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Flashcards in ID - Pneumonia Deck (27):
0

Most common pathogen for community community acquired pneumonia? For nosocomial pneumonia?

Strep pneumonia

Gram-negative rods (E. coli, Pseudomonas) and staph aureus

2

Definition of Community acquired pneumonia versus Nosocomial pneumonia?

Acquired before or within 48-72 hours of hospitalization versus later

2

Infection from community acquired pneumonia result from what mechanism?

Aspiration of oropharyngeal secretions

4

Sputum in bacterial PNA?

PE sIgn bacteremic pneumonia?

Rust colored

Rigors

5

Main Types of lower tract infection?

Next test to order?

Pneumonia and acute bronchitis.

Chest x-ray

6

Test to order invitations with suspected pneumonia?

1. Chest x-ray
2. Labs – CBC, BUN, creatinine, glucose, electrolytes
3. O2 sat
4. 2 pretreatment blood cultures
5. Gram stain and culture of sputum
6. Antibiotics

7

Most common causes of atypical pneumonia if bacterial?

Viral?

1. Mycoplasma
2. Chlamydia pneumonia
3. Chlamydia psittaci
4. Coxiella (Q fever)
5. Legionella


1. Influenza
2. adenovirus
3. parainfluenza
4. RSV

8

1. Alcoholic pneumonia?
2. Immigrants with pneumonia?
3. Nursing home resident with pneumonia?
4. HIV-positive patient with pneumonia?
5. COPD pt?
6. Post-flu?
7. Young, healthy pts?
8. Birds?
9. Farmer/Veterinarian?

1. Klebsiella
2. TB
3. Pseudomonas
4. PCP and TB
5. H flu
6. Strep Peumo
7. Mycoplasma
8. Chlamydia
9. Coxiella

9

Test if suspect Legionella?

If suspect and need to confirm PCP?

Urinary antigen assay (antigen persists in urine for weeks)

Bronchoalveolar lavage

10

Considered admitting to hospital if?

CURB65 of 2+
Confusion
Uremia>20
RR>30
BP under 90
Age>65

OR
#pH under 7.35
#HR>125
#Temp > 104
#Cancer, COPD, CHF, Renal failure, Liver disease

11

If pneumonia becomes empyema, need to?

Place chest tube for drainage

12

Areas of the lungs that may developed abscesses from aspirated contents?

Posterior segments of upper lobes and superior segments of lower lobes

13

Pts with high risk of pneumonia: history?

Age >50
History of cancer
CHF
Cerebrovascular disease
Renal/liver disease

14

Every patient with pneumonia will have a visible pulmonary infiltrate on chest x-ray except?

#Immunosuppressed patients
#severe neutropenia,
#very early pneumonia

15

Diffuse interstitial infiltrates are common in pneumonia caused by?

PCP
Coxiella
Mycoplasma
Chlamydia
Viruses

16

PCP PNA can be ruled out if?

PCP much less likely if?

#Pleural effusion is present

#Normal LDH

17

Appearance of cavitation suggests?

TB, staph aureus, gram-negative organisms (Klebsiella)

18

With sputum results, how to determine if it is uncontaminated?

>25 PMNs and <10 epithelial cells

19

Outpatient therapy of community acquired pneumonia?

When to add fuoroquinolone?

Hospitalized patients with community acquired pneumonia are treated with?

Macrolides (azithromycin) or Doxycyclne

ABx in last 3 months or comorbidities

Fluoroquinolone OR Ceftriaxone+Azithromycin

20

Treatment for immunocompetent patient with hospital-acquired or ventilator-associated pneumonia?

Antipseudomonal beta-lactam (Zosyn/cefepime) plus aminoglycoside (may also add clindamycin)

21

1. Pt with hemoptusis and cureant jelly suputum?
2. Foul-smelling sputum?
3. Mryingitis (infx and vesicles on tympanic membrane)
4. Legionella presents with hypoNa, GI sx and?

1. Klebsiella
2. Anerobes
3. mycoplasma
4. Headache/confusion

22

Who should get pneumovax?

#Age>65
#Heart, lung, liver, kidney disorders
#Sickle cell
#Cancer/HIV/immunosuppressed
#CSF leak, cochlear implants

23

HCAP treatment?

VAP?

#Cefepine/Cedrazidime
OR #Zosyn
OR #Cabapenems

#Antipseudomonal cephalosporin/zosyn/carbapenum
AND #Aminoglycoside/Fluoroquinolone
AND #Vanc/Linezolid

24

Abx can can cause seizures and renal failure?

Imipenum

25

Do not order this test if suspect aspiration PNA?

Sputum culture (everyone's sputum has anaerobes from mouth)

26

Suspect lung abscess - imaging? tx?

CXR/CT for cavitation

Clindamycin or Penicillin

27

Drugs to treat PCP PNA if reaction to bactrim?

If pt develops neutropenia and hemolytic anemia

#Pentamidine
#Clindamycin + Primaquine

#Pentamidine (Primaquine contraindicated in G6PD)

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