13 Pneumonia - Boards and Beyond

Lobar

  • involves one or more lobes of lungs, ultimately entire lung

  • currant jelly sputum
  • currant jelly stool different (intussusception)

  • 2: lung becomes to look like the liver, red
  • exudates give lung red color

  • gray: everything is dying
  • 4: return to normal, regen, little scarring

Bronchopneumonia

.

  • splotches everywhere instead of 1 lobe
  • staph aureus, H. influenza, pseudomonas, moraxella, legionella

Legionella

  • atypical

Interstitial Pneumonia

  • streaky white lines in both lung fields
  • more benign
  • pts not as sick

  • atypical because not strep pneumoniae
  • RSV: most common atypical in infants
  • CMV: atypical with post transplant immunosuppression
  • Influenza: elderly
  • Coxiella: Q fever
  • PCP: HIV

Influenza

  • nonspecific symptoms
  • damage mucociliary escalator

Mycoplasma

CMV

  • clearing around dark material

RSV

  • wheezing: infect and narrow the bronchioles

  • CHD: can have life threatening disease if infected with RSV

PCP

  • dark black

Other Causes

Age

  • neonates: same bug that causes meningitis, come from mother and passed to baby

Community vs Hospital

  • clinically, don't isolate bug, treat based on symptoms
  • VAP: get while on ventilator

  • uncomplicated

  • levo usually just given because can treat all kinds of pneumonia

Aspiration

  • anaerobic bacteria normally present in oral cavity

Symptoms

  • chest pain on inhalation from stretching of pleura

  • lavage: liquid solution, collect cells in lungs

ARDS

  • same problem as pulmonary edema in HF but leaky vasculature instead of hydrostatic pressure

  • looks just white

  • set low TV and higher RR to compensate: less injury to lungs

Lung Abscesses

  • aspirate anaerobes and cause abscess

  • walled off area on imaging with fluid at bottom (pus)