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RC Test 4 > B4.075 Lower Airway Infection > Flashcards

B4.075 Lower Airway Infection Flashcards

1
Q

features of acute bronchitis

A 
cough (may be purulent)
not usually associated with changes in vitals
self limiting
usually viral
no or symptomatic treatment
antibiotics not indicated
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2
Q

what distinguishes pneumonia from acute bronchitis

A

similar symptoms BUT
associated with changes in vitals and/or end organ function
changes on CXR
alveoli involvement

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3
Q

definition of pneumonia

A

inflammation of lung parenchyma caused by bacteria, virus, or fungi which is characterized by intra-alveolar exudation

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4
Q

route of entry of pneumonia causing pathogens

A

aspiration
inhalation
bloodborne

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5
Q

what causes a tip in host/organism dynamic resulting in symptoms of pneumonia

A

defect in host defenses
virulent organisms
overwhelming inoculum

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6
Q

mechanical and structural defenses

A 
nose
cough/gag
airway branching
mucociliary clearance
normal oropharengeal flora (acidic)
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7
Q

cellular defenses

A

macrophages
epithelial cells
neutrophils

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8
Q

humoral/molecular defenses

A

IgG, IgA
cytokines
colony stimulating factors

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9
Q

discuss the progression of pneumonia

A

edema: presence of proteinaceous exudates and often bacteria in small airways and alveoli
inflammatory debris: erythrocytes, neutrophils, fibrin
resolution: macrophages predominate, inflamm debris cleared

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10
Q

pattern of bronchopneumonia

A

alveoli filled with exudate or purulent organisms

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11
Q

pattern of interstitial pneumonia

A

involved interstitium, alveolar walls, and connective tissue

alveoli not fully filled

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12
Q

pattern of military pneumonia

A

numerous discrete lesion of hematogenous spread

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13
Q

pneumonia symptoms seen during clinical evaluation

A 
cough
fever
pleuritic chest pain
dyspnea
sputum production
rapid onset of symptoms
GI symptoms
altered mental status
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14
Q

what is one of the first systemic organs affected in pneumonia?

A

kidneys

sometimes see renal failure

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15
Q

vitals associated with pneumonia

A

fever
tachypnea
tachycardia
hypotension

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16
Q

lab findings w pneumonia

A

leukocytosis

left shift

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17
Q

lung findings w pneumonia

A

crackles

egophany

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18
Q

specific testing done when called for

A 
sputum culture
blood culture
urinary antigens
resp viruses
PCR
procalcitonin
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19
Q

what organisms are identified by PCR

A

chlamydia pneumonia

mycoplasma pneumonia

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20
Q

what organisms are identified by urinary antigens

A

strep pneumo

legionella

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21
Q

why is alcohol abuse a indication for extensive testing

A

weakened defense systems

high risk for systemic involvement

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22
Q

indications for most extensive diagnostic testing

A

ICU admission
alcohol abuse
pleural effusion

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23
Q

which test is particularly important in diagnosing pneumonia in a patient w severe chronic lung disease

A

sputum culture

works better in these patients than other

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24
Q

common outpatient pneumonia

A 
step pneumo
mycoplasma pneumo
h. flu
chlamydia pneumo
resp viruses
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25
Q

common non ICU inpatient pneumonias

A 
strep pneumo
mycoplasma pneumo
chlamydia pneumo
h. flu
legionella
aspiration
resp viruses
26
Q

common ICU pneumonias

A 
strep pneumo
staph aureus
legionella
gram neg bacilli
h. flu
27
Q

distinct pathogens in alcoholism

A

oral anaerobes

klebsiella

28
Q

distinct pathogens in COPD and/or smoking

A

pseudomonas

moraxella

29
Q

distinct pathogens with lung abscesses

A

CA-MRSA

30
Q

pathogens associated with early HIV infection

A

similar to non-HIV population
strep pneumo
h flu

31
Q

pathogens associated with hotel or cruise stay

A

legionella

32
Q

pathogens associated with late HIV infection

A

opportunistic
multiple fungi
pseudomonas
h flu

33
Q

pathogen associated with whooping cough

A

bordetella pertussis

34
Q

distinct pathogens with structural lung disease (bronchiectasis)

A

pseudomonas
burkholderia cepacia
staph aureus
(drug resistant)

35
Q

2 main risk stratification tools

A

PORT Score/PSI

CURB65

36
Q

how does the PORT score work

A

if you have any severe indications listed in step 1, move to step 2
step 2 lists demographics, comorbidities, exam findings, lab/radiograph findings and calculates a score

37
Q

CURB65

A 
confusion
BUN >7
resp > 30
SBP <90, DBP  <60
age > 65
38
Q

curb score 2

A

admit

39
Q

curb score 3-5

A

consider ICU

40
Q

HCAP

A

health care associated pneumonia
“at risk” for MDR pathogens
nursing home, dialysis, infusion center
hospitalization in previous 90 days

41
Q

HAP/VAP

A

high risk for MDR pathogens
occurs 48 hours after admission
VAP- 48 hours after intubation

42
Q

risk factors for MDR VAP

A 
prior IV antibiotic use within 90 d
septic shock
ARDS precedingVAP
5 or more days of hospitalization
acute renal replacement therapy
43
Q

risk factors for MDR HAP

A

prior IV antibiotic use within 90 d

44
Q

recommended antibiotics for outpatient CAP

A
  1. previously healthy and no use of antimicrobials within 3 months: macrolide
  2. presence of comorbidities: fluoroquinolone OR B lactam + macrolide
45
Q

recommended antibiotics for non ICU inpatient CAP

A

fluoroquinolone OR B lactam + macrolide

46
Q

recommended antibiotics for ICU CAP

A

B lactam (ceftriaxone) + azithromycin OR fluoroquinolone

47
Q

what organisms are covered in VAP recommended treatment

A

MRSA and double antipseudomonal/gram neg coverage

48
Q

recommended antibiotics for VAP

A

A. gram + antibiotics with MRSA activity: vancomycin OR linezolid
B. gram neg antibiotics with antipseudomonal activity (B lactam based): piperacillin/tazobactam OR cephalosporin OR carbapenem OR monobactams
C. gram nep antibiotic with antipseudomonal activity (non B lactam based): fluoroquinolone OR aminoglycoside OR polymixin

49
Q

most common treatment for VAP

A

vanc + piperacillin/tazobactam + ciprofloxacin
duration 7-14 days
de-escalate with culture results

50
Q

adjunctive management with pneumonia

A

assess for pleural effusion
biomarkers
steroids
vaccination/prevention

51
Q

uncomplicated parapneumonic effusion

A

can result from inflammation without infected fluid

52
Q

complicated parapneumonic effusion

A

fluid resulting from infected pleural space
has to be drained completely
antibiotics poorly penetrate the space

53
Q

which imaging modalities are most sensitive for pleural effusion

A

ultrasound

CT

54
Q

what procalcitonin

A

a peptide precursor of calcitonin that is released by parenchymal cells in response to bacterial toxins

55
Q

why is procalcitonin evaluated

A

differentiates infectious from noninfectious pneumonia

determines when to stop antibiotics

56
Q

why are steroids potentially beneficial in pneumonia

A

counteract inflammatory response in CAP that is the source of much of the end organ damahe
numerous adverse effects as well, however

57
Q

who would benefit more from steroids?

A

sicker patients

58
Q

pneumococcal vaccine recommendations

A

all persons >65
high risk persons 2-64 years of age
current smokers

59
Q

flu vaccine recommendations

A

all persons > 50

all persons over 6 mo without a contra-indication

60
Q

what are pneumococcal vaccines aimed at

A

aimed at capsule of bacteria

RC Test 4 (22 decks)

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