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Step 2 CK > Pulmonology - Pneumonia > Flashcards

Pulmonology - Pneumonia Flashcards

(44 cards)

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1
Q

Pneumonia acquired in the community or within the first 72 hours of hospitalization

A

Community acquired pneumonia (CAP)

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2
Q

Pneumonia acquired during hospitalization after the first 72 hours

A

Hospital acquired pneumonia

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3
Q

Most common bacterial pathogen of CAP

A

Streptococcus pneumoniae

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4
Q

Pneumonia in a patient with alcohol use

A

Klebsiella

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5
Q

Pneumonia in a nursing home resident (nosocomial pathogen)

A

Pseudomonas

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6
Q

Pneumonia in an organ transplant recipient

A

Legionella

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7
Q

Pneumonia in a newborn

A
  • E. coli
  • Group B Strep
  • Streptococcus pneumoniae
  • Haemphilus influenzae
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8
Q

Pneumonia in children (1 month-18 years)

A
  • Chlamydia trachomatis (infants)
  • Chlamydia pneumoniae
  • Streptococcus pneumoniae
  • RSV
  • Mycoplasma
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9
Q

Most common bacterial pathogens of HAP

A

gram negative rods (E. coli, Pseudomonas) and Staphylococcus aureus

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10
Q

Single dose conjugate vaccine approved for all adults 19+ with risk factors and 65+

A

PCV20 (Prevnar 20)

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11
Q

Standard conjugate vaccine for infants and children against pneumococcal pneumonia

A

PCV13 (Prevnar 13)

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12
Q

Conjugate vaccine that must be followed with PPSV23 (Pneumovax 23) after at least 1 year; used when PCV20 is not available or contraindicated.

A

PCV15 (Prevnar 15)

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13
Q

Polysaccharide vaccine that protects against 23 types of pneumococcus, but does not create a strong long-term memory immune response

A

PPSV23 (Pneumovax 23)

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14
Q

Pneumonia vaccine schedule for children

A

PCV13
2, 4, and 6 months and booster at 12-15 months
(some use PCV15 or PCV20 instead)

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15
Q

Pneumonia vaccine schedule for adults 19-64 with risk factors

A
  • PCV20 or PCV21
    OR
  • PCV15 and PPSV23 at least one year apart
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16
Q

Pneumonia vaccine schedule for adults over 65

A
  • PCV20 or PCV21
    OR
  • PCV15 followed by PPSV23 at least 1 year apart
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17
Q

Pneumonia vaccine schedule for adults with a prior PCV13 as a child

A

PCV20 or PCV21

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18
Q

Pneumonia vaccine schedule for an adult with previous PCV13 and PPSV23

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A

PCV20 or PCV21 at least 5 years after last vaccine

19
Q

Which vaccine do you always give first?

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A

Always give PCV before PPSV23 if both are needed because PPSV23 may blunt the immune response to later conjugate vaccines.

20
Q

What comorbidities in younger patients require pneumococcal vaccination?

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A
  • heart disease
  • sickle cell disease
  • pulmonary disease
  • diabetes
  • alcoholic cirrhosis
  • asplenia
21
Q

Atypical bacterial causes

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A
  • legionella
  • chlamydia
  • mycoplasma
  • psittacosis
  • Q fever (coxiella)
22
Q

How does atypical pneumonia start?

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A

Atypical pneumonia associated with mycoplasma or chlamydia often begins with sore throat and headache followed by NON-productive cough and dyspnea.

23
Q

Typical pneumonia CXR findings

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A

Lobar pneumonia or bronchopneumonia

24
Q

CXR finding of lobar pneumonia

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A
  • opacity in one or more lobes
  • air bronchograms
25
CXR findings of bronchopneumonia
- poorly defined patchy infiltrates scattered throughout the lungs - air bronchograms
26
Appearance of translucent bronchi inside opaque areas of alveolar consolidation on CXR
air bronchogram
27
Atypical pneumonia findings
Interstitial pneumonia - diffuse reticulonodular infiltrates; diffuse reticular opacities
28
When is chest CT indicated?
- inconclusive chest X-ray - recurrent pneumonia - poor response to ABX
29
Indications for sputum culture and gram stain
- severe CAP - patient with a history of parenteral ABX in the hospital in the last 90 days - currently on MRSA or pseudomonal ABX - structural lung disease
30
CURB-65
C - confusion U - urea ( >7 mmol/L) or BUN > 20mg/dL R - RR of 30+ B - BP less than 90 systolic or 60 diastolic 65 - 65+ years old
31
What CURB-65 score qualifies for inpatient treatment?
2+
32
Monotherapy for OUTPATIENT CAP in a previously healthy patient with NO co-morbidities
1. amoxicillin 2. doxycycline 3. macrolide (clarithromycin or azithromycin)
33
Combination therapy for OUTPATIENT CAP in a patient with co-morbidities or risk factors for resistant pathogens
1. beta-lactam + macrolide 2. beta-lactam + doxycycline
34
Monotherapy for OUTPATIENT CAP in a patient with co-morbidities or risk factors for resistant pathogens
Fluoroquinolone
35
When should patients being treated outpatient follow up?
In 48-72 hours
36
Monotherapy for INPATIENT CAP
Fluoroquinolone
37
Combination therapy for INPATIENT CAP
1. beta-lactam + macrolide 2. beta-lactam + doxycycline
38
Combination therapy for INPATIENT CAP with risk factors for pseudomonas
1. anti-pseudomonal beta-lactam + macrolide 2. anti-pseudomonal beta-lactam + doxycycline 3. anti-pseudomonal beta-lactam + fluoroquinolone
39
Who should receive double antipseudomonal coverage?
Patients with structural lung disease and/or high risk for mortality
40
Empiric antibiotics for ventilator-associated pneumonia
1. beta-lactam + Vanc (MRSA) + fluoroquinolone
41
Antibiotics for CAP to avoid in pregnancy
clarithromycin (azithromycin is preferred), fluoroquinolones, tetracyclines
42
Complications of pneumonia
- pleuritis - pleural effusion - empyema - lung abscess - ARDS - respiratory failure - sepsis
43
A complication of lung masses that occlude the large and medium airways, usually due to centrally located primary lung malignancy
Post-obstructive pneumonia
44
Presentation of pneumonia
- fever - tachycardia - tachypnea - leukocytosis - new pulmonary infiltrate on CXR

Step 2 CK (44 decks)

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