Epidemiology and Clinical features of CAP
Differentiate community aquired pneumonia from Nosocomial pneumonia
Community aquired= acquired outside of the hospital setting
Hospital aquired= Pneumonia that occurs > 48 hours after admission to hospital and did not appear to be developing before that time. A subtype is ventilator-associated pneumonia, which occurs 48–72 hours following endotracheal intubation.
Name 4 auscultation findings in typical community-acquired pneumonia
Previously healthy patients without comorbidities or risk factors for resistant pathogens should be started on monotherapy with one of ? (three options)
Amoxicillin
Doxycycline
A Macrolide: Azithromycin or Clarithromycin
Hypoventilation causes _____________ acidosis, and explain why
Respiratory acidosis
Three clinical features of community aquired typical pneumonia include...?
What are malaise, fever, and productive cough
What are two Chest X-ray findings indicative of Lobar pneumonia?
1. Opacity of one or more pulmonary lobes
1. Presence of air bronchograms:appearance of translucent bronchi inside opaque areas of alveolar consolidation
A concern/consideration when administering a macrolide for pneumonia is.....
Pneumoccocal resistance; should only be given in areas with resistance <25%
The compensation for respiratory acidosis is _____________
Renal retention of base and excretion of hydrogen ions
Community aquired pneumonia is more common in 5 groups of people including.....?
1. Individuals with chronic disease
2. Immunosuppressed
3. Smokers
4. Elderly
5. Those with impaired airwar protection (stroke, seizure, alcoholics, dysphagia)
What are two chest X-ray findings indicative of bronchopneumonia?
Patients with comorbidities or risk factors for resistant pathogens should be treated with combination therapy with which two medications?
Hyperventilation causes ___________; the compensation is _______________
Respiratory alkalosis; the compensation for respiratory alkalosis is renal excretion of base and retention of hydrogen ions
The four most common pathogen causes of community-acquired pneumonia are the bacteria:
1. Streptococcus pneumoniae
2. Haemophilus influenzae
3. Klebsiella pneumoniae
4. Staphylococcus Aureus
Pneumonia may present with _____(type of respiration rate) and ______ chest pain
Tachypnea and pleuritic
Alternatively, patients with comorbidities or risk factors for resistant pathogens can be treated with monotherapy with?
A respiratory fluoroquinolone
Metabolic acidosis is caused by ingestion, infusion, overproduction, or decreased renal excretion of __________ or ________. The compensation is _______________
Hydrogen ions, or loss of bicarbonate ions
The compensation for metabolic acidosis is increased alveolar ventilation.
Streptococcus pneumoniae primarily causes pneumonia in which two locations
Lobar pneumonia- affecting one lobe of a lung
Bronchopneumonia- Bronchioles and adjacent alveoli
Describe the pathogenesis of pneumococcal pneumonia
Bacterial invasion of the lung parenchyma causes the alveoli to be filled with an inflammatory exudate, thus causing consolidation (“solidification”) of the pulmonary tissue.
What is the typical duration of treatment with antibiotics for pneumonia?
5-7 days
Name and explain 4 causes of tissue hypoxia
Low Alveolar PO2
Diffusion impairment
Right-to-left shunts
Ventilation-perfusion mismatch