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Pneumonia Flashcards

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1
Q

Influenza etiology

A

Influenza virus: Type A & B

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2
Q

Type A subtypes

A
  1. Hemagglutinins H1, H2, H3

2. Neuraminidases N1, N2

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3
Q

Influenza clinical presentation

A 
FACTS:
F-Fever
A-Aches
C-Chills
T- Tiredness
S-Sudden onset
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4
Q

What is the gold standard diagnostic test for influenza? Why?

A

Viral Culture

Higher SENSITIVITY

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5
Q

Indications for antiviral treatment

A
  1. Illness requiring hospitalization
  2. Progressive, severe or complicated illness
  3. High risk complications
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6
Q

What are we worried about in children <19 y.o. on chronic ASA therapy? (high risk group)

A

Rye syndrome

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7
Q

List Antiviral medication and what strain it covers

A

Neuraminidase Inhibitors
-Oseltamivir (Tamiflu)
Influenza A/B

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8
Q

What antiviral medication is NOT recommended for use in the US?

A

Adamantanes

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9
Q

Zanamivir (Relexna) side effects and contraindications

A

ADE: Bronchospasm
Contraindicated: Respiratory dz

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10
Q

When must you initiate antiviral treatment to see benefit?

A

24-48 hrs
Relieve sx’s up to 3 days earlier
Less severe sx’s

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11
Q

What is the number one complication of influenza?

A

Pneumonia

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12
Q

Who should receive the influenza vaccine?

A

Universal vaccination >6 months

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13
Q

Who is the influenza vaccine contraindicate in?

A

Previous severe reaction to flu vaccine

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14
Q

How many doses do pediatric patients receive the first time the get the influenza vaccine?

A

2 doses

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15
Q

What is the most common cause of acute bronchitis?

A

Viral

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16
Q

What is the only bacterial organism that requires treatment in acute bronchitis?

A

Bordetella pertussis

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17
Q

What is the most common sx in acute bronchitis?

A

Cough >5 days

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18
Q

Acute bronchitis PEx

A
  1. Wheezing
  2. Rhonchi that clears with coughing
  3. Negative for rales and any signs of consolidation
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19
Q

When is a CXR indicated in suspected acute bronchitis?

A

Fever- R/O pneumonia

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20
Q

What is the most common cause for overly prescribed abx?

A

Acute bronchitis=60-90%

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21
Q

What is another name for Pertussis?

A

Whooping cough

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22
Q

What causes Pertussis?

A

Bordetella pertussis

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23
Q

Bordetella pertussis

MOA

A
  • Releases toxin that damages cilia and causes airways to swell
  • Causes classic cough
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24
Q

What population do we see Bordetella pertussis in?

A

< age 2 y/o

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25
Bordetella pertussis incubation period
7-17 days
26
How long are you contagious for after onset of cough in pertussis?
2 week s
27
What are the 3 stages of Pertussis and time periods?
1. Catarrhal: 1-2 weeks 2. Paroxysmal: begins in 2nd week, last 2-3 mos. 3. Convalescent: 1-2 weeks
28
Catarrhal sx's
- Malaise - Rhinorrhea - Cough - Cough - Lacrimation and conjunctival injection
29
Paroxysmal sx's
- Fits of numerous, rapid cough followed by "Whooping" sound | - Vomiting following coughing
30
Convalescent sx's
Gradual reduction in frequency and severity of cough
31
Pertussis diagnosis
Nasopharyngeal culture
32
Pertussis treatment
1. Macrolide | 2. Bactrim
33
When should pregnant women receive their Tdap?
27-36 weeks gestation
34
At what age do adolescents receive their Tdap booster?
11-18 y.o.
35
What are the complication os pertussis in babies under 1 y/o?
1. Hospitalization=50% 2. Pneumonia=23% 3. Apnea=61%
36
What is the most common form of transmission of pneumonia?
Aspiration from the oropharynx
37
What is the most common pneumonia?
Community Acquired Pneumonia
38
What is the most common bacterial infection of CAP?
S. pneumoniae
39
List Atypical bacteria in CAP
1. Mycoplasma pneumoniae 2. Legionella 3. Chamydophilia
40
Viral causes of CAP
Influenza
41
CAP clinical presentation
1. Fever 2. Cough 3. Dyspnea 4. Chest discomfort 5. Fatigue, weakness 6. Myalgias, arthralgia
42
CAP physical exam findings
1. Fever 2. Rales 3. Signs of consolidation 4. Tachypnea 5. Tachycardia 6. Low O2 sat
43
What is another name for Mycoplasma Pneumoniae? What age group does it commonly occur in?
"Walking pneumonia" | Children and adolescents
44
Legionella presentation
- GI disorders: Watery diarrhea | - From contaminated water sources
45
What organism has a usual complaint of "sudden onset of a single episode of rigors or chills"
S. pneumoniae
46
Klebsiella pneumoniae | presentation
- Currant jelly sputum | - Alcoholics, DM, COPD
47
What is the gold standard diagnostics for CAP?
CXR
48
What would you expect to see on CBC in pneumonia?
Leukocytosis with left shift
49
CXR findings
1. Lobar- One lobe consolidation 2. Interstitial- patchy distribution 3. Cavitation
50
What organism would you use a urine antigen test?
S. pneumonia | Legionella
51
What does Procalcitonin levels help you determine?
bacterial vs. viral
52
CURB 65
C-Confusion U- Urea >7 mol/L (BUN>20) R-Respiratory Rate >30 B- Blood pressure, SBP<90 OR DBP < or equal to 60 65- Age> or equal 65
53
CURB 65 score 0-1
Treat outpatient
54
CURB 65 score 2
Admit
55
CURB 65 score 3-5
Assess for ICU
56
Who needs a follow-up CXR following abx treatment?
Smokers
57
Abx treatment for outpatient and no abx in last 3 months
1. Macrolide OR | 2. Doxycyline
58
Abx treatment for outpatient with: abx in last 3 months Macrolide resistant S.pneumoniae
1. Respiratory Fluoroquinolone OR | 2. Beta-Lactam + Macrolide
59
Abx treatment for Inpatient, Non-ICU
1. Respiratory Fluoroquinolone OR | 2. Beta-Lactam + Macrolide
60
Abx treatment for ICU patients
Anti-pneumococcal beta-lactam PLUS: - azithromycin OR - respiratory fluoroquinolone
61
Abx treatment for ICU patients with PCN allergy
respiratory fluoroquinolone + aztreonam
62
CAP treatment if pseudomonas risk
Antipneumococcal, antipseudomonal beta lactam* + ciprofloxacin or levofloxacin (750 mg)
63
Duration of inpatient treatment
Minimum of 5 days and: 1. Afebrile for 48-72 hours 2. Supplemental O2 not needed 3. Heart rate < 100 4. RR < 24 5. SBP ≥ 90 mm Hg
64
List CAP Vaccination Prevention
1. Influenza- All 2. PPSV23 (Pneumovax)- Adults > 65 y.o. 3. PCV13 (Prevnar)- All <2 y.o.
65
Hospital Acquired Pneumonia (Nosocomial) Definition
- 48 hours or more after admission | - Did NOT appear to be incubating at the time of admission
66
Ventilator Associated Pneumonia definition
- type of HAP | - Develops more than 48 – 72 hours after endotracheal intubation
67
Etiology of HAP and VAP
1. Aerobic gram-negative bacilli: E.coli, Klebsiella, enterobacter, pseudomonas aeruginosa 2. Gram (+): S. aureus, Strept.
68
HAP and VAP diagnosis
New lung infiltrate + evidence that the infiltrate is of infectious origin: 1. New onset of fever 2. Purulent sputum 3. Leukocytosis 4. Decline in oxygenation
69
Duration of treatment in HAP/VAP
14-21 days | 7 days if responding to tx
70
What organism ALWAYS gets the full 14-21 days of tx?
Pseudomonas aeruginosa
71
Best treatment of VAP
Prevention! - Avoidance of acid-blocking meds - Decontamination of oropharynx
72
What is a common complication of viral pneumonia?
Secondary bacterial pneumonia= STAPH!
73
What is the most common opportunistic infection in AIDS pt's?
``` Pneumocystis jirovecii (Pneumocystis carinii, ‘PCP’) -Atypical Fungi ```
74
Pneumocystis pneumonia treatment
TMP-SMX (Bactrim) x 21 days | +/- corticosteroids based on severity
75
Prophylaxis Pneumocystis pneumonia Tx for AIDS pt's
CD4 count < 200 | TMP-SMX (bactrim)
76
Organism that cause Aspiration Pneumonia
1. Gram (-) | 2. Anaerobic pathogens
77
Aspiration Pneumonia clinical présentation
Cough with foul smelling purulence | Poor dentition
78
How do you obtain a culture for Aspiration Pneumonia
1. Transthoracic aspiration 2. Thoracentesis 3. Bronchoscopy
79
What is a common CXR findings in Aspiration pneumonia?
RLL infiltrate
80
Aspiration pneumonia abx treatment
Clindamycin or amoxicillin-clavulanate (Augmentin)

Foundations-Pulmonary (9 decks)

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