Exam 3 Flashcards
(166 cards)
1
Q
community-acquired pneumonia (CAP)
A
pneumonia developed outside of the hospital or within the first 48 hours of admission
2
Q
What are three methods of pathogenesis for acquiring CAP?
A
-aspiration
-aerosolization
-bloodborne
3
Q
Which microorganism class is the most common pathogenic organism for CAP?
A
viruses
4
Q
What are common bacterial pathogens of CAP?
A
-Streptococcus pneumoniae
-Haemophilus influenzae
-Staphylococcus aureus
-Mycoplasma pneumoniae
-Chlamydia pneumoniae
-Legionella pneumophila
5
Q
What are risk factors for MRSA for CAP?
A
-2-14 days post-influenza
-previous MRSA infection
-previous hospitalization
-previous use of IV antibiotics
6
Q
What two organisms cause a gradual onset of symptoms for CAP?
A
-Mycoplasma pneumoniae
-Chlamydia pneumoniae
7
Q
What characteristics of the chest x-ray indicate bacterial origin of CAP?
A
dense lobar consolidation or infiltrates
8
Q
What characteristics of the chest x-ray indicate atypical or viral pathogens causing CAP?
A
patchy, diffuse interstitial infiltrates
9
Q
What characteristics of sputum samples can be evaluated for CAP?
A
->25 PMNs
-<10 epithelial cells
10
Q
What two major criteria alone indicate CAP?
A
-septic shock requiring vasopressors
-respiratory failure requiring mechanical ventilation
11
Q
What minor criteria indicate CAP (need at least three)?
A
-respiratory rate ≥30 rpm
-PaO2/FlO2 ≤250
-multi-lobar infiltrates
-confusion/disorientation
-uremia (BUN ≥20 mg/dL)
-leukopenia (WBC <4,000 cells/uL)
-thrombocytopenia (Plt <100,000/uL)
-hypothermia (<36ºC)
-hypotension requiring aggressive fluids
12
Q
What are supportive measures for treatment of CAP?
A
-humidified oxygen
-bronchodilators
-fluids
-chest physiotherapy
13
Q
What are the appropriate empiric therapy options for healthy outpatient CAP patients?
A
-amoxicillin OR
-doxycycline OR
-azithromycin (if macrolide resistance <25%)
14
Q
What are the appropriate empiric therapy options for outpatient CAP patients with comorbidities?
A
-respiratory fluoroquinolone OR
-beta-lactam AND macrolide OR doxycycline
15
Q
What are the recommended beta-lactams for outpatient CAP patients with comorbidities?
A
-Augmentin
-cefpodoxime
-cefuroxime
16
Q
What are the appropriate empiric therapy options for inpatient non-severe CAP patients?
A
-respiratory fluoroquinolone OR
-beta-lactam AND macrolide
17
Q
What are the recommended beta-lactams for inpatient CAP patients?
A
-Unasyn
-ceftriaxone
18
Q
What are the appropriate empiric therapy options for inpatient severe CAP patients with no MRSA/Pseudomonas aeruginosa risk factors?
A
-respiratory fluoroquinolone AND beta-lactam
-beta-lactam AND macrolide
19
Q
What drugs cover MRSA for CAP?
A
-vancomycin
-linezolid
20
Q
What drugs cover Pseudomonas aeruginosa for CAP?
A
-Zosyn
-cefepime
-meropenem
21
Q
What is the preferred target therapy of penicillin-susceptible Streptococcus pneumoniae for CAP?
A
-penicillin G
-amoxicillin
22
Q
What is the preferred target therapy of penicillin-resistant Streptococcus pneumoniae for CAP?
A
-ceftriaxone
-respiratory fluoroquinolone
23
Q
What is the preferred target therapy of Haemophilus influenzae for CAP?
A
-2nd/3rd-generation cephalosporin
-Unasyn
-Augmentin
24
Q
What is the preferred target therapy of Mycoplasma pneumoniae and Chlamydia pneumoniae for CAP?
A
-macrolide
-doxycycline
25
What is the preferred target therapy of Legionella pneumophila for CAP?
-fluoroquinolone
-azithromycin
26
What is the preferred target therapy of MSSA for CAP?
-cefazolin
-nafcillin
27
What is the preferred target therapy of anaerobes for CAP?
-beta-lactam/beta-lactamase inhibitor
-add metronidazole if using cephalosporin
28
What is the preferred target therapy of Enterobacterales for CAP?
-3rd/4th-generation cephalosporin
-carbapenem
29
What is the duration of therapy for CAP?
5 days of clinical stability
30
hospital-acquired pneumonia
pneumonia occurring ≥48 hours after hospital admission
31
ventilator-associated pneumonia
pneumonia occurring ≥48 hours after endotracheal intubation
32
What drugs cover Pseudomonas aeruginosa for HAP?
-Zosyn
-cefepime
-meropenem
-imipenem
-levofloxacin
33
What is the duration of therapy for HAP?
7 days of clinical stability
34
What are signs and symptoms of acute bronchitis?
-cough
-sore throat
-coryza
-malaise
-headache
-fever
-normal chest imaging
35
chronic bronchitis
chronic cough with productive sputum on most days for ≥3 consecutive months for 2 consecutive years
36
What are signs and symptoms of an acute exacerbation of chronic bronchitis?
-increased sputum purulence
-increased sputum volume
-increased cough or shortness of breath
37
What are common causative pathogens of acute exacerbations of chronic bronchitis?
-Streptococcus pneumoniae
-Haemophilus influenzae
-Moraxella catarrhalis
38
What are the preferred treatment options for an acute exacerbation of chronic bronchitis?
-Augmentin
-cefpodoxime
-cefuroxime
39
What are alternative treatment options for an acute exacerbation of chronic bronchitis?
-doxycycline
-Bactrim
-azithromycin
40
What antibiotic should be used for Pseudomonas aeruginosa risk in an acute exacerbation of chronic bronchitis?
levofloxacin 750 mg PO QD
41
What is the duration of therapy for an acute exacerbation of chronic bronchitis?
5 to 7 days
42
What is a common causative pathogen of acute pharyngitis?
Streptococcus pyogenes
43
What are signs and symptoms of acute pharyngitis?
-sudden onset of sore throat with dysphagia and fever
-pharyngeal hyperemia and tonsillar swelling
-enlarged, tender lymph nodes
-red, swollen uvula
-petechiae on soft palate
44
What are the preferred treatment options for acute pharyngitis?
-penicillin VK
-amoxicillin
45
What are alternative treatment options for acute pharyngitis if the patient has non-anaphylactic reactions to penicillins?
-cephalexin
-cefadroxil
-cefuroxime
-cefpodoxime
46
What are alternative treatment options for acute pharyngitis if the patient has anaphylactic reactions to penicillins?
-azithromycin
-clindamycin
47
How long may acute rhinosinusitis last?
≥ 4 weeks
48
How long may viral rhinosinusitis last?
< 10 days
49
How long may acute bacterial rhinosinusitis (ABRS) last?
≥ 10 days
50
recurrent acute rhinosinusitis
≥ 4 episodes of ABRS/year
51
chronic rhinosinusitis
≥ 2 s/s for ≥ 12 weeks
52
What are common causative pathogens of acute bacterial rhinosinusitis?
-Streptococcus pneumoniae
-Haemophilus influenzae
-Moraxella catarrhalis
53
What are major symptoms of acute bacterial rhinosinusitis?
-purulent anterior and/or posterior nasal discharge
-nasal congestion and obstruction
-facial congestion and fullness
-facial pain and pressure
-hyposmia or anosmia
-fever
54
What are minor symptoms of acute bacterial rhinosinusitis?
-headache
-ear pain, pressure, or fullness
-halitosis
-dental pain
-cough
-fatigue
55
What is the first-line treatment for acute bacterial rhinosinusitis?
Augmentin
56
What are the second-line treatment options for acute bacterial rhinosinusitis?
-doxycycline
-levofloxacin
-moxifloxacin
57
What are supportive care measures for acute bacterial rhinosinusitis?
-intranasal saline irrigation
-warm facial packs
-NSAIDs and/or acetaminophen
-hydration
58
What are characteristics of complicated UTIs?
-anatomical abnormality of urinary tract
-recent urologic procedure or instrumentation
-immunocompromised patients
-recurrent infections despite appropriate treatment
-male sex
-UTI in pregnancy
59
What is the most common causative pathogen of UTIs?
E. coli
60
What are additional signs and symptoms of pyelonephritis?
-systemic signs of infection
-flank pain
61
What are signs and symptoms of a catheter-associated UTI?
-pain over kidney and bladder
-fever
-lethargy and malaise
62
What is the microbiologic criteria for the diagnosis of cystitis?
≥10^5 of ≥1 bacterial species from a clean void
63
What is the microbiologic criteria for the diagnosis of pyelonephritis?
≥10^3 of ≥1 bacterial species from a catheter
64
What four key components of a urinalysis are related to a UTI?
-bacteria present
-WBC present (≥10 cells/hpf)
-leukocyte esterase present
-nitrite may or may not be present
65
What is a situation in which asymptomatic bacteriuria (ASB) needs to be treated?
pregnancy
66
What are commonly used agents for outpatient treatment of
only uncomplicated UTIs?
-nitrofurantoin
-fosfomycin
67
What are outpatient treatment options for UTIs?
-Bactrim
-fluoroquinolones
-beta-lactams
68
What beta-lactams can be used to treat UTIs in the outpatient setting?
-cephalexin
-cefadroxil
-cefpodoxime
-Augmentin
-amoxicillin
69
What is the duration of therapy for uncomplicated UTIs?
3 to 7 days
70
What is the duration of therapy for complicated UTIs?
7 to 14 days
71
What are common inpatient treatment options for UTIs?
-ampicillin + gentamicin
-cefazolin +/- gentamicin
-ceftriaxone
-cefepime
-gentamicin
72
What are recommended treatment options for prostatitis?
-Bactrim
-fluoroquinolones
-beta-lactams
73
What is the duration of therapy for prostatitis?
2 to 4 weeks
74
recurrent UTI
-≥3 infections in 1 year
-≥2 infections in 6 months
75
What are examples of non-purulent SSTIs?
-cellulitis
-erysipelas
76
What are signs and symptoms of non-purulent SSTIs?
-tenderness
-erythema
-swelling
-warm to touch
-orange peel-like skin
77
What are culture recommendations for non-purulent SSTIs?
blood cultures if immunocompromised, severe infection, and/or animal bites
78
What classifies an SSTI as mild?
no systemic signs of infection
79
What classifies an SSTI as moderate?
systemic signs of infection
80
What classifies an SSTI as severe?
meets SIRS criteria
81
SIRS criteria
-temperature <36ºC or >38ºC
-HR >90 bpm
-RR >20 rpm
-WBC <4 or >12
82
What are common causative pathogens of non-purulent SSTIs?
-Streptococcus spp.
-MRSA
83
What are the recommended oral treatment options for mild non-purulent SSTIs?
-penicillin VK
-cephalosporin
-clindamycin
84
What are the recommended IV treatment options for moderate non-purulent SSTIs?
-penicillin
-ceftriaxone
-cefazolin
-clindamycin
85
What are the recommended pharmacological treatment options for severe non-purulent SSTIs?
vancomycin AND Zosyn
86
What is the duration of therapy for non-purulent SSTIs?
5 days
87
What are examples of purulent SSTIs?
-abscesses
-furuncles
-carbuncles
88
abscess
collection of pus within the dermis and deeper skin tissues
89
furuncle (boil)
small abscess that forms on the hair follicle
90
carbuncle
infection involving several adjacent follicles
91
What are signs and symptoms of purulent SSTIs?
-tenderness
-red nodules
-erythema
-warm to touch
-systemic signs of infection
92
What are culture recommendations for purulent SSTIs?
wound cultures
93
What are common causative pathogens of purulent SSTIs?
-MRSA
-MSSA
-Streptococcus spp.
94
What is the treatment recommendation for mild purulent SSTIs?
incision and drainage
95
What are empiric antibiotic therapy options for moderate purulent SSTIs?
-Bactrim
-doxycycline
96
What are target antibiotic therapy options for moderate purulent SSTIs caused by MRSA?
-Bactrim
-doxycycline
97
What is the target antibiotic therapy recommendation for moderate purulent SSTIs caused by MSSA?
cephalexin
98
What are empiric antibiotic therapy options for severe purulent SSTIs?
-vancomycin
-daptomycin
-linezolid
99
What are target antibiotic therapy options for severe purulent SSTIs caused by MRSA?
-vancomycin
-daptomycin
-linezolid
100
What are target antibiotic therapy options for severe purulent SSTIs caused by MSSA?
-nafcillin
-cefazolin
-clindamycin
101
What is the duration of therapy for purulent SSTIs?
5 days
102
What are signs and symptoms of necrotizing fasciitis?
-profound systemic toxicity
-change in color of skin
-crepitus
-edema
-severe pain
103
What are culture recommendations for necrotizing fasciitis?
blood and wound
104
What imaging is needed for necrotizing fasciitis?
CT/MRI
105
What are empiric antibiotic therapy options for necrotizing fasciitis?
vancomycin AND Zosyn
106
What are target antibiotic therapy options for necrotizing fasciitis caused by Streptococcus pyogenes?
penicillin AND clindamycin
107
What are target antibiotic therapy options for polymicrobial necrotizing fasciitis?
vancomycin AND Zosyn
108
When should antibiotic therapy be stopped for necrotizing fasciitis?
-further debridement is no longer necessary
-patient has improved clinically
-afebrile for 48 to 72 hours
109
impetigo
small, painless fluid-filled vesicles that can lead to thick golden crusts
110
What is the treatment option of impetigo for few lesions?
topical mupirocin for 5 days
111
What is the treatment option of impetigo for many lesions or an outbreak?
cephalexin PO for 7 days
112
What is the drug of choice for impetigo caused by Streptococcus ONLY?
penicillin
113
What are the drugs of choice for impetigo in patients with a penicillin allergy or caused by MRSA?
-doxycycline
-clindamycin
-Bactrim
114
What are culture recommendations for animal bites?
blood cultures
115
What is the duration of therapy for preemptive bites?
3 to 5 days
116
What is the duration of therapy for an established infection due to bites?
7 to 14 days
117
What factors require preemptive treatment for bites?
-immunocompromised
-asplenia
-moderate to severe bites
-bites on face/hand
-bites that penetrate joints
118
What is the drug of choice for bites?
Augmentin
119
What are alternative drugs for bites?
2nd/3rd-generation cephalosporins AND anaerobic coverage
120
What are drug recommendations for bites in patients with beta-lactam allergies?
ciprofloxacin or levofloxacin AND anaerobic coverage OR moxifloxacin
121
What vaccines are suggested for patients with bites?
-Tdap (if necessary)
-rabies (optional)
122
What are culture recommendations for diabetic foot infections?
-wound (except mild)
-bone
-blood (for severe)
123
What are common causative pathogens of infected ulcers in diabetic foot infections?
-Staphylococcus aureus
-Streptococcus spp.
124
What are common causative pathogens of chronic infected ulcers in diabetic foot infections?
-Staphylococcus aureus
-Streptococcus spp.
-Enterobacterales
-anaerobes
125
What are common causative pathogens of macerated ulcers due to soaking in diabetic foot infections?
-Staphylococcus aureus
-Streptococcus spp.
-Pseudomonas aeruginosa
126
What are common causative pathogens of chronic non-healing ulcers?
-Staphylococcus aureus
-Streptococcus spp.
-Enterobacterales
-Pseudomonas aeruginosa
-anaerobes
127
What are MRSA risk factors for patients with diabetic foot infections?
-previous MRSA infection within past year
-local MRSA prevalence >30%
-recent hospitalization
-failed non-MRSA antibiotics
128
What are Pseudomonas risk factors for patients with diabetic foot infections?
-h/o Pseudomonas infection
-soaking feet in water
-warm climate
-severe infection
-failed non-Pseudomonal antibiotics
129
What pathogens need to be covered for mild diabetic foot infections?
-MSSA
-Streptococcus spp.
130
What are the first-line treatment options for mild diabetic foot infections?
-cephalexin
-clindamycin
131
What is the duration of therapy for mild diabetic foot infections?
1 to 2 weeks
132
If a patient was recently on antibiotics, then what treatment options are available for mild diabetic foot infections?
-Augmentin
-levofloxacin
-moxifloxacin
133
What antibiotics are recommended in mild diabetic foot infections with MRSA risk factors?
-Bactrim
-doxycycline
134
What pathogens need to be covered for moderate diabetic foot infections?
-MSSA
-Streptococcus spp.
-Enterobacterales
-anaerobes
135
What are the first-line treatment options for moderate diabetic foot infections?
-moxifloxacin
-Augmentin
-ciprofloxacin OR levofloxacin AND clindamycin OR metronidazole
136
What is the duration of therapy for moderate diabetic foot infections?
2 to 3 weeks
137
What antibiotics are recommended in moderate diabetic foot infections with Pseudomonal risk factors?
ciprofloxacin OR levofloxacin AND clindamycin OR metronidazole
138
What antibiotics are recommended to be added in moderate diabetic foot infections with MRSA risk factors?
-doxycycline
-linezolid
-vancomycin
-Bactrim
139
What pathogens need to be covered for severe diabetic foot infections?
-MSSA
-Streptococcus spp.
-Enterobacterales
-anaerobes
-Pseudomonas
140
What are the first-line treatment options for severe diabetic foot infections?
-Zosyn
-carbapenems
-cefepime AND clindamycin OR metronidazole
141
What is the duration of therapy for severe diabetic foot infections?
2 to 3 weeks
142
What antibiotics are recommended to be added in severe diabetic foot infections with MRSA risk factors?
-linezolid
-vancomycin
-daptomycin
143
What are common causative pathogens of acute otitis media?
-Streptococcus pneumoniae
-Haemophilus influenzae
-Moraxella catarrhalis
144
What are signs and symptoms of the tympanic membrane in acute otitis media?
-bulging
-cloudy or purulent effusion
-immobility
145
What are the characteristics of non-severe acute otitis media?
-mild otalgia AND
-fever <39ºC in past 24 hours
146
What are the characteristics of severe acute otitis media?
-moderate to severe otalgia OR
-fever ≥39ºC
147
At what age cutoff is observation not a treatment option for acute otitis media?
<6 months
148
At what age range is observation a treatment option for non-severe unilateral acute otitis media?
6 months to 2 years
149
At what age cutoff is observation a treatment option for non-severe acute otitis media?
≥2 years
150
How long can antibiotics be deferred for acute otitis media?
48 to 72 hours
151
What is the first-line treatment for acute otitis media?
amoxicillin
152
What is the dosing of amoxicillin for acute otitis media?
80 to 90 mg/kg/day divided Q12H for 5 to 10 days
153
When should amoxicillin not be used in acute otitis media?
-known resistance
-treatment failure
-amoxicillin use in last 30 days
-allergy
-concurrent conjunctivitis
154
What are the second-line treatments for acute otitis media?
-Augmentin
-cefpodoxime
-cefdinir
-cefuroxime
155
What dose should clavulanate be kept at to prevent GI side effects?
≤10 mg/kg/day
156
What drug can be used in severe cases of acute otitis media?
ceftriaxone
157
What is the duration of therapy for acute otitis media in patients <2 years old?
10 days
158
What is the duration of therapy for acute otitis media in patients ≥2 years old?
5 to 7 days
159
What are adjunctive therapy options for the treatment of acute otitis media?
-acetaminophen
-ibuprofen
-lidocaine otic drops
160
When should young infants with severe episodes of acute otitis media or children of any age with continuing pain after an acute otitis media infection be followed up with?
within days
161
When should infants or young children with histories of frequent recurrences of acute otitis media infections be followed up with?
2 weeks
162
When should children with only a sporadic episode of acute otitis media be followed up with?
1 month
163
When are tympanostomy tubes indicated?
-≥3 episodes in <6 months
-≥4 episodes in <12 months
164
What are treatment options for UTIs in pediatric patients?
-amoxicillin
-cephalexin
-Augmentin
-Bactrim
165
What are supportive therapy measures for bronchiolitis?
-oxygen
-hydration
-mechanical ventilation
-ECMO
166
When should pregnant women be vaccinated for RSV?
-before and during start of RSV season (Sept to Jan)
-32 to 36 weeks pregnant
-at least 14 days before delivery
