Term
| What is the leading cause of death in the us due to infections? |
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Definition
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Term
| What is the 6th leading cause of death in the us? |
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Definition
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Term
| (where the infection has invaded an area. it has filtrated into an area of tissue) |
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Definition
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Term
| (infection has filled an area of tissue) |
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Definition
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Term
| A confused 62 year old gentleman with a hx of alcoholism, smoking and copd presents w/ a respiratory rate of 35/min, a blood pressure of 88/58, and a bun of 35. This pt has risk factors for what illness? |
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Definition
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Term
| Within what time frame of admittance is pneumonia considered cap vs. nosocomial? |
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Definition
| w/in 48 hrs of admission = cap |
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Term
| Cystic fibrosis, copd, and smoking are risk factors for what illness? |
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Definition
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Term
| What are 4 organisms that cause typical pneumonia? |
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Definition
| strep, pneumococcus, haemophils, staph |
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Term
| What is the most common atypical bacteria? What are 2 other orgs that cause atypical pneumonia? |
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Definition
| mycoplasma (prevalent)= most common. also legionella, chlamydia (both rare) |
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Term
| The following organisms cause pneumonia in what population: s. pneumoniae, h. influenzae, mycoplasma? |
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Definition
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Term
| The following organisms cause pneumonia in what population: s. pneumo, h. flu, s. aureus? |
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Definition
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Term
| The following organisms cause pneumonia in what population: h. flu, s. pneumoniae, anaerobes (wide mixture)? |
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Definition
| debilitated (asthma, smoking, copd, alcoholism) |
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Term
| The following organisms cause pneumonia in what population: p. aerugionsa, e.coli, s. aureus? |
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Definition
| hospitalized (nosocomial) |
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Term
| With what pathology would a pt likely present w/pneumonia due to the following organisms: k.pneumoniae, anaerobes, m.catharrhalis? |
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Definition
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Term
| With what pathology would a pt likely present w/pneumonia due to the following organisms: k. pneumoniae, h.flu, s.pneumoniae, ,s.aureus? |
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Definition
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Term
| HIV pts present more frequently with which pneumonia: p.jiroveci (pcp) or s. pneumoniae? |
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Definition
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Term
| With what pathology would a pt likely present w/pneumonia due to the following organisms: s.pneumoniae, h.flu? |
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Definition
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Term
| With what pathology would a pt likely present w/pneumonia due to the following organisms: s.pneumoniae, h.flu, m.catarrhalis? |
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Definition
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Term
| With what pathology would a pt likely present w/pneumonia due to the following organisms: s.pneumoniae, h.flu? |
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Definition
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Term
| With what pathology would a pt likely present w/pneumonia due to the following organisms: p.jiroveci, s.pneumo, h.flu, cryptococcus? |
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Definition
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Term
| What is the most common cause of pneumonia? |
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Definition
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Term
| What percent of individuals carry s.pneumoniae in their nasal passsages? |
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Definition
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Term
| What may influence pneumonia-causing organism's ability to increase it's affinity in the tissue? |
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Definition
| strong association w/viral illness |
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Term
| What is the most common reason for nosocomial pneumonia? |
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Definition
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Term
| Once aerosolized, pneumonia-causing organisms invade which cells? |
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Definition
| type h alveolar cells and then multiplies |
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Term
| What follows inflammation due to pneumonia-causing organisms in lungs? |
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Definition
| inflammation occurs and thus consolidation |
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Term
| What type of bacteria tend to deteriorate the tissue? What potential does this entail? |
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Definition
| atypical bacteria have the ability to injure the cilia |
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Term
| Which type of bacteria tend to be immune mediated and have the ability to spread across lung boundaries? What characteristic of this type of pneumonia is explained by this mechanism? |
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Definition
| atypical pneumonia. this is why atypical pneumonia effects multiple lobes |
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Term
| Why might pneumonia pts experience pain? |
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Definition
| referred pain from consolidation |
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Term
| Why might you inspect pneumonia pt's head/neck? |
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Definition
| alcoholism: teeth decay? dehydration- are the mucous membranes moist? is the neck supple? |
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Term
| Besides the most common reason of aspiration, what might cause pneumonia? |
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Definition
| colonization of bacteria in the nasopharynx and stomach |
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Term
| Advanced age, malnutrition, altered level of consciousness, swallowing disorders, prolonged endotracheal intubation all are risk factors for what illness? |
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Definition
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Term
| What might present in a cardiac pe in a pt w/pneumonia? |
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Definition
| hypotension leads to change in blood viscosity, leading to murmurs. (this can also occur w/anemia). also look for rate, rhythm |
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Term
| A pt. presents w/ a fever of 101, cough w/o sputum, sweats, rigors, chills, aching muscles, headache, stomach ache, and chest pain. What might the pt have? |
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Definition
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Term
| Why examine a pneumonia pt's chest? |
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Definition
| check for pathologies you might have missed |
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Term
| What might you look for in a pneumonia pt's pe of lower extremity? |
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Definition
| edema, distal pulses, profusion, adequate volume, clubbing, cyanosis |
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Term
| What is the most important aspect of an exam on pneumonia pt? |
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Definition
| *vital signs, vital signs, vital signs* |
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Term
| What is the o2 sat level that causes concern? |
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Definition
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Term
| A pe on a pneumonia pt should inlude what 6 areas? |
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Definition
| head and neck. cardiac. lung. abdominal. lower extremities. remember vital signs! |
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Term
| what labs should be ordered for pneumonia? |
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Definition
| sputum gram stain w/culture and sensitivity. are you going to wait to see what culture and sensitivity come back on? (no- tx empirically- get blood cultures before 4 hrs, then sart tx) blood cultures- (kids, some hospitals is standing protocol, co-morbity lending to sepsis). cbc, bmp, hfp, cd4 and viral loads, cardiac enzymes |
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Term
| What are you looking for on cbc in pneumonia? |
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Definition
| expected elevated wbc's 1st, bandemia- body is building up a defense quickly to pour out more wbc's to fight infection- left shift, anything that indicates an acute inflammatory infection. (hgb and hct to make sure pt hasn't become anemic) (or indication of another problem) |
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Term
| What are you looking for on bmp in pneumonia? |
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Definition
| electrolytes: adequate equilibration. most important: renal function, bun, creatinine- greater risk. if not, why? dehydration? renal insufficiency/failure in hx? glucose is important- how well is diabetes managed? |
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Term
| What are you looking for on hepatic function panel in pneumonia? |
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Definition
| make sure they're not having hepatic impairment if you give drug metabolized in liver (also co-moribities in liver) |
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Term
| When would you order cardiac enzymes in pneumonia pt? |
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Definition
| risk factor/history of heart disease. if pneumonia causes hypoxia, less o2 to heart, illness increases 02 demands- causes ischemia |
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Term
| The following silhouette indicates which lobe/segment on a cxr: R diaphragm? |
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Definition
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Term
| The following silhouette indicates which lobe/segment on a cxr: R heart margin? |
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Definition
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Term
| The following silhouette indicates which lobe/segment on a cxr: ascending aorta? |
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Definition
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Term
| The following silhouette indicates which lobe/segment on a cxr: aortic knob? |
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Definition
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Term
| The following silhouette indicates which lobe/segment on a cxr: L heart margin? |
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Definition
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Term
| The following silhouette indicates which lobe/segment on a cxr: descending aorta? |
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Definition
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Term
| The following silhouette indicates which lobe/segment on a cxr: L diaphragm? |
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Definition
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Term
| What type of pneumonia presents w/signs of bullous myringitis? |
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Definition
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Term
| In what population and season does mycoplasma pneumonia occur? |
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Definition
| young healthy adults, summer and fall mos |
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Term
| How might lung sounds change as pneumonia progresses? |
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Definition
| start w/early crackles, to rales (gurgly drowning quality) in some cases can cause wheeze and others |
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Term
| What type of pneumonia might present w/similar sx to illnesses such as influenza or complications from influenza? |
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Definition
| viral (differentiate based on h&p) (wbc- normal to slightly elevated. then you look at differential- neutrophils more than lymphocytes) |
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Term
| Hemolytic anemia and rashes might indicate what type of pneumonia? |
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Definition
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Term
| Which of the following are useful for differentiating bacterial pneumonias: appearance, sx, hx? |
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Definition
| come in a wide array of views and bacterial types. many appear similar. most have the same sx. hx is different! |
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Term
| What aspect of exam is important when dx tb? |
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Definition
| hx is important w/regard to any exposure, drug use, hiv+. also hx of fever, chills, weight loss (profound), night sweats are key! any positive ppd or prior use of inh or rifampin for tx |
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Term
| Pt presents w/s/s of pneumonia and fevers, chills, weight loss of 10 lbs in the past 10 days, and night sweats. What type of pneumonia is likely? |
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Definition
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Term
| What is a typical classical sign of tb? They won't tell you this- you have to ask. |
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Definition
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Term
| INH or Rifampin are used for tx of what illness? |
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Definition
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Term
| What must you do w/pt admitted w/tb? |
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Definition
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Term
| What type of pneumonia has more apical infiltrates and *cavitary lesions*? |
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Definition
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Term
| What type of pneumonia is found to be associated w/ hx of immunocompromised state, hx of geographic location (sw or ohio valley)? What are 3 examples? |
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Definition
| fungal pneumonia- cryptococcus, coccidioides, histoplasma |
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Term
| What percentage of fungal pnumonia clears w/o tx in young healthy adults? What is the mortality in the HIV population? |
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Definition
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Term
| What caused 182 cases of pneumonia and 29 deaths at a 1976 outbreak at the Philadelphia American Legion convention, and was found to be caused from the condensation of the air conditioners and also from contaminated water in institutions? |
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Definition
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Term
| What is the tx of most cap in outpt setting? |
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Definition
| most tx is empiric tx w/abx |
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Term
| Outpt CAP tx w/abx involves coverage for what? |
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Definition
| most common 2-3 pathogens: tx empirically- don't wait for test results |
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Term
| Dose for CAP outpt abx depends on what? |
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Definition
| age, renal function, co-morbid disease (cost) |
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Term
| What sx should be tx w/pneumonia? |
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Definition
| sx that are also the complaint of the pt (ask "what is the no. 1 thing that bothers you about the illness?") |
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Term
| What should be rx for cough and sob w/pneumonia? |
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Definition
| bronchodilators (albuterol) |
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Term
| What should be rx for congestion in pneumonia pts? |
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Definition
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|
Term
| What should be rx for cough/pain in pneumonia pts? |
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Definition
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Term
| What should be rx for *prevention* for elderly, renal and comorbid pts to prevent pneumonia? |
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Definition
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Term
| What should be limited or eliminated with pneumonia pts? |
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Definition
| limit or eliminate exposure to bcteria or infectious agents (tb, ac, contaminated h2o) |
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Term
| What should be consulted when determining whether you admit a pneumonia pt? |
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Definition
| Pneumonia Pt Outcomes Research Team (PORT): 19 clinical variables and determines if admission is necessary based on risk and mortality |
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Term
| What could you rx for a pneumonia pt's cough? |
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Definition
| anti-tussives (guifenasen, chlorpheramine, benzanoate (tessalon pearls)) |
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Term
| What are 3 other considerations beside PORT when deciding whether to admit a pneumonia pt? |
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Definition
| compliance, social status, subjective look of pt |
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Term
| What is the preferred and alternate abx tx for strep pneumoniae? |
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Definition
| preferred: pcn g, amoxicillin. alt: macrolides, cephalosporins, doxycycline. |
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Term
| board question: what ms should be taken w/post-splenectomy pt every year? |
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Definition
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Term
| What is the preferred and alternate abx tx for H. flu? |
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Definition
| preferred: ceftriaxone, doxycycline, azithromycin, bactrim. alt: fluoroquinolone, clarithromycin |
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Term
| What is the preferred and alternate abx tx for staph aureus? |
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Definition
| preferred: pcn-resistant w or w/wo rifampin. for mrsa vancomycin w/ or w/o gentamycin, rifampin, linezolid. alt: cephalosporin, clindamcin, bactrim, fluroquinolone |
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Term
| What is the preferred and alternate abx tx for klebsiella pneumonia? |
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Definition
| 3rd gen cephalosporin, add aminoglycoside for severe. alt: azitreonam umipenem, aminoglycoside, fluroquinolone. |
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Term
| What is the preferred and alternate abx tx for e.coli? |
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Definition
| 3rd gen cephalosporin, add aminoglycoside for severe. alt: aztreonam, imipenem, aminoglycoside, fluroquinolone |
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Term
| What is the preferred and alternate abx tx for pseudomonas aeroginosa? |
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Definition
| anti-pseudomonal beta lactram aminoglycoside. alt: cipro + aminoglycoside or anti-pseudomonal beta lactam |
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Term
| What is the preferred and alternate abx tx for |
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Definition
|
|
Term
| If a pt's o2 stats are less than 90 or they are hypotensive, should you consider admittance? |
|
Definition
|
|
Term
| What is the preferred and alternate abx tx for anaerobes? |
|
Definition
| clindamycin, beta-lactam/beta lactamase inhibitor, imapenem. alt: none |
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Term
| What is the preferred and alternate abx tx for mycoplasma pneumoniae? |
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Definition
| preferred: doxycycline, erythromycin. alt: clarithromycin, azithromycin or a fluroquinolone. |
|
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Term
| What is the preferred and alternate abx tx for legionella spp? |
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Definition
| preferred: macrolide w/ or w/o rifampin, a fluroquinolone. alt: doxycycline w/ or w/o rifampin, bactrim |
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Term
| How do you determine when to d/c pt w/pneumonia? |
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Definition
| stable vital signs for 24-hr period. pt can take oral abx. pt can maintain adequate hydration and nutrition. pt's mental status is nml. pt has no other active clinical or psychosocial prob's requiring hospitalization. (also consider if they need home health or nursing stay if they live alone) |
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Term
| What is the preferred and alternate abx tx for chlamydia? |
|
Definition
| preferred: doxycycline. alt: erythromycin, clarithromycin, azithromycin or a fluroquinolone. |
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Term
| What is the preferred and alternate abx tx for moraxella catahraralis? |
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Definition
| 2nd or 3rd gen cephalosporin fluroquinolone. alt: bactrim, amoxicillin-clavulanic, macrolide. |
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Term
| What is the preferred and alternate abx tx for p. jiroveci? |
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Definition
| bactrim or pentamidine predinsone. alt: dapsone and trimetroprim. clindamycin and primaquine. trimetraxate adn folinic acid. |
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|
Term
| Why might you prescribe alt tx? |
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Definition
| allergy. pregnancy. child. |
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|
Term
| What might you consider with a pneumonia complication of endobronchial obstruction? |
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Definition
| you must consider an underlying cause (ie carcinoma, aspirated foreign body, cystic fibrosis) |
|
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Term
| When dealing w/pneumonia complications of endobronchial obstruction, some pts may need what to determine root cause? |
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Definition
| flexible bronchoscopy or a rigid bronchoscopy to determine root cause of obstruction. you can also obtain samples of tissue and fluid if needed. |
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|
Term
| Kid w/big consolidated pneumonias, ask what? |
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Definition
| how long has he had cough? weeks: maybe aspirated foreign body. then take family hx: sweat chloride test? (cf) |
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|
Term
|
Definition
| consolidated mass of infection (pus) loculated in the lung parenchuma. |
|
|
Term
|
Definition
| tx most of the time is thoracotomy and/or chest drain |
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|
Term
| When can pericarditis occur? What causes this? |
|
Definition
| can occur after an infection w/pneumococcal spp. caused by the pneumonococcus bacteria. |
|
|
Term
| How prevalent is pericarditis? |
|
Definition
| although rare, these infections are severe and life threatening. |
|
|
Term
| How quickly does empyema develop? What should you do if you suspect empyema? |
|
Definition
| slowly. do another cxr do assess progression. |
|
|
Term
| What may pts require for dx/tx of pericarditis? |
|
Definition
| pericardiocentesis for fluid analysis and proper tx |
|
|
Term
| White to clear gelatinous infiltrate: gorilla sneezed into pericardium around heart. What does this describe? |
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Definition
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|
Term
| Global ST seg elevation is present in what complication of pneumonia? |
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Definition
|
|
Term
| What is pleural effusion? |
|
Definition
| fluid build up in the lung space |
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|
Term
| What complication of pneumonia decreases your v/q (ventilation to profusion) ratio? |
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Definition
|
|
Term
| What is key to know underlying cause of plueral effusion? Which pneumonias cause this? |
|
Definition
| hx and recent illness known are key. all pneumonia's can cause a pleural effusion. |
|
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Term
| If pleural effusion is quite large or pt is symptomatic (moderate to severe breathing difficulty), what might pt require? What are you analyzing for? |
|
Definition
| thoracentesis or thoracotom/scope. fluid can be analyzed for infection, neoplasms, cells. |
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|
Term
| What are 4 complications of pneumonia? |
|
Definition
| pleural effusion. endobronchial obstruction. empyema. pericarditis. |
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