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SALMAN HARRISON'S > 121 - Pneumonia > Flashcards

121 - Pneumonia Flashcards

1
Q

Pneumonia is an __ of the lung’s __

A

inflammation

parenchyma

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2
Q

Pneumocystis pneumonia and viral pneumonia usually involve the __ and are not __

A

alveoli

interstitium

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3
Q

What are the 4 categories of pneumonia?

A

CAP- community acquired pneumonia
HAP- hospital acquired pneumonia
VAP- ventilator acquired pneumonia
MDR-multidrug resistant pneumonia

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4
Q

What is the most common CAP pathogen?

A

Streptococcus pneumoniae

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5
Q

What are the typical CAP pathogens? 5

A 
S. pneumoniae
H. influenza
S. aureus
Klebsiella pneumoniae
Pseudomonas aeruginosa
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6
Q

What are the atypical CAP pathogens? 4

A

Chlamydia pneumoniae
Mycoplasma pneumoniae
Legionella
Viruses (Influenza/adenovirus/human metapneumovirus/RSV)

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7
Q

10-15% of CAP are __ combining both __ and __ pathogens

A

polymicrobial
typical
atypical

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8
Q

__ pathogens tend to complicate and form __, __, and __

A

anaerobic
abscess
empyema
parapneumonic effusions

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9
Q

Alcoholism typically cause CAP due to __, __, __, __

A

strep pneumoniae
oral anaerobes
Klebsiella pneumoniae
acinetobacter

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10
Q

COPD/smoking typically cause CAP due to __, __, __, __

A

H. influenza
pseudomonas
legionella
strep pneumoniae

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11
Q

Dementia/stroke typically cause CAP due to __, __

A

oral anaerobes

G (-) enteric bacteria

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12
Q

Lung abscess typically cause CAP due to __, __, __, __

A

CA-MRSA
oral anaerobes
tuberculosis
atypical bacteria

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13
Q

Travel to southeast Asia may cause CAP due to __, __

A

Hantavirus

coccidioides app

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14
Q

When on a cruise sheep or in an hotel for > 2 weeks, CAP may develop, usually due to __

A

legionella

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15
Q

Exposure to birds/bats may cause CAP due to __, __

A

H capsulatum

Chlamydia psittaci

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16
Q

Exposure to goats/cats may cause CAP due to __, __

A

coxiella burnetii (Q fever)

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17
Q

__% of CAP patients get ___ again within a __ from release

A

18
readmitted
month

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18
Q

Mention 5 RF for CAP

A 
alcoholism
asthma
immunosuppression
hospitalization
age >=70
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19
Q

What are the RF for pneumococcal pneumonia? 6

A 
dementia
seizures
HF
COPD/smoking
alcoholism
HIV
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20
Q

RF for legionella include 7

A 
diabetes
malignancy
RF
HIV
smoking
male
cruise/hotel
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21
Q

Pneumatoceles = __

A

intrapulmonary gas-filled cystic spaces

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22
Q

Pneumatoceles suggest __ infection

A

S. aureus

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23
Q

Cavitary lesion in the upper lobe suggest __ infection

A

Tuberculosis

24
Q

What are the 6 ways in which we can diagnose the etiology of CAP?

A 
G stain + phlegm culture
blood culture
urine antigen
PCR
serology 
biomarkers /
25
Q

Urine antigen allows to look for __ and __.

A

pneumococcus

legionella

26
Q

The typical biomarkers used for pneumonia diagnosis are __ and __

A

CRP

procalcitonin

27
Q

Procalcitonin is used to differentiate between __ and __ infection

A

viral

bacterial

28
Q

What are the two criteria scales we use to decide if a CAP patients should be hospitalized or not?

A

PSI (pneumonia severity index)

CRUB 65

29
Q

CRUB 65= __

A 
Confusion
RR >= 30/min
Urea> 7mmol/L
BP (systolic <= 90 mmHg, diastolic <= 60 mmHg)
65 <= age
30
Q

CURB= 0: __
CURB= 1-2: __
CURB> 3: __

A

outpatient, mortality 1.5% within 30 days
hospitalization, beside if age is the only positive
ICU, mortality of 22%

31
Q

Regardless of PSI and CURB 65, if the patient has __ or __, than __ is indicated.

A

septic shock
respiratory failure
ICU

32
Q

The main RF for antibiotic resistant pneumococcal infection is using ___ in the last __ months

A

specific Abx

3

33
Q

For severe CAP __ reduce mortality

A

macrolides

34
Q

CAP + ICU = __ against __, __ such as __+__

A

wide spectrum Abx
pneumococcal and atypical
azithromycin
ceftriaxone

35
Q

If the pathogen is immune to macrolides, use __. If that does not work- use __/ __+__

A

doxycycline
fluoroquinolone
beta lactam + macrolide

36
Q

__is better than ceftriaxone for empiric treatment for CAP

A

ceftaroline

37
Q

For pneumococcal pneumonia use __ + __/__

A

beta lactam (ceftriaxone)
macrolide (azithromycin/clarithromycin)
quinolone

38
Q

When a CAP patient is stable- use __ __. If the pneumonia is uncomplicated, treat for __ days

A

oral
fluoroquinolone
5

39
Q

What are the correct supportive care treatment for pneumonia? What will you add in severe CAP

A 
hydration
oxygen
vasopressors
ventilation
prednisone
40
Q

If CAP patients do not respond to treatment within the first _ days, we can call it __ and should __

A

3
treatment failure
reevaluate

41
Q

In aspiration pneumonia __ should be added if __ is found

A

clindamycin

abscess

42
Q

The imaging typical for pneumonia may endure for - weeks

A

4-12

43
Q

Primary prevention of pneumonia is with __

A

PCV13 (Prevenar)

44
Q

CAP treated in the community should be given __ or __ if the patient is otherwise healthy and did not use Abx in the last __ months

A

macrolide
doxycycline
3

45
Q

CAP treated in the community should be given __ or __ or __ if the patient is has comorbidities / used Abx in the last __ months

A 
fluoroquinolone (moxifloxacin/gemifloxacin/levofloxacin)
beta lactam (amoxicillin/ augmentin)
ceftriaxone, cefuroxime + macrolide/doxycycline
46
Q

CAP patients requiring hospitalization should be treated with __ or __+__

A

fluoroquinolone (moxifloxacin/gemifloxacin/levofloxacin)
beta lactam (ceftriaxone/ampicillin/ertapenem)
macrolide

47
Q

CAP patients requiring ICU should be treated with __ + __or__

A

beta lactam (ceftriaxone/ampicillin/ertapenem)
azithromycin
fluoroquinolone (moxifloxacin/gemifloxacin/levofloxacin)

48
Q

If we suspect CAP due to pseudomonas treat with __+__

A 
beta lactam (piperacillin/cefepime/tazobactam/meropenem/imipenem)
fluoroquinolone (ciprofloxacin/levofloxacin)
49
Q

If we suspect CAP due to CA-MRSA treat with __ or __ +__

A

vancomycin
linezolid
clindamycin

50
Q

The main RF for VAP is __

A

endotracheal tube

51
Q

In VAP, the more __ the sample is, the ,more __ it is. Other factors that can increase diagnosis are: 4

A 
distal
specific
G stain
CBC
intracellular stain
local proteins
52
Q

Empirical Abx treatment for HAP/VAP patients with no RF for resistant G (-) pathogens includes: __/__/__

A

piperacillin
cefepime
levofloxacin

53
Q

Empirical Abx treatment for HAP/VAP patients with resistant G (-) pathogens includes: 5 + 4

A

piperacillin/cefepime/ceftazidime/imipenem/meropenem

amikacin/gentamicin/ciprofloxacin/levofloxacin

54
Q

If VAP/HAP patient has a risk factor for MRSA add __/__

A

linezolid

vancomycin adjusted dose

55
Q

In VAP/HAP patients, treatment course of - days has the same effectiveness of _ weeks course, while leading to less resistant strains

A

7-8

2

56
Q

The best way to avoid VAP is to avoid placing __. Other ways include: 3

A 
endotracheal tube
short term Abx prophylaxis
raising the head of the bed to 30 degrees
preventing gastric pH increase
hygiene

SALMAN HARRISON'S (163 decks)

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