Questions and Answers
Which of the following is NOT a common sign or symptom of bacterial pneumonia?
What is the most common route of exposure to pathogens causing pneumonia?
Which factor is likely to impair the clearance of secretions in patients with pneumonia?
Which organism is associated with atypical pneumonia?
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Which physical exam finding is least likely to be present in pneumonia?
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What is the purpose of performing a sputum culture in diagnosing bacterial pneumonia?
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In the CURB-65 criteria, what would a respiratory rate of 28 breaths/min indicate?
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What is the preferred empiric therapy for a healthy outpatient with bacterial pneumonia?
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Study Notes
Signs and Symptoms of Bacterial Pneumonia
- Common symptoms include fever, chills, productive cough with purulent sputum, pleuritic chest pain, dyspnea, tachypnea, and tachycardia.
- In elderly patients, symptoms can be atypical, often presenting as confusion, lethargy, or a general decline in function; fever may be absent.
Routes of Exposure to Pathogens
- The most common route is inhalation of airborne droplets.
- Aspiration of oropharyngeal or gastric contents occurs frequently in individuals with dysphagia, alcohol use, or stroke.
- Hematogenous spread, or pathogen spread through the bloodstream, is rare.
- Pathogens can also extend directly from adjacent structures, such as abscesses.
Factors Preventing Clearance of Secretions
- An impaired cough reflex, which may stem from stroke, sedatives, or neuromuscular diseases, can hinder secretion clearance.
- Excessive mucus production, such as in chronic bronchitis, contributes to retention.
- Ciliary dysfunction, often due to smoking or cystic fibrosis, impairs airflow.
- A weak immune system, particularly in the elderly or immunocompromised, affects defense mechanisms.
- Airway obstruction from tumors or foreign bodies can prevent effective clearance of secretions.
Bacteria Responsible for Atypical Pneumonia
- Common bacterial causes include Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila, Coxiella burnetii (Q fever), and Chlamydia psittaci (exposure from birds).
Physical Exam Findings in Pneumonia
- Auscultation may reveal crackles or rales over affected lung fields.
- Presence of bronchial breath sounds may be noted.
- Dullness to percussion may occur over areas of lung consolidation.
- Increased tactile fremitus indicates lung involvement.
- Egophony, characterized by E-to-A changes over consolidated areas, can be observed.
Diagnostic Studies for Bacterial Pneumonia
- Chest X-ray (CXR) may show lobar consolidation, interstitial infiltrates, or cavitation.
- Complete blood count (CBC) may indicate leukocytosis, often with a left shift.
- Sputum culture is utilized to identify the causative organism.
- Blood cultures are recommended in severe pneumonia cases or hospitalized patients.
- Pulse oximetry and arterial blood gases (ABG) assess oxygenation status.
- Urine antigen tests are available for detecting Legionella or Streptococcus pneumoniae.
Indicators for Admission (including CURB-65 Criteria)
- CURB-65 criteria include confusion, urea levels > 7 mmol/L, respiratory rate of ≥ 30 breaths/min, low blood pressure (SBP < 90 mmHg or DBP ≤ 60 mmHg), and age ≥ 65 years.
- Scoring 0-1 points suggests outpatient treatment; 2 points indicate consideration for hospitalization; scoring 3 or more warrants assessment for ICU admission.
- Additional admission indicators include multilobar pneumonia, hypoxemia, significant comorbidities, or septic shock.
Empiric Therapy for Bacterial Pneumonia
- Outpatient treatment for healthy patients typically includes amoxicillin; doxycycline or a macrolide (e.g., azithromycin) for atypical coverage.
- Outpatient treatment for patients with comorbidities may involve amoxicillin-clavulanate or cephalosporin combined with a macrolide or doxycycline, or monotherapy with a respiratory fluoroquinolone (e.g., levofloxacin).
- Inpatient treatment (non-ICU) usually includes a beta-lactam (e.g., ceftriaxone) combined with a macrolide (azithromycin) or levofloxacin.
- For patients in ICU, a beta-lactam (e.g., ceftriaxone) is combined with either a macrolide or fluoroquinolone, with additional coverage for MRSA or Pseudomonas when required.
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Description
This quiz covers the common signs and symptoms associated with bacterial pneumonia, including presentations in both general and elderly patients. It outlines key indicators such as fever, cough, and potential atypical symptoms. Test your knowledge on identifying these critical symptoms.
