PNA/Influenza

Question 1

Pneumonia definition + main types

Answer 1

• infection of the lung parenchyma
• community acquired pneumonia (CAP) = infection outside of health-care system
• health-care associated pneumonia (HCAP) = infections relating to health-care system
  
  • hospital-acquired
  • ventilator associated

Question 2

Pathogenesis of Pneumonia

Answer 2

• **inhalation of infectious particles ==> CAP
• inhalation of oropharyngeal/gastric contents
• hematogenous spread
• infectious from adjacent structures
• direct inoculation
• reactivation

Question 3

Pneumonia symptoms

Answer 3

• fever, chills
• pleuritic chest pain
• dyspnea
• cough
  
  • productive ==> bacterial
  • non-productive ==> viral/atypical
• anorexia, nausea, vomiting, diarrhea
• mental status changes

Question 4

Pneumonia signs

Answer 4

• tachypnea
• tachycardia
• lungs ==> crackles, rhonchi
  
  • egophany
  • dullness to percussion
• bronchial breath sounds

Question 5

Historical features ==> infectious differential diagnosis

Answer 5

• COPD ==> S. pneumo, H. influenzae, M. catarrhalis, Legionella sp.
• HIV ==> M. tuberculosis
• Postinfluenza ==> S. pneumo, S. aureus, Strep pyogenes, H. influenzae
• Aspiration ==> mixed aerobic, anaerobic

Question 6

Common radiographic reatures of pneumonia

Answer 6

• lboar consolidation
• interstitial infiltrates
• cavitation

Question 7

Differential dx of radiographic abnormalities on CXR

Answer 7

• pneumonia
• pulmonary edema
• pulmonary/diffuse alveolar hemorrhage
• pulmonary embolism
• malignancy
• drug-induced lung disease
• inflammation

Question 8

Radiographic patterns ==> infections differential dx

Answer 8

Question 9

Pneumonia Severity Index definition

Answer 9

• risk scale developed by PORT (patient outcome research team) study
• divides pts into risk classes (I ==> V) based on risk factors and helps provide indications for admission

Question 10

Tests recommended for all suspected pneumonias

Answer 10

• CXR
• CBC
• metabolic profile
• blood gas or pulse ox

Question 11

Advanced dx testing for pneumonia

Answer 11

• sputum sample + staining
  
  • gram-staining ==> gram + or - bacteria
  • acid fast stain ==> mycobacteria
• bronchoalveolar lavage or pleural fluid analysis for organisms
• sputum culture ==> tailor therapy
• blood cultures
• fiberoptic bronchoscopy
• biopsy: transbronchial or open lung

Question 12

Serologic testing in pneumonia

Answer 12

• high IgG titers in blood can indicate infection w/:
  
  • Legionella
  • Mycoplasma
  • C. pneumonia

Question 13

Molecular techniques used to dx pneumonia

Answer 13

• DNA probes detect bacteria in sputum:
  
  • Legionella
  • M. pneumoniae
  • M. tubuerculosis
• PCR assay of sputum:
  
  • atypical bacteria
  • viruss
  • mycobacteria
• procalcitonin in blood:
  
  • elevated levels indicate inflammation/bacterial infections

Question 14

Possible substances that can fill alveoli

Answer 14

• Poor Funny Boy Cant Piss For Crap

Poor - Pus

Funny - Fluid

Boy - Blood

Can’t - Cells/Cancer

Piss - Protein

For - Fat (Lipid)

Crap - Calcium

Question 15

Pneumonia DDX: airway diseases

Answer 15

• •Cryptogenic Organizing Pneumonia (COP)
• •Allergic Bronchopulmonary Aspergillosus (ABPA)
• •Bronchiectasis
• •Bronchopulmonary sequestration
• •Bronchocentric granulomatosis

Question 16

Pneumonia DDx: vascular diseases

Answer 16

•Alveolar Hemorrhage Syndromes •Eosinophilic lung diseases •Pulmonary infarction •Fat emboli •Vasculitis •Collagen Vascular Diseases •Vascular tumors •Acute chest syndrome in sickle cell crisis

Question 17

Pneumonia DDx: parenchyma diseases

Answer 17

• •Hypersensitivity pneumonitis
• •Drug reaction
• •Transfusion reaction
• •Alveolar proteinosis
• •Granulomatous lung diseases
• •Lipoid pneumonia
• •Pulmonary edema
• •Neoplasms
• •ARDS
• •Radiation pneumonitis
• •Idiopathic interstitial pneumonias

Question 18

Common causes of CAP

Answer 18

• Typical Organisms
  
  • •Streptococcus pneumoniae - 30 - 60% of CAP
  • •Haemophilus influenzae
  • •Moraxella Catarrhalis
  • •Staphylococcus aureus
  • •Group A Streptococci
  • •Anaerobes
  • •Aerobic Gram Negatives
• –Atypical Organisms - 10 - 20% of CAP
  
  • •Legionella species
  • •Mycoplasma pneumoniae
  • •Chlamydia pneumoniae

Question 19

Outpatient tx of CAP

Answer 19

–Macrolide or Doxycyline

–Respiratory Fluoroquinolone

–Beta-lactam + Macrolide

Question 20

Inpatient tx of CAP

Answer 20

• –Non - Intensive Care Unit (ICU)
  
  • •Respiratory Fluoroquinolone
  • •Beta-lactam + Macrolide
• –Intensive Care Unit (ICU)
  
  • •Beta-lactam + Macrolide
  • •Beta-lactam + Respiratory Fluoroquinolone

Question 21

Antiobiotic tx of HCAP

Answer 21

• •Antipseudomonal Agent:
  
  • •Cephalosporin
  • •Carbopenem
• •Plus 1 of the Following:
  
  • •Anti-pseudomonal Fluoroquinolone
  • •Anti-Gram Negative Aminoglycoside
• •Plus 1 Anti-MRSA Medication:
  
  • •Linezolid
  • •Vancomycin

Question 22

Common community-acquired respiratory viruses

Answer 22

• •Orthomyxovirus
• •Paramyoviruses
• •Picornaviruses
• •Enteroviruses
• •Herpes Viruses
• •Adenovirus
• •Coronavirus
• •Papilloma Virus
• •Hantavirus

Question 23

Pathogenesis of influenza

Answer 23

• •IFN Hemagglutinin surface glycoprotein binds to sialic acid residues on respiratory epithelial cell surface glycoproteins - Infection Initiation.
• • After viral replication, progeny virions are also bound to the host cell membrane.
• Neurominidase cleaves these links to liberate new virons and spread infection.

Question 24

Clinical features of influenza infection

Answer 24

• signs/sx:
  
  • fever
  • lethargy
  • runny nose, sore throagt
  • coughing, wheezing
  • anorexia, nausea, vomiting, diarrhea
• ==> primary viral pneumonia and/or secondary bacterial pneumonia

Question 25

Influenza prevention

Answer 25

• vaccines developed every year
• targeted groups:
  
  • 6-18 yo + >50yo
  • chronic care facility pts
  • adults w/chornic diseases
  • pregnant women
  • healthcare workers

Question 26

Treatment of influenza

Answer 26

• Antiviral drugs:
  
  • • Adamantanes - Active only against IFN A
  • -Amantadine and Rimantidine - Neurominidase Inhibitors - Active against IFN A and B
  • Oseltamivir and Zanamivir
• Benefits of Treatment
  
  • Can shorten duration and severity of symptoms
  • Greatest Benefit if given within the first 24 - 30 Hrs