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Pulmonology Exam 2 latest update
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Pulmonology Exam 2 Pulmonology Exam 2 Pulmonology Exam 2
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Pulmonology Exam 2How many cases of pneumonia occur annually in the US? - More than 3 million cases
- 20% result in hospitalization
- Approximately 25% of pts in ICU develop pneumonia
During which months is pneumonia more prevalent? - Winter months
What is the overall mortality rate of untreated pneumonia? - More than 30%
- 40,000-70,000 die each year
What is considered the most lethal hospital-acquired infection? - Pneumonia
What is pneumonia? - Inflammation of the alveoli or interstitium of the lungs caused by
microorganisms that infect the lower respiratory tract
Has a predilection for extremes of ages
What is pneumonitis? - A general term for the inflammatory process in the lung tissue that may
predispose an individual for the risk of infection
What are the types of pneumonia? - Bacterial
- Community acquired (in community and up to 2 days in hospital)
- Hospital acquired (>2 days in hospital)
Viral pneumonia
Fungal pneumonia
Aspiration pneumonia
- Either bacteria or chemical pneumonitis
,What are the routes of entry for pathogens in pneumonia? - Inhalation of airborne pathogens
- Microorganisms released into air via cough, sneeze, talking
Aspiration
Spread from other infected sites (hematogenous spread-- IV drug users))
Underlying conditions like mucociliary disease processes (CF, bronchiectasis, malignancy)
Immunocompromised states (HIV, DM, CKD)
What are some common typical bacterial etiologies of CAP? - Streptococcus pneumoniae -- m/c
Haemophilus influenzae
Moraxella catarrhalis
Staph aureus
Klebsiella pneumoniae
**Bacterial causes are more common in adults**
Name some atypical etiologies of CAP - Legionella pneumoniae
Mycoplasma pneumoniae -- m/c
Chlamydia pneumoniae
Which viruses can cause CAP? - Influenza
SARS CoV-2
RSV
Adenovirus
Parainfluenza virus
**Viral causes are more common in children**
,What is the most common etiology of pneumonia in children/infants? - VIRAL infections such as RSV,
adenovirus, parainfluenza virus, Influenza A & B, and viral exanthems (varicella, measles, rubella)
Parasitic and fungal cases are also seen in adults and children
What are some predisposing factors for pneumonia? - Viral infections
Decreased consciousness (can't protect airway)
- Chronic ETOH
- Aspiration (~45% of healthy subjects aspirate during sleep --> the oropharynx of hospitalized pts
may become colonized with aerobic gram negative bacteria (gram negative bacilli)
Smoking
Heart failure
COPD
Age extremes
Immunosuppression
Malnutrition
Mucociliary compromise/ciliary dyskinsa
Anatomic deformities (kyphoscoliosis)
What is the most likely pathogen associated with ETOH abuse and DM? What are the clinical
manifestations associated? - Klebsiella pneumonia
Clinical manifestations: Currant jelly sputum
**Think: Clebsiella = Chronic alcohol, Currant jelly**
What is the most likely pathogen associated with COPD? - Haemophilus pneumoniae
**Think Ham = Pig = Cop= COPD??? lolol**
, What is the most likely pathogen associated with cystic fibrosis/bronchiectasis? - Pseudomonas
What is the most likely pathogen associated with young adults, college dorm setting (close
quarters)? What are clinical manifestations associated? - Mycoplasma pneumoniae
Chlamydia pneumoniae
Clinical manifestations:
- Sore throat, hoarseness, low grade fever, bullous myringitis
- Chlamydia prodromal sxs may be >2 weeks
What is the most likely pathogen associated with air conditioning/ water source? What are clinical
manifestations associated? - Legionella pnuemoniae
Clinical manifestations:
- HYPONATREMIA
- GI symptoms
What is the most likely pathogen associated with leukemia/lymphoma? - Fungal
What is a common cause of pneumonia in children under 2 years old? - Respiratory syncytial virus
Parainfluenza virus
What is the most likely pathogen associated with HIV? What are the clinical manifestations
associated? - Streptococcus
PJP is the opportunistic infection
Clinical manifestations:
- Increased LDH
- Hypoxemia
- CD4 <200
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