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PHM 603 > CAP/HAP/LRTI/URTI > Flashcards

CAP/HAP/LRTI/URTI Flashcards

1
Q

CAP Main Causative Agent

A

S. Pneumoniae

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2
Q

Main difference between In/Outpatient CAP

A

Inpatient caused by more atypical agents

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3
Q

Typical Characteristics

A

OCCUR W/IN 24 HR (abrupt onset): fever/chills/sweats, purulent sputum production, unilateral well-defined infiltrate, cough, general predominance of pleuritic chest pain (primarily pulmonary sx)

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4
Q

Atypical Characteristics

A

Gradual Onset: diffuse infiltrates (ground-glass appearance), mild fever/dyspnea, dry cough, myalgias,/diarrhea/abdominal pain (extrapulmonary sx common)

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5
Q

CAP: S. Pneumoniae RF

A

Rusty colored sputum (SEVERE, maybe mild/mod)

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6
Q

CAP: H. Influenzae, M. Catarrhalis RF

A

COPD, EtOH abuse, CF, HIV, Impaired Humoral Immunity

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7
Q

CAP: Anaerobes RF

A

Loss of consciousness after EtOH/drug overdose, post seizure, gingival disease, esophageal motility disorder

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8
Q

CAP: CA-MRSA RF

A

RARE; After influenza, cavity lesions, Severe CAP/ICU admission, empyema

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9
Q

CAP: Legionella pneumophilia

A

Occurs after water exposure/more in males/smokers; presents w/ severe hypophosphatemia, hyponatremia, diarrhea, confusion, HA, Bradycardia, LFT elevations, pulse-temperature dissociation; ABX include FQ (IV LEVO 10-21d), Azithromycin

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10
Q

CAP Outpatient Treatment

A 
PO AMOXICILLIN (Doxycycline if Blactam allergy, Macrolide)
Comorb: PO Augmentin or Cephalosporin (cefpodox, cefdinir, cefurox) + Macrolide (azithro, clarithro)
*PO FQ (levo, moxi)
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11
Q

CAP Comorbidities

A

Age <2 or >65, Blactam w/in 3 mo prior, EtOH abuse, Immunosuppression, exposure to daycare, cancer, chronic respiratory disease

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12
Q

CAP Inpatient Treatment

A

Non-severe/Severe: IV Blactam (amp/sul, CEFTRIAXONE) + Macrolide/FQ
*de-escalate asap

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13
Q

Severe CAP defined as…

A

SEPSIS

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14
Q

CAP ABX Duration

A

5-7d (for severe may go longer), should be afebrile for 48-72 hrs

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15
Q

CAP Pretreatment Tests

A

Blood cultures and Sputum samples for all w/ anti-MRSA/Pseudomonal abx orders
Urinary Antigen Test for Legionella and S. pneumoniae for those w/ Severe CAP

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16
Q

Switch from IV to PO…

A

when hemodynamically stable, clinical improvement, can tolerate PO, normal functioning GI

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17
Q

Viral Pneumonia (non-covid)

A

More common in kids, signif morbidity in elderly, can result in co-infection w/ bacteria

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18
Q

CAP Main Causative Agent

A

+:S. Aureus (MRSA)

-: K. Pneumoniae, P. Aeruginosa

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19
Q

Empiric Therapy for HAP/VAP?

A

Broad: late onset (>5d) of MDR RF (prior abx, colonization, hospitalization, chronic care, immunosuppressive disease/therapy)
*limited otherwise

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20
Q

HAP/VAP Empiric Therapy

A

Ceftriaxone -> Amp/Sul (reserve levo/moxi, ertapenem for Blactam allergy)

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21
Q

HAP/VAP Empiric MRSA Coverage…

A

when: prior IV abx use w/in prev 90d, >20% MRSA in area, severe presentation (septic shock, vent. support), prev inf)
how: Vancomycin, Linezolid

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22
Q

HAP/VAP Empiric Pseudomonas Coverage…

A

when: prior IV abx use w/in prev 90d, severe presentation (septic shock, vent. support), prev inf), immunosuppression
how: CEFEPIME, Pip/Tazo (renaltox)
* Ceftazidime, Imipenem. Meropenem, Aztreonam, FQ (cip/levo), aminoglycosides, Colistin/PolyB reserved

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23
Q

HAP/VAP Cultures

A

1st obtain cultures noninvasively (endotracheal aspiration) and then BAL if possible

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24
Q

HAP/VAP ABX Duration

A

7d

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25
Pneumonia Definition
New lung infiltrate & clinical evidence that it's of infectious origin (onset of fever, purulent sputum, leukocytosis, dec O2) * RR>30, HR>100, Fever>100 * WHEN REACHES ALVEOLI
26
Pneumonia S/Sx
COUGH, SPUTUM PROD, DYSPNEA, FEVER&CHILLS, hemoptysis, pleuritic chest pain, tachypnea, tachycardia, diminished breath sounds, egophony, inc wbc *commonly see bilateral infiltration
27
Gram Stains LRTI
S. Pneumoniae (+ diplococci), S. Aureus (+ cocci), H. Influenzae (- coccobacilli), M. Catarrhalis (- diplococci), K. Pneumoniae (- plump rods), P. Aeruginosa (- thin rods)
28
LRTI Diagnostics
BAL (invasive), Blood Cultures (admitted&severe), Procalcitonin (severe/sepsis), O2 Sat, Urinary Antigen Testing (Pneumococcal, Legionalla), Viral Panel
29
CURB-65
Tells whether or not patient should be admitted 0-1: OUT 2: IN >/3: ICU
30
CURB-65 Criteria
``` Confusion +1 Uremia (BUN>20) +1 RR>/30 +1 SBP<90/DBP<60 +1 Age>65 +1 ```
31
Pneumonia Severity Index (PSI)
Takes in more complexities than CURB-65 for Pneumonia Admission
32
Pneumonia Severity Index (PSI) Complexities
Demographics, coexisting illness, PE findings, Age, Sex, Nursing Home, Cancer, Liver, HF, CVA, Renal, Altered Mental Status, RR, SBP, Temp, Pulse, pH, BUN, Na, Glucose, HCT, Pleural Effusions, O2 Req
33
CAP Definition
No exposure to the healthcare system
34
HAP Definition
Pneumonia not incubating at time of admission and occurring >/48hrs after admit (incl. coming from community who received IV abx w/in 90d of admit)
35
VAP Definition
Pneumonia occurring .48hrs after endotracheal intubation
36
OM Common Pathogens
S. Pneumoniae, H. Influenzae, M. Catarrhalis
37
OM S/Sx
Middle Ear fluid, Inflam of middle ear mucosa (erythema of tympanic membrane), ear pain, ear drainage, hearing loss, nonspecific fever/lethargy/irritability
38
OM Criteria
MIDDLE EAR EFFUSION + mod/severe bulging of tympanic mem/new onset otorrhea OR mild bulging & onset of ear pain within last 48hr/intense erythema of tympanic mem
39
OM Management
Vaccination: Pneumococcal Conjugate (PCV7), Influenza ABX: ACUTE OM Pain: PO APAP/IBU, OTIC IBU (5-12y); All PRN for up to 1w
40
OM ABX?
``` YES-- 6mo-12y: mod-sev pain OR temp 102.2 6-23mo: nonsevere bilateral acute OM CONSIDER-- 6mo-12y:acute nonsevere OM 6-23mo: nonsevere unilateral OM ```
41
OM ABX Dosing
1st: Amox 80-90 mg/kg in 2 doses OR Augmentin (90 mg/kg Amox w/ 6.4 mg/kg of Clav *4:1 ratio) in 2 doses if have used Amox w/in 30d, have purulent conjunctivitis, or recurrent unresponsive to Amox *2nd Gen Cephalosporins Alternatively (Pen Allergy) AFTER 2-3d of failed ABX: Augmentin (dosing above) or Ceftriaxone (50 mg IM/IV for 3d)
42
Corticosteroids for COPD Exacerbation Treatment
Duration/Route provides no difference in mortality or relapse of sx
43
Use of ABX in COPD Exacerbation
When patient has inc dyspnea, inc sputum prod, inc sputum purulence *or just 2 if 1 is sputum purulence ALSO anyone req mechanical vent w/ an exacerbation
44
ABX Duration for COPD Exacerbation
5-7d
45
ABX for COPD Exacerbation
Azithromycin, Doxycycline, Augmentin | *consider IV when admitted for respiratory decomp/SIRS
46
ABX for COPD Exacerbation
Azithromycin, Doxycycline, Augmentin | *consider IV when admitted for respiratory decomp/SIRS
47
Sinusitis Sx
Purulent anterior nasal discharge, Purulent or discolored posterior nasal discharge, Nasal congestion/obstruction, Facial congestion/fullness, Dec smell, Fever, HA, Ear pain/pressure/fullness, halitosis, dental pain, cough, fatigue
48
Sinusitis Treatment
Viral: Decongestants, Irrigation, Mucolytics Bacterial: NO decongestants/AntiHis
49
ABX Use for Sinusitis?
persistent sx >/10d w/o clinical improvement, severe sx (fever>102F, purulent nasal discharge, facial pain) >/3-4d @ beginning of illness, worsening sx after typ viral URTI of ~5d (double sickening, new onset fever, HA, inc nasal drainage)
50
Bacterial Sinusitis Treatment
S. Pneumoniae, H. Influenzae, M. Catarrhali
51
ABX of Choice for Bacterial Sinusitis
AUGMENTIN: use in region w/ >/10% pen-nonsuscept S. Pneumoniae, severe inf, attendance @ daycare, age <2/>65, recent hospitalization, abx use in prior month, immunocompromised
52
Alternate ABX for Bacterial Sinusitis
FQ, Clindamycin + Cefpodxime/Cefuroxime for mild allergies, Doxycycline
53
Bacterial Sinusitis ABX Duration
Adults: 5-7d Kids: 10-14d
54
Chronic Sinusitis
Sx persist >12w, most likely S. Pneumoniae or H. Influenzae, cultures rec
55
Pharyngitis Common Pathogens
GROUP A STREP, | *if viral mainly rhinovirus
56
Group A Strep Pharyngitis Characteristics
sudden onset sore throat, fever, HA, tonsilopharyngeal inflam, palatal petechiae, anterior cervical adenitis, scarlatinform rash
57
Viral Pharyngitis Characteristics
Conjunctivitis, Coryza, Cough, DIarrhea, Hoarseness, Discrete ulcerative stomatitis, viral exanthema
58
Pharyngitis Diagnosis
Throat Culture: sensitive, results in 24-48hrs | Rapid Antigen Test: specific, little less sensitive, 10-15 min results
59
When to treat Pharyngitis?
+ RADT/Throat Swab in symptomatic adults/children, + throat culture in children after a - RADT/Throat Swab
60
Pharyngitis ABX of Choice and Duration
Penicillin VK or Amoxicillin for 10d
61
Pharyngitis ABX Alternatives
Cephalexin (1st gen Ceph) x10d for mild pen allergy, Clindamycin x10d OR Azithromycin x5d for severe pen allergy *Benzathine pen IM x1 for unlikely adherence
62
Pharyngitis Adjunctive Treatment
APAP/NSAID, Lidocaine/Benzocaine | *DON'T USE CORTICOSTEROIDS

PHM 603 (4 decks)

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