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MS Pulm > Pneumonia > Flashcards

Pneumonia Flashcards

0
Q

CAP divided into

A

Typical

Atypical

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1
Q

Four types of pneumonia

A

CAP
HCAP
HAP
VAP

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2
Q

Causes of typical CAP

A 
Pneumococcus
H. Influenza
S. Aureus
GNR
M. Catarrhalis
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3
Q

Causes of atypical CAP

A 
Mycoplasma
Chlamydophila
Legionella
Endemic fungi (cocci, histo, blasto)
Virus (flu, adeno, rsv)
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4
Q

Atypical pneumonias are resistant to

A

Beta lactam antibiotics

:( bc this is typical first line for empiric CAP

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5
Q

Think of CAP in treatment as:

A

Empiric: when organism not known
Or
Pathogen directed: when organism known

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6
Q

Symptoms of PNA

A 
Fever
Anorexia
Sweats
Dyspnea
Sputum production
Cough
Pleurisy

N, v, d 20%

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7
Q

PE of PNA

A

Tavhcardia
Tachypnea
Consolidation: inc tactile fremitus, bronchial bs, crackles

Para pneumonic effusion: decreased tactile fremitus & percussion

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8
Q

When do you work up aggressively CAP

A

Risk factors for severe dz (lung prob, uncontrolled comirbidities)
ICU admission
Unresponsive to empiric treatment

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9
Q

Who do you order a sputum gram stain & culture

A 
Severe/unresponsive CAP
COPD
Hx etoh abuse
Cavitiary infiltrates 
Pleural effusion
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10
Q

In incubated patient with PNA for gs & culture

A

Get deep suctioned aspirated or BAL ASAP

Bc in ICU targeted abx>empiric abx

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11
Q

If you suspect TB in PNA patients add

A

AFB stain

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12
Q

Sputum c&s results accurate only if

A

> 25 neutrophils & < 10 epi’s per low power field

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13
Q

Who with PNA should get blood cultures

A 
Severe/unresponsive CAP
COPD
Liver dz
Hx etoh abuse
Cavitiary infiltrate
Asplenia
Pleural effusion
Leukopenia
Positive pneumococcal urine antigen test
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14
Q

If severe CAP add what additional tests?

A

Urine antigen test for pneumococcus & legionella

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15
Q

Empiric treatment is started before pathogen ID & depends on

A

Severity of illness & new for hospitalization (PSI & CURB 65)

Likelihood of certain pathogen based on associated risk factors

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16
Q

PORT PSI range in scores

A

1-5

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17
Q

Determine port PSI by determining if risk category 1 by?

A

History & physical solely

If risk category I no further workup needed

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18
Q

What determines if patient is PSI category I?

A

Age <50
No co-morbidity
PE ok
(Normal MS & vitals)

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19
Q

If patient is not PSI 1 what is next step?

A

Blood test & imaging to deeming which category 2-5 patient is

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20
Q

Bases on PORT PSI who do you admit?

A

4 & 5 category

1-3 can treat outpatient

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21
Q

CURB 65 stands for

A

Confusion
BUN >20
RR => 30
BP 65

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22
Q

Who do you admit from CURB 65?

A

=>2 risks MODERATE risk group

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23
Q

Thinking pneumococcus PNA in:

A

Chronic diseases
(Heart, stroke, sz, dementia, COPD, HIV/AIDS)

Smoking
Alcoholism

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24
Q

Consider drug resistant pneumococcus PNA in:

A 
Age>65
Recent (3mo) beta lactam therapy
Multiple comorbidities
Alcoholism 
Exposure to child in day care
COPD
DM
Renal or CHF
Malignancy
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25
Q

Staph aureus pneumonia is associated with?

A

Influenza virus superinfection

“Bacterial superinfection”

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26
Q

CA MRSA is now a cause of

A

CAP!!!

Severe with necrotic complications

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27
Q

CA-MRsA more common in what groups

A 
Native Americans
Homeless
Gay men
Prisoners
Military
Day care 
Contact sport athletes
28
Q

GN organisms are associated with

A

Uncontrolled chronic diseases
Immunosuppression
Alcoholism

29
Q

Legionella is associated with

A 
DM
Cancer
Kidney disease
HIV/AIDS
Recent cruise ship or hotel stay
30
Q

Organism associated with COPD or immunoglobulin deficiency (IGG)

A

M. Catarrhalis

H. Influenza

31
Q

Organism associated with cattle or sheep

A

Coxiella burnetii (Q fever)

32
Q

Organism associated with bird fanciers:

A

Chlamydophila psittaci (psittacosis)

33
Q

Organism associated with hunters:

A

Francisella tularensia (tularemia)

34
Q

Organism associated with bat caves in Mississippi & Ohio river valleys:

A

histoplasMOsis

35
Q

Organism associated with travel to California or Arizona:

A

Coccidioides immitis

36
Q

Organism associated with living or traveling to central, southeast & midAtlantic states (esp Illinois & Arkansas)

A

Blastomyces dermatitidis (blastomycosis)

37
Q

Organism associated with risk factors for AIDS/HIV or other immunocompromised:

A

PJP or TB

38
Q

Outpatient treatment of CAP

A

Macrolide (azithromycin or claritgromycin)

Or

Doxycycline

39
Q

Why don’t we use erythromycin for CAP outpt tx?

A

GI side effects

Less effective against H. Influenza

40
Q

If patient has risk factor for drug resistent strep PNA or comorbidities that can affect outcome treat with?

A

Respiratory quinolone or High dose amoxicillin

High dose beta lactam can sometimes overcome resistance

41
Q

What are the respiratory fluroquniolones?

A

Levofloxacin
Gemfloxacin
Moxifloxacin

42
Q

Inpt non ICU empiric treatment

A

Respiratory fluroquniolones

Or

IV/PO Beta lactam + macrolide or doxycycline

43
Q

ICU treatment for PNA without pseudomonas risk factors

A

Beta lactam + respiratory fluroquniolones or macrolide

44
Q

ICU treatment for PNA with pseudomonas risk factors

A

Beta lactam + respiratory fluroquniolones or macrolide

2 antipseudomonal drugs also!

45
Q

ICU treatment PNA with CA-MRSA

A

Beta lactam + respiratory fluroquniolones or macrolide

And linezolid or vancomycin

46
Q

Narrow empiric therapy if clinical improvement on

A

Day 3

Can try to switch to oral med

47
Q

Treatment of PNA

A

5-14 days depending on extent of pneumonia

48
Q

When do you do a repeat CXR for PNA?

A

4-6 weeks after discharge

49
Q

If patient with pneumonia previously had persistent abnormality on CXR after treatment consider?

A

Malignancy

50
Q

If your patient deteriorates over first 3 days on empiric PNA treatment

A

1) maybe wrong diagnosis
2) maybe empiric regimen is not covering causative organism
3) maybe there’s a new infection

51
Q

People high risk for pneumococcal dz

A 
>65
DM
Alcoholism
Lung, heart, renal dz
Asplenic (sickler)
Humoral immunodeficiency: AIDS, myeloma, CLL, lymphoma
52
Q

If at risk patient comes with shaking chills, pleuritic cp & rust colored sputum think what organism

A

Streptococcal

53
Q

Pneumococcus gram stain

A

Lancet shaped gram positive diplocci

Intracellular

54
Q

Complications from pneumococcus:

A

Lung abscess
Pneumatoceles
Empyema

55
Q

What increases mortality in a patient with pneumococcus?

A

Multilobar disease
Bacteremia
WBC <6,000

56
Q

3 pneumococcal vaccinations

A

23 valent
7 valent
12 valent

57
Q

Who gets PPSV23 valent vaccination?

A 
Age >65
Smoker
Chronic dz (COPD, asthma, DM, cirrhosis)
Asplenic
Immunocompromised
58
Q

Who gets PPV23 booster?

A

Patients >65 if >5 years have elapsed since initial vaccination

59
Q

Gram stain of H. Influenza

A

Pleomorphic GN cocci bacilli

60
Q

Nontypeable H. Influenza seen in what patients

A

COPD

AIDS

61
Q

Treatment of H. Influenza

A 
Ampicillin (or if resist amp-clavul)
3rd gen ceph
Doxy
Fluroquniolones 
Tmp/smx
62
Q

Staph aureus regularly doesn’t cause problems in immunocompetent patients unless

A

Skin break

63
Q

Presentation of staph pneumonia

A

Salmon pink sputum
Diffuse lung infiltrate
Pneumatocele

64
Q

Gram stain staph aureus

A

Gram positive cocci in clusters

65
Q

Staph aureus complications

A

Empyema
Glomerulonephritis
Pericarditis

66
Q

Treatment MSSA pneumonia

A

DOC nafcillin

67
Q

Treatment MRSA pneumonia

A

Vancomycin
Linezolid

Do NOT use daptomycin for respiratory infections

68
Q

MRSA covered by

A 
Tmpsmx
Quinolones
Clindycin 
Vancomycin
Daptomycin 
Linezolid

MS Pulm (4 decks)

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