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ICM -- Pulmonology > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

Gold standard for pneumonia diagnosis

A

CXR

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2
Q

Common symptoms of pneumonia

A

Fever/Chills
Dyspnea
Purulent Sputum
CXR signs

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3
Q

Three classifications of pneumonia (as per dr. islam)

A

Major Immunodeficiency
Tuberculosis
Relatively normal hosts w/out active TB

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4
Q

Four types of pneumonia seen in non TB, IC patients

A

HAP
VAP
HCAP
CAP

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5
Q

Criteria for hospital acquired pneumonia

A

48+ hours following admission

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6
Q

Criteria for VAP

A

48 hours following endotracheal intubation

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7
Q

Criteria for HCAP

A

Long term care facility
Dialysis
Outpatient Chemo
Health Care Worker

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8
Q

Criteria for CAP

A

Outside hospital or extended care facility

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9
Q

Suspect TB and isolate with two+ of the following symptoms…

A

Hempptysis
Cough more than 2 weeks
Night sweats
More than 10 lbs lost in 10 months

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10
Q

If suspecious CXR for TB, what do you do?

A

Order AFB smears

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11
Q

How to determine if a pneumonia patient should be hospitalized?

A

CURB 65. Hospitalize with a score of 2+

Confusion, Urea, RR, BP, 65

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12
Q

A SMART COP score of ___ indicated need for respiratory (probs ventilator) support

A

3 or more

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13
Q

A higher PIRO score indicates that a patient will require…

A

A longer ICU stay and more mechanical ventillation days

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14
Q

Two major indicators for ICU admission/Severe CAP

A

Invasive mechanical ventilation

Septic shock with the need for vasopressors

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15
Q

Three minor indicators for ICU admission/Severe CAP

A

BP over 90
PaO2/FiO2 under 250
Multilobar Disease

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16
Q

Risk factors for severe pneumonia

A 
Alcoholism
COPD
Immunosuppression
Heart Disease
Institutionalization
Over 70 yo
Inhaler/PPI use
17
Q

Important physical exam findings in pneumonia

A

Irregular vitals + Confusion

High RR over 30, Low BP, Pulse over 125, irregular temp

18
Q

Three mechanisms by which bacteria reaches the lungs

A

Inhalation
Aspiration
Hematogenous

19
Q

If a pneumonia is bad enough to send a patient to the ICU, what bonus tests should you run

A

Legionella and pneumococcal UAT

20
Q

Six ost common causes of bacterial pneumonia

A 
S pneumo
H influenzae
Chlamydia pneumo
Myco pneumo
Legionella
S aureus
21
Q

Criterion for a good sputum sample

A

under 10 squamous cells
over 25 WBC
Low Powered Field

22
Q

What should you look for to IS a lingular pneumonia?

A

Obscuration of the cardiac apex

23
Q

Effect of bacterial and viral pneumonia on procalcitonin levels?

A

Bacterial – Rises

Viral – Lowers via IFN-g

24
Q

Practical use for watching the PCT levels?

A

Use to assess duration of antibiotic therapy

25
Q

Consider ABs with a PCT above…

A

0.25 ug/L

26
Q

Who needs a follow up Chest X ray in 4-6 weeks

A

Everyone over 40

All Smokers, Former Smokers

27
Q

General guidelines for antibiotic management of CAP

A

Give empiric treatment within 4-8 hours

28
Q

Increased risk of pseudomonas with …

A

structural lung disease (bronchiectasis)
Corticosteroid Therapy
Broad spectrum AB activity for a week in the past month
Malnutrition

29
Q

Drug treatment for an overall healthy outpatient with no ABs in the past 3 months…

A

Macrolide OR Doxy

30
Q

Drug treatment for outpatient patient with cardiopulmonary disease, beta-lactam reaction in past 3 mos, alcoholism, immunosuppressive rx, or day care exposure

A

Respiratory Quinalone
OR
beta-lactam AND macrolide/doxy

31
Q

How long should an outpatient pneumonia patient be on antibiotics

A

5-7 days

32
Q

Rx for inpt. CAP

A

Resp. Quinolone
OR
(Ceftriaxone/Ceftazimide) + Azithro/Doxy

33
Q

ICU treatment for CAP

A

(Ceftriaxone/Ceftazimide) + Azithro/Respiratory Quinalone

34
Q

How to treat suspected aspiration pneumonia

A

Unasyn/Zosyn
Augmentin/Clindamycin
Respiratory Quinalone

35
Q

Important considerations if CAP pneumonia treatment isn’t effective

A

Bronchoscopy
Further Diagnostic Testing
Escalation/Change of Therapy

36
Q

When can you switch from IV to PO

A

Improved cough, dyspnea
Afrbrile on two occasions 8 hrs apart
Decreasing WBC count
Fxnal GI tract

37
Q

Criteria for discharge..

In the past 24 hours, no more than one of…

A

Fever, Tachycardia, tachypnea (over 24)
Drop in BP, O2 Sat
Can’t maintain oral intake
Altered Mental Status

38
Q

Which risk stratification determines outpatient vs inpatient

A

CURB 65

39
Q

Treatment for HCAP

A

Vancomycin

ICM -- Pulmonology (9 decks)

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