CAP Flashcards

1
Q

Duration of therapy in treatment of Community Acquired Pneumonia

A

Minimum treatment at least 5 days

Afebrile for 48-72 hours

Procalcitonin can guide abx cessation

No more than one CAP associated sign of instability (low BP, low O2, high RR, high HR)

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2
Q

Indications (8) for sputum cultures in diagnosis of Community Acquired Pneumonia

A

ICU/severe pneumonia
Prior hospital stay
Abx in last 90 days/abx failures
Cavitary lesions
Alcohol use
Severe obstructive lung disease
Pleural effusion
Positive urine for pneumococcus or legionella

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3
Q

Prevention of Community Acquired Pneumonia

A

PREVNAR-20

Flu vaccine (all patients 6 months or older get yearly, high dose if 65+)

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4
Q

Antibiotics (3) selection in treatment of Community Acquired Pneumonia patient who is inpatient, without MRSA or pseudomonas

A

IV B-lactam + macrolide

Fluroquinolone

IV B-lactam + doxycycline (if fluoroquinolone or macrolide allergy)

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5
Q

On chest x-ray you see bilateral lower lobe infiltrates in a patient with Community Acquired Pneumonia patient. What do you suspect is causing this patient’s conidition?

A

Mycoplasma

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6
Q

MRSA risk factors (3)

A

Recent influenza
Fluoroquinolones in previous 30-60 days
Cramped living conditions/contact sports

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7
Q

True or false. Sputum cultures are routinely recommended for diagnosis of Community Acquired Pneumonia

A

False

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8
Q

True or false. Blood cultures are routinely recommended in the diagnosis of Community Acquired Pneumonia

A

False. But can be helpful in critically ill

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9
Q

When are urine antigen tests indicated in Community Acquired Pneumonia, and what might they detect?

A

Indicated in severe CAP

Used to detect s. pneumoniae and legionella

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10
Q

Diagnosis for Community Acquired Pneumonia

A

GOLD STANDARD = Chest x-ray (PA + lateral)

If negative C-XR with high suspicion either:
- Get CT for better visibility
- Repeat C-XR after 24 hours

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11
Q

Antibiotics (2) selections in treatment of a Community Acquired Pneumonia patient with DRSP risk factors and is outpatient

A

B-lactam (augmentin or ceph) + doxycycline or macrolide

Fluoroquinolone (levo or moxifloxacin)

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12
Q

Community Acquired Pneumonia symptoms

A

Pleuritic chest pain that is focal and with inspiration

Cough, fever, chills, dyspnea, sputum production

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13
Q

Describe methods used to classify the severity of Community Acquired Pneumonia

A

PSI score: More sensitive, better for high risk patients, complex (let EHR do it)

CURB-65: More specific
- Confusion
- Uremia (BUN >20)
- Resp rate (>30)
- Blood pressure (<90/60)
- 65+ years old

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14
Q

Antibiotics (3) selection in treatment of Community Acquired Pneumonia patient who is healthy, without DRSP risk factors, and is outpatient

A

Amoxicillin

Doxycycline

Macrolides (azithromycin good because anti-inflammatory)

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15
Q

Antibiotics selection in treatment of Community Acquired Pneumonia patient who is inpatient, with risk for MRSA or pseudomonas

A

B-lactam
+
Azithromycin OR fluoroquinolone
+
IV linezolid OR IV vancomycin

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16
Q

Most common cause of Community Acquired Pneumonia

A

Strep pneumoniae

17
Q

Risk factors (6) for antibiotic resistance in treatment of Community Acquired Pneumonia

A

Age 65+
Beta-lactam, fluoroquinolone, macrolide therapy in past 1-3 months
Alcoholism
Medical co-morbidities
Immunosuppression
Exposure to daycare children

18
Q

In the treatment of Community Acquired Pneumonia, antibiotics must cover all (5) of these bacteria

A

S. pneumoniae
M. pneumoniae
H. influenza
C. pneumoniae
S. aureus

19
Q

What biologic marker is detected in diagnosis of Community Acquired Pneumonia and how does it guide treatment?

A

Procalcitonin

Presence suggests bacterial infection rather than viral

Most helpful in determining when to discontinue antibiotics (once procalcitonin starts to decrease)