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Pneumonia Flashcards

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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
Consider drug resistant pneumococcus PNA in:
``` Age>65 Recent (3mo) beta lactam therapy Multiple comorbidities Alcoholism Exposure to child in day care COPD DM Renal or CHF Malignancy ```
25
Staph aureus pneumonia is associated with?
Influenza virus superinfection "Bacterial superinfection"
26
CA MRSA is now a cause of
CAP!!! Severe with necrotic complications
27
CA-MRsA more common in what groups
``` Native Americans Homeless Gay men Prisoners Military Day care Contact sport athletes ```
28
GN organisms are associated with
Uncontrolled chronic diseases Immunosuppression Alcoholism
29
Legionella is associated with
``` DM Cancer Kidney disease HIV/AIDS Recent cruise ship or hotel stay ```
30
Organism associated with COPD or immunoglobulin deficiency (IGG)
M. Catarrhalis | H. Influenza
31
Organism associated with cattle or sheep
Coxiella burnetii (Q fever)
32
Organism associated with bird fanciers:
Chlamydophila psittaci (psittacosis)
33
Organism associated with hunters:
Francisella tularensia (tularemia)
34
Organism associated with bat caves in Mississippi & Ohio river valleys:
histoplasMOsis
35
Organism associated with travel to California or Arizona:
Coccidioides immitis
36
Organism associated with living or traveling to central, southeast & midAtlantic states (esp Illinois & Arkansas)
Blastomyces dermatitidis (blastomycosis)
37
Organism associated with risk factors for AIDS/HIV or other immunocompromised:
PJP or TB
38
Outpatient treatment of CAP
Macrolide (azithromycin or claritgromycin) Or Doxycycline
39
Why don't we use erythromycin for CAP outpt tx?
GI side effects | Less effective against H. Influenza
40
If patient has risk factor for drug resistent strep PNA or comorbidities that can affect outcome treat with?
Respiratory quinolone or High dose amoxicillin | High dose beta lactam can sometimes overcome resistance
41
What are the respiratory fluroquniolones?
Levofloxacin Gemfloxacin Moxifloxacin
42
Inpt non ICU empiric treatment
Respiratory fluroquniolones Or IV/PO Beta lactam + macrolide or doxycycline
43
ICU treatment for PNA without pseudomonas risk factors
Beta lactam + respiratory fluroquniolones or macrolide
44
ICU treatment for PNA with pseudomonas risk factors
Beta lactam + respiratory fluroquniolones or macrolide 2 antipseudomonal drugs also!
45
ICU treatment PNA with CA-MRSA
Beta lactam + respiratory fluroquniolones or macrolide And linezolid or vancomycin
46
Narrow empiric therapy if clinical improvement on
Day 3 Can try to switch to oral med
47
Treatment of PNA
5-14 days depending on extent of pneumonia
48
When do you do a repeat CXR for PNA?
4-6 weeks after discharge
49
If patient with pneumonia previously had persistent abnormality on CXR after treatment consider?
Malignancy
50
If your patient deteriorates over first 3 days on empiric PNA treatment
1) maybe wrong diagnosis 2) maybe empiric regimen is not covering causative organism 3) maybe there's a new infection
51
People high risk for pneumococcal dz
``` >65 DM Alcoholism Lung, heart, renal dz Asplenic (sickler) Humoral immunodeficiency: AIDS, myeloma, CLL, lymphoma ```
52
If at risk patient comes with shaking chills, pleuritic cp & rust colored sputum think what organism
Streptococcal
53
Pneumococcus gram stain
Lancet shaped gram positive diplocci Intracellular
54
Complications from pneumococcus:
Lung abscess Pneumatoceles Empyema
55
What increases mortality in a patient with pneumococcus?
Multilobar disease Bacteremia WBC <6,000
56
3 pneumococcal vaccinations
23 valent 7 valent 12 valent
57
Who gets PPSV23 valent vaccination?
``` Age >65 Smoker Chronic dz (COPD, asthma, DM, cirrhosis) Asplenic Immunocompromised ```
58
Who gets PPV23 booster?
Patients >65 if >5 years have elapsed since initial vaccination
59
Gram stain of H. Influenza
Pleomorphic GN cocci bacilli
60
Nontypeable H. Influenza seen in what patients
COPD | AIDS
61
Treatment of H. Influenza
``` Ampicillin (or if resist amp-clavul) 3rd gen ceph Doxy Fluroquniolones Tmp/smx ```
62
Staph aureus regularly doesn't cause problems in immunocompetent patients unless
Skin break
63
Presentation of staph pneumonia
Salmon pink sputum Diffuse lung infiltrate Pneumatocele
64
Gram stain staph aureus
Gram positive cocci in clusters
65
Staph aureus complications
Empyema Glomerulonephritis Pericarditis
66
Treatment MSSA pneumonia
DOC nafcillin
67
Treatment MRSA pneumonia
Vancomycin Linezolid Do NOT use daptomycin for respiratory infections
68
MRSA covered by
``` Tmpsmx Quinolones Clindycin Vancomycin Daptomycin Linezolid ```

MS Pulm (4 decks)

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