319.2 🩺 國考版

319.2.1 高頻考點

319.2.1.1 Aspiration Pneumonia

  • Risk factors: stroke, dementia, intoxication, seizure, anesthesia
  • Dependent lobes (RLL > LLL supine; RUL right side down)
  • Polymicrobial (anaerobes + aerobes)
  • Mendelson syndrome (acid; no routine abx)

319.2.1.2 Treatment

  • Amoxicillin-clavulanate (outpatient)
  • Pip-tazo / ampicillin-sulbactam (inpatient)
  • Clindamycin alternative (penicillin allergy)
  • Duration: 7-14 days CAP; 4-6 weeks abscess

319.2.1.3 Lung Abscess

  • Cavity > 2 cm + air-fluid level + communication with airway
  • Most common: aspiration + anaerobes
  • Septic pulmonary embolism: S. aureus (endocarditis, IVDU)
  • Necrotizing pneumonia: Klebsiella, S. aureus, Acinetobacter

319.2.1.4 Aspiration Lobe Distribution

  • Supine: RLL, RUL (posterior), LUL (superior)
  • Right side down: RUL
  • Left side down: LUL (posterior), lingula

319.2.1.5 Specific Pathogens

  • Klebsiella: alcoholic, currant jelly, upper lobe cavity
  • S. aureus: post-flu, IVDU, septic embolism
  • Anaerobes: foul sputum, alcoholic, aspiration

319.2.1.6 Treatment Duration

  • CAP: 5-7 days
  • HAP/VAP: 7 days
  • Aspiration pneumonia: 7-14 days
  • Lung abscess: 4-6 weeks
  • Septic embolism: until source resolved (e.g., endocarditis 4-6 weeks)

319.2.1.7 Prevention

  • SLP evaluation
  • Thickened liquids
  • HOB ≥ 30°
  • Oral hygiene
  • Stroke care bundle

319.2.2 易混淆比范

Type Onset Bacteria Treatment
Mendelson syndrome Acute (minutes) Initially sterile Supportive; no routine abx
Aspiration pneumonia Subacute (days) Polymicrobial Amox-clav / pip-tazo, 7-14 d
Lung abscess Insidious (weeks) Anaerobes ± aerobes 4-6 wk antibiotics
Septic pulmonary embolism Variable S. aureus Source control + abx

319.2.3 Special Topics

319.2.3.1 Septic Pulmonary Embolism

  • Right-sided endocarditis (tricuspid valve)
  • IVDU
  • Indwelling catheters
  • Bilateral, peripheral, often cavitating
  • Treatment: vancomycin + source control

319.2.3.2 Cricopharyngeal Dysfunction

  • Reduced relaxation of upper esophageal sphincter
  • Dysphagia, aspiration
  • Zenker diverticulum
  • Botulinum injection or myotomy