the trachea and bronchi?

Back 7

cough, epiglottic reflexes, mucociliary apparatus, production of immunoglobulins (IgA, IgM, IgG)

Front 8

What are the defense mechanisms for the lower respiratory tract?

Back 8

Cough
Physical structure of airways
Epithelial cells in conducting airways production of surface liquid

Front 9

What are some commonly impaired host defenses?

Back 9

Impaired cough reflex
Depressed mucociliary transport
Anatomic changes
Inflammatory cells
Blunted cellular and humoral immune response
Reduced granulocyte chemotaxis
Neutropenia
Dysfunctional alveolar macrophages
Diminished antibody production or function
Iatrogenic manipulation
Tobacco
Aging

Front 10

Important aspects of a history when pneumonia is suspected?

Back 10

High fever, chills, productive cough, dyspnea, pleuritic chest pain with typical pathogens
Low-grade fever, nonproductive cough more common with atypical pathogens
Past medical history (COPD, HIV, bronchiectasis)
Look for specific exposures to animals, occupational exposures
Ask about travel and sexual history

Front 11

How does someone with typical pneumonia present?

Back 11

High fever
chills
productive cough
dyspnea
pleuritic chest pain

Front 12

How does someone with atypical pneumonia present?

Back 12

Low grade fever
non productive cough
"Walking Pneumonia"

Front 13

What is fieget's sign?

Back 13

fever + bradycardia; atypical and commonly seen in Legionella and atypical pneumonia

Front 14

How do patients with legionella present?

Back 14

fieget's sign, tachypneic, thonchi, egophony

Front 15

What is toxic pneumonia?

Back 15

high temperature, high respiratory rate, high pulse

Front 16

What is non-toxic appearance on pneumonia?

Back 16

they look mild or normal

Front 17

How to diagnose pneumonia?

Back 17

clinical presentation, epidemiologic considerations, gram-stain of sputum, characteristic x-ray appearance, blood cultures, antigen tests

Front 18

What defines a good sputum sample?

Back 18

less than 10 epithelial cells and more than 25 neutrophils in high field

Front 19

What is the most common form of community-acquired pneumonia?

Back 19

streptococcus pneumoniae

Front 20

Presentation of streptococcus pneumoniae

Back 20

high fevers, chills, productive rusty spurum, focal infiltrate on x-ray; if left untreated, neutrophilic pus could invade pleural cavity (empyema)

Front 21

Which pneumonia has the highest fatality rate?

Back 21

streptococcus pneumoniae

Front 22

What are suppurative complications of streptococcus pneumoniae?

Back 22

sinusitis, otitis media, endocarditis, meningitis, parapneumonic effusion (empyema)

Front 23

How does streptococcus pneumoniae appear on culture?

Back 23

alpha-hemolytic, gram postiive diplococci

Front 24

How does hemophilus influenzae present?

Back 24

high fever, productive sputum, chills

Front 25

In which populations is hemophilus influenzae common?

Back 25

individuals with COPD and alcoholics

Front 26

What is a complication of untreated h. influenzae pneumonia?

Back 26

pleural effusion

Front 27

To which antibiotics does h. influenzae show resistance?

Back 27

all penicillin based antibiotics becasue of beta-lactamase

Front 28

How does haemophilus influenzae appear on culture?

Back 28

gram negative diplococci

Front 29

Which population does Klebsiella pneumoniae most affect?

Back 29

alcoholics

Front 30

How does Klebsiella pneumoniae present?

Back 30

high fever, chest pain, dyspnea, hemopstysis, sputum, lethargic

Front 31

What is a common name for Klebsiella pneumoniae?

Back 31

Friedlander's Pneumonia

Front 32

How does Klebsiella pneumoniae appear on x-ray?

Back 32

bulging infiltrate; k pneumoniae is very mucoid and its exudate pushes on the lung

Front 33

How does Klebsiella pneumoniae appear on culture?

Back 33

whtie mucoid colonies of gram-negative bacillus

Front 34

What is a typical prsentation of Staphylococcal pneumoniae?

Back 34

someone who has the flu and gets pneumonia immediately after; sputum, fever, rhinitis

Front 35

What are the most common causes of atypical pneumonia?

Back 35

legionella, and then mycobacterium (tb)

Front 36

How does legionella pneumonia present?

Back 36

high fever, feiget's sign, gi symptoms, hyponatremia, multilobar pna, rapid progression

Front 37

How is legionella diagnoses?

Back 37

serology

Front 38

how is streptococcus pneumonia diagnoses?

Back 38

antibody urine test

Front 39

how does legionella appear on culture?

Back 39

gram negative rods

Front 40

How does mycoplasma pneumoniae present?

Back 40

sore throat, nonproductive cough, headache, bullous myringitis; x-rays often appear worse than clinical findings

Front 41

How is a clinical diagnosis of mycoplasma pneumoniae confirmed?

Back 41

serology or culture

Front 42

What is atypical pneumonia?

Back 42

"walking pneumonia"; patients do not have a fever, look normal, have normal WBC, but have cough

Front 43

What causes aspirational pneumonia?

Back 43

mostly bacterial of chemical; a lot of times its due to the natural flora in your mouth and airway

Front 44

How is nosocomial pneumonia caused?

Back 44

colonization of oropharynx with pathogen followed by aspiration; second most frequent nosocomial infection

Front 45

Which pathogen commonly causes parapneumonic effusion?

Back 45

streptococcus pneumonia; exudate into pleural cavity can causes empyema if left untreated

Front 46

Which organisms commonly cause nosocomial pneumonia?

Back 46

60% due to gram negative bacilli, 13-40% due to s aureus

Front 47

What are the risk factors for viral pneumonia?

Back 47

HIV/AIDS, transplant patients, underlying lung disease, premature infants

Front 48

What are the causes of viral pneumonia?

Back 48

CMV, influenza, parainfluenza, adenovirus, respiratory syncytial virus, SARS

Front 49

Which pneumonia causing pathogens are more common in immunosuppresed hosts?

Back 49

fungal (aspergillus, cryptococus pneumocystis), nocardia, rhodococcus equi, and tb

Front 50

What is the treatment for aspergillus pneumonia?

Back 50

long-term antifungal Rx and reversal of immunosuppresion

Front 51

What is a major cause of PJP pneumonia?

Back 51

defective t cell immunity

Front 52

What is a parapneumonic effusion?

Back 52

pleural effusion that arises as a result of pneumonia; pleural fluid with pH <7.2, glucose <60, high LDH, and bacteria