121 - Pneumonia Flashcards by Salman Majid

Pneumonia is an __ of the lung’s __

inflammation

parenchyma

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Pneumocystis pneumonia and viral pneumonia usually involve the __ and are not __

alveoli

interstitium

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What are the 4 categories of pneumonia?

CAP- community acquired pneumonia
HAP- hospital acquired pneumonia
VAP- ventilator acquired pneumonia
MDR-multidrug resistant pneumonia

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What is the most common CAP pathogen?

Streptococcus pneumoniae

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What are the typical CAP pathogens? 5

S. pneumoniae
H. influenza
S. aureus
Klebsiella pneumoniae
Pseudomonas aeruginosa

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What are the atypical CAP pathogens? 4

Chlamydia pneumoniae
Mycoplasma pneumoniae
Legionella
Viruses (Influenza/adenovirus/human metapneumovirus/RSV)

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10-15% of CAP are __ combining both __ and __ pathogens

polymicrobial
typical
atypical

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__ pathogens tend to complicate and form __, __, and __

anaerobic
abscess
empyema
parapneumonic effusions

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Alcoholism typically cause CAP due to __, __, __, __

strep pneumoniae
oral anaerobes
Klebsiella pneumoniae
acinetobacter

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COPD/smoking typically cause CAP due to __, __, __, __

H. influenza
pseudomonas
legionella
strep pneumoniae

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Dementia/stroke typically cause CAP due to __, __

oral anaerobes

G (-) enteric bacteria

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Lung abscess typically cause CAP due to __, __, __, __

CA-MRSA
oral anaerobes
tuberculosis
atypical bacteria

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Travel to southeast Asia may cause CAP due to __, __

Hantavirus

coccidioides app

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When on a cruise sheep or in an hotel for > 2 weeks, CAP may develop, usually due to __

legionella

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Exposure to birds/bats may cause CAP due to __, __

H capsulatum

Chlamydia psittaci

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Exposure to goats/cats may cause CAP due to __, __

coxiella burnetii (Q fever)

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__% of CAP patients get ___ again within a __ from release

18
readmitted
month

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Mention 5 RF for CAP

alcoholism
asthma
immunosuppression
hospitalization
age >=70

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What are the RF for pneumococcal pneumonia? 6

dementia
seizures
HF
COPD/smoking
alcoholism
HIV

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RF for legionella include 7

diabetes
malignancy
RF
HIV
smoking
male
cruise/hotel

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Pneumatoceles = __

intrapulmonary gas-filled cystic spaces

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Pneumatoceles suggest __ infection

S. aureus

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Cavitary lesion in the upper lobe suggest __ infection

Tuberculosis

What are the 6 ways in which we can diagnose the etiology of CAP?

G stain + phlegm culture
blood culture
urine antigen
PCR
serology 
biomarkers /

Urine antigen allows to look for __ and __.

pneumococcus | legionella

The typical biomarkers used for pneumonia diagnosis are __ and __

CRP | procalcitonin

Procalcitonin is used to differentiate between __ and __ infection

viral | bacterial

What are the two criteria scales we use to decide if a CAP patients should be hospitalized or not?

PSI (pneumonia severity index) | CRUB 65

CRUB 65= __

``` Confusion RR >= 30/min Urea> 7mmol/L BP (systolic <= 90 mmHg, diastolic <= 60 mmHg) 65 <= age ```

CURB= 0: __ CURB= 1-2: __ CURB> 3: __

outpatient, mortality 1.5% within 30 days hospitalization, beside if age is the only positive ICU, mortality of 22%

Regardless of PSI and CURB 65, if the patient has __ or __, than __ is indicated.

septic shock respiratory failure ICU

The main RF for antibiotic resistant pneumococcal infection is using ___ in the last __ months

specific Abx | 3

For severe CAP __ reduce mortality

macrolides

CAP + ICU = __ against __, __ such as __+__

wide spectrum Abx pneumococcal and atypical azithromycin ceftriaxone

If the pathogen is immune to macrolides, use __. If that does not work- use __/ __+__

doxycycline fluoroquinolone beta lactam + macrolide

__is better than ceftriaxone for empiric treatment for CAP

ceftaroline

For pneumococcal pneumonia use __ + __/__

beta lactam (ceftriaxone) macrolide (azithromycin/clarithromycin) quinolone

When a CAP patient is stable- use __ __. If the pneumonia is uncomplicated, treat for __ days

oral fluoroquinolone 5

What are the correct supportive care treatment for pneumonia? What will you add in severe CAP

``` hydration oxygen vasopressors ventilation prednisone ```

If CAP patients do not respond to treatment within the first _ days, we can call it __ and should __

3 treatment failure reevaluate

In aspiration pneumonia __ should be added if __ is found

clindamycin | abscess

The imaging typical for pneumonia may endure for _-_ weeks

4-12

Primary prevention of pneumonia is with __

PCV13 (Prevenar)

CAP treated in the community should be given __ or __ if the patient is otherwise healthy and did not use Abx in the last __ months

macrolide doxycycline 3

CAP treated in the community should be given __ or __ or __ if the patient is has comorbidities / used Abx in the last __ months

``` fluoroquinolone (moxifloxacin/gemifloxacin/levofloxacin) beta lactam (amoxicillin/ augmentin) ceftriaxone, cefuroxime + macrolide/doxycycline ```

CAP patients requiring hospitalization should be treated with __ or __+__

fluoroquinolone (moxifloxacin/gemifloxacin/levofloxacin) beta lactam (ceftriaxone/ampicillin/ertapenem) macrolide

CAP patients requiring ICU should be treated with __ + __or__

beta lactam (ceftriaxone/ampicillin/ertapenem) azithromycin fluoroquinolone (moxifloxacin/gemifloxacin/levofloxacin)

If we suspect CAP due to pseudomonas treat with __+__

``` beta lactam (piperacillin/cefepime/tazobactam/meropenem/imipenem) fluoroquinolone (ciprofloxacin/levofloxacin) ```

If we suspect CAP due to CA-MRSA treat with __ or __ +__

vancomycin linezolid clindamycin

The main RF for VAP is __

endotracheal tube

In VAP, the more __ the sample is, the ,more __ it is. Other factors that can increase diagnosis are: 4

``` distal specific G stain CBC intracellular stain local proteins ```

Empirical Abx treatment for HAP/VAP patients with no RF for resistant G (-) pathogens includes: __/__/__

piperacillin cefepime levofloxacin

Empirical Abx treatment for HAP/VAP patients with resistant G (-) pathogens includes: 5 + 4

piperacillin/cefepime/ceftazidime/imipenem/meropenem amikacin/gentamicin/ciprofloxacin/levofloxacin

If VAP/HAP patient has a risk factor for MRSA add __/__

linezolid | vancomycin adjusted dose

In VAP/HAP patients, treatment course of _-_ days has the same effectiveness of _ weeks course, while leading to less resistant strains

7-8 | 2

The best way to avoid VAP is to avoid placing __. Other ways include: 3

``` endotracheal tube short term Abx prophylaxis raising the head of the bed to 30 degrees preventing gastric pH increase hygiene ```