112114 clinical and path Flashcards
rusty sputum
classic for pneumococcal pneumonia
causes of CAP-what organisms most often?
strep
myco
chlam
leg
atypical pneumonia findings
moderate to no sputum
no physical findings of lung consolidation (like E/A sounds)
moderate to no elevation in WBCs
lack of alveolar exudate
in actuality, these do not help differentiate
what antibiotics are used for atypical pneumonia
macrolides
quinolones
PCN resistant and drug resistant pneumococci develop in whom with CAP?
modifying risk factors-- age over 65 beta lactam in past 3 months alcoholism immunosuppression multiple medical comorbidities exposure to child at day care center
enteric gram negatives develop in whom with CAP?
nursing home resident
cardiopulm dis
multiple medical comorbities
recent antibiotic therapy
p aeruginosa develops in whom?
bronchiectasis
steroids more than 10 mg/day
malnutrition
how long should you wait for resolution of CAP?
72 hours
clearing of opacities on CXR will occur in 75% at what time point for CAP?
6 weeks
what if pt, after antibiotics, fails to improve?
maybe inadequate antimicrobial selection unusual pathogens (blasto, non-bac) non-infectious illnesses (PE, CHF, neoplasm) metastatic infections (pleural space, joints, etc)
what is the first question we ask for a pleural effusion?
transudate vs exudate
how do you determine if it’s an exudate?
LIght’s criteria
PF-LDH > 2/3 upper limit of serum normal
PF/S-LDH >0.6
PF/S-protein >0.5
any one of the above three means it’s exudate
parapneumonic effusion
pleural effusion
should we use a chest tube?
see slide 33
approach to dyspnea
chest wall pleural space parenchyma (alveolar, interstitial) airways nerve cardiac (1/3 of pts) blood (anemia) psychogenic
