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ICM -- Pulmonology > Pneumonia > Flashcards

Flashcards in Pneumonia Deck (39):
1

Gold standard for pneumonia diagnosis

CXR

2

Common symptoms of pneumonia

Fever/Chills
Dyspnea
Purulent Sputum
CXR signs

3

Three classifications of pneumonia (as per dr. islam)

Major Immunodeficiency
Tuberculosis
Relatively normal hosts w/out active TB

4

Four types of pneumonia seen in non TB, IC patients

HAP
VAP
HCAP
CAP

5

Criteria for hospital acquired pneumonia

48+ hours following admission

6

Criteria for VAP

48 hours following endotracheal intubation

7

Criteria for HCAP

Long term care facility
Dialysis
Outpatient Chemo
Health Care Worker

8

Criteria for CAP

Outside hospital or extended care facility

9

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

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

10

If suspecious CXR for TB, what do you do?

Order AFB smears

11

How to determine if a pneumonia patient should be hospitalized?

CURB 65. Hospitalize with a score of 2+
Confusion, Urea, RR, BP, 65

12

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

3 or more

13

A higher PIRO score indicates that a patient will require...

A longer ICU stay and more mechanical ventillation days

14

Two major indicators for ICU admission/Severe CAP

Invasive mechanical ventilation
Septic shock with the need for vasopressors

15

Three minor indicators for ICU admission/Severe CAP

BP over 90
PaO2/FiO2 under 250
Multilobar Disease

16

Risk factors for severe pneumonia

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

17

Important physical exam findings in pneumonia

Irregular vitals + Confusion
(High RR over 30, Low BP, Pulse over 125, irregular temp)

18

Three mechanisms by which bacteria reaches the lungs

Inhalation
Aspiration
Hematogenous

19

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

Legionella and pneumococcal UAT

20

Six ost common causes of bacterial pneumonia

S pneumo
H influenzae
Chlamydia pneumo
Myco pneumo
Legionella
S aureus

21

Criterion for a good sputum sample

under 10 squamous cells
over 25 WBC
Low Powered Field

22

What should you look for to IS a lingular pneumonia?

Obscuration of the cardiac apex

23

Effect of bacterial and viral pneumonia on procalcitonin levels?

Bacterial -- Rises
Viral -- Lowers via IFN-g

24

Practical use for watching the PCT levels?

Use to assess duration of antibiotic therapy

25

Consider ABs with a PCT above...

0.25 ug/L

26

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

Everyone over 40
All Smokers, Former Smokers

27

General guidelines for antibiotic management of CAP

Give empiric treatment within 4-8 hours

28

Increased risk of pseudomonas with ...

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

29

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

Macrolide OR Doxy

30

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

Respiratory Quinalone
OR
beta-lactam AND macrolide/doxy

31

How long should an outpatient pneumonia patient be on antibiotics

5-7 days

32

Rx for inpt. CAP

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

33

ICU treatment for CAP

(Ceftriaxone/Ceftazimide) + Azithro/Respiratory Quinalone

34

How to treat suspected aspiration pneumonia

Unasyn/Zosyn
Augmentin/Clindamycin
Respiratory Quinalone

35

Important considerations if CAP pneumonia treatment isn't effective

Bronchoscopy
Further Diagnostic Testing
Escalation/Change of Therapy

36

When can you switch from IV to PO

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

37

Criteria for discharge..
In the past 24 hours, no more than one of...

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

38

Which risk stratification determines outpatient vs inpatient

CURB 65

39

Treatment for HCAP

Vancomycin