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Flashcards in Pneumonnia Deck (47):
1

what should you do if you have a high clinical suspicion but CXR is negative?

get serial xrays, the disease may blossom

2

what do you do if the CXR shows what looks like pneumonia but the clinical picture doesn't fit?

think of something else

3

what are classic presentation of legionella pneumonia?

GI sxs
hyponatremia

4

what is drug of choice for legionnella?

azithromycin

5

what are drugs that get good atypical coverage?

macrolides
doxycyline
fluorquinolones

6

what is proper dosing of levaquin for pneumonia?

750mg IV

7

what do you do with pleural fluid with a pneumonia?

tap it if there is enough (antibiotics won't be enough)

8

what do you do with pts with pneumonia in flu season?

flu swab and if you still think they have it do a PCR

9

what are DOC in outpatient previously healthy pt with pneumonia?

macrolide
tetracycline

10

what are DOC in outpatient with comorbid dz with pneumonia?

levaquin, moxiflox,
combo therapy (aug + azithromycin)

11

what are DOC in inpatient non ICU pneumonia?

levaquin, moxiflox,
ceftaroline OR
combo (rocephin PLUS azithro)

12

what are DOC in inpatient, ICU pneumonia?

zosyn 4.5 PLUS cipro PLUS vanc

13

what type of pneumonia hits hard and very abrupt?

strep pneumonia

14

what is the criteria for sepsis?

10% bands on WBC count

15

how can you evaluate for a pleural effusion?

US or CT without contrast

16

how long might a pneumonia take to get better radiographically?

2-4 weeks

17

always, always follow pneumonia until it does what?

clears up radiographically

18

what is the definition of an MDR pathogen?

bug with resistance to 2 or more of the abx typically used to treat it (esp important in regards to Gram negative bacilli)

19

what is the leading cause of death of nosocomial infections?

hospital acquired pneumonia

20

what are common HAP bugs?

klebsiella
e. coli
pseudomonas
acinetobacter
enterobacter

MRSA

21

what are clinical signs of HAP?

fever
purulent sputum
decline in oxygenation
leukocytosis
new infiltrate on CXR

22

what is zosyn?

pipercillin and BL inhibitor

23

people die because of what?

they don't get abx quickly enough or the right kind

24

what should you do when you go to a new job/hospital?

learn your bugs so you can tailor abx choices based on where you are

25

what is the trough that you want for vanc?

15-20

26

what are good/bads with linezolid for MRSA?

expensive, easier to dose, GI issues

27

what are good/bad with vancomycin for MRSA?

nephrotoxic, harder to dose, cheaper

28

what is the timing goal for abx therapy?

direct approach at 72hrs

29

what time frame determines a chronic lung absess?

> 1month

30

what is a common cause of a lung abscess?

aspiration

31

what defines a primary abscess?

healthy host

32

what defines a secondary abscess?

immunocompromised

33

what are most bugs that cause lung abscess?

anaerobes from the mouth

34

what is Lemierre's syndrome?

thrombophlebitis of the IJ
can cause lung abscess
fusobacterium

35

what are classic sxs of lung abscess?

cough, fever, wt loss, purulent sputum, bad taste in mouth, poor dentition

36

what bug is a/w DM and lung abscess?

klebsiella

37

nocardia

bactrim

38

actinomyces

penicillin

39

think about these bugs in PING and lung abscess?

mycobacterium
nocardia
aspergillus
rhodococcus

40

where is TB usually located in the lungs?

upper lobes with associated parenchymal involvement

41

what type of carcinoma of the lung cavitates?

squamous cell

42

what causes multifocal lesions, recurrent sinusitis, renal failure, and hematuria?

wegner's granulomatous

43

txment of lung abscess with no MDR risks

unasyn and clinda

44

txment of lung abscess with no MDR risks and PCN allergy

fluorquinolones

45

once off IV abx continue treatment with

augmentin
PCN fluor + clinda

46

how long do you treat with abx?

6-8 weeks with serial images to ensure resolution

47

what is the last, last choice with lung abscess?

no abx choices and can not tolerate surgery

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