Snapshot A 77-year-old man is brought in by EMS after waking up in the middle of the night covered in sweat, with a high fever, and a coughing up yellow sputum. A chest xray is shown. Introduction Definition infection of lung parenchyma that usually occurs in defined lobar patterns, though may also present more diffusely Clinically defined as fever, cough and new infiltrate on CXR Pathophysiology See Microbiology of Pneumonia topic Risk factors impaired cough reflex damage to respiratory cilia mucus plugs Classification Classic patterns include lobar intra-alveolar exudate which consolidates may involve entire lung or be confined to 1 lobe 4 stages brochopnuemonia acute inflammatory infiltrates from bronchioles into adjacent alveoli patchy distribution involves ≥ 1 lobes interstitial diffuse patchy inflammation localized to interstitial areas of alveolar walls distribution involving ≥ 1 lobes generally less severe than lobar or bronchopneumonia Presentation Symptoms classically presents with sudden-onset of fever productive cough purulent yellow-green hemoptysis dyspnea night sweats pleuritic chest pain atypical presentations are gradual in onset and flu-like dry cough headaches myalgias sore throat Physical exam auscultation of the lungs reveals decreased or bronchial breath sounds crackles/rales wheezing E-to-A egophany with consolidation percussion reveals dullness over affected lobe(s) tactile fremitus increased with consolidation decreased with pleural effusion Evaluation CXR may show lung opacification/consolidation in affected lobe(s) establishes diagnosis in combination with Gram stain or culture CBC elevated WBC count Sputum Gram stain and cultures identify pathogen directs antimicrobial therapy Treatment Pharmacologic empiric antibiotics directed at most likely pathogens (depends on clinical scenario) organism-specific antibiotics if organism identified
QUESTIONS 1 of 4 1 2 3 4 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.PL.15.24) Myeloperoxidase (MPO) is a heme-containing molecule that is found in the azurophilic granules of neutrophils. Upon release, the enzyme catalyzes hypochlorous acid production during the phagocytic response. In the setting of pneumonia, which of the following is the end result and clinical significance of this reaction? QID: 100827 Type & Select Correct Answer 1 Green color of sputum 52% (33/64) 2 Cough 2% (1/64) 3 Rust-tinged sputum 34% (22/64) 4 Fever 3% (2/64) 5 Shortness of breath 8% (5/64) M 1 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic (M1.PL.13.37) A 21-year-old college student with a history of hypertrophic cardiomyopathy and a systolic murmur heard best at the left sternal border presents to the emergency room with a temperature of 102.3 F, worsening shortness of breath, chest pain and productive cough. He states that two days ago upon returning from Spring Break in Australia he drank a significant amount of alcohol and had an episode of vomiting. He recalls little about the evening. His electrocardiogram displays a regular sinus rhythm and his chest radiograph is shown in Figure A. Which of the following is the most likely etiology of his illness? QID: 100102 FIGURES: A Type & Select Correct Answer 1 Long distance travel 14% (10/73) 2 Impaired cough reflex 45% (33/73) 3 Hypertrophic cardiomyopathy 8% (6/73) 4 Valvular disease 11% (8/73) 5 Close living quarters 19% (14/73) M 2 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (M1.PL.13.136) A 48-year-old male dies in the intensive care unit following a severe Streptococcus pneumonia pneumonia and septic shock. Autopsy of the lung reveals a red, firm left lower lobe. What would you most likely find on microscopic examination of the lung specimen? QID: 100939 Type & Select Correct Answer 1 Eosinophilia in the alveolar septa 4% (6/154) 2 Vascular dilation and noncaseating granulomas 8% (12/154) 3 Fragmented erythrocytes 6% (10/154) 4 Alveolar exudate containing neutrophils, erythrocytes, and fibrin 76% (117/154) 5 Collagen whorls 2% (3/154) M 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic
All Videos (2) Login to View Community Videos Login to View Community Videos Egophony Thomas Heineman Respiratory - Pneumonia E 3/2/2015 65 views 3.0 (1) Login to View Community Videos Login to View Community Videos Pneumonia Chris Battista Respiratory - Pneumonia E 3/27/2013 104 views 0.0 (0)