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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
Q

Pneumonia Definition

A

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
Q

Pneumonia S/Sx

A

COUGH, SPUTUM PROD, DYSPNEA, FEVER&CHILLS, hemoptysis, pleuritic chest pain, tachypnea, tachycardia, diminished breath sounds, egophony, inc wbc
*commonly see bilateral infiltration

27
Q

Gram Stains LRTI

A

S. Pneumoniae (+ diplococci), S. Aureus (+ cocci), H. Influenzae (- coccobacilli), M. Catarrhalis (- diplococci), K. Pneumoniae (- plump rods), P. Aeruginosa (- thin rods)

28
Q

LRTI Diagnostics

A

BAL (invasive), Blood Cultures (admitted&severe), Procalcitonin (severe/sepsis), O2 Sat, Urinary Antigen Testing (Pneumococcal, Legionalla), Viral Panel

29
Q

CURB-65

A

Tells whether or not patient should be admitted
0-1: OUT
2: IN
>/3: ICU

30
Q

CURB-65 Criteria

A 
Confusion +1
Uremia (BUN>20) +1
RR>/30 +1
SBP<90/DBP<60 +1
Age>65 +1
31
Q

Pneumonia Severity Index (PSI)

A

Takes in more complexities than CURB-65 for Pneumonia Admission

32
Q

Pneumonia Severity Index (PSI) Complexities

A

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
Q

CAP Definition

A

No exposure to the healthcare system

34
Q

HAP Definition

A

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
Q

VAP Definition

A

Pneumonia occurring .48hrs after endotracheal intubation

36
Q

OM Common Pathogens

A

S. Pneumoniae, H. Influenzae, M. Catarrhalis

37
Q

OM S/Sx

A

Middle Ear fluid, Inflam of middle ear mucosa (erythema of tympanic membrane), ear pain, ear drainage, hearing loss, nonspecific fever/lethargy/irritability

38
Q

OM Criteria

A

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
Q

OM Management

A

Vaccination: Pneumococcal Conjugate (PCV7), Influenza
ABX: ACUTE OM
Pain: PO APAP/IBU, OTIC IBU (5-12y); All PRN for up to 1w

40
Q

OM ABX?

A 
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
Q

OM ABX Dosing

A

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
Q

Corticosteroids for COPD Exacerbation Treatment

A

Duration/Route provides no difference in mortality or relapse of sx

43
Q

Use of ABX in COPD Exacerbation

A

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
Q

ABX Duration for COPD Exacerbation

A

5-7d

45
Q

ABX for COPD Exacerbation

A

Azithromycin, Doxycycline, Augmentin

*consider IV when admitted for respiratory decomp/SIRS

46
Q

ABX for COPD Exacerbation

A

Azithromycin, Doxycycline, Augmentin

*consider IV when admitted for respiratory decomp/SIRS

47
Q

Sinusitis Sx

A

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
Q

Sinusitis Treatment

A

Viral: Decongestants, Irrigation, Mucolytics
Bacterial: NO decongestants/AntiHis

49
Q

ABX Use for Sinusitis?

A

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
Q

Bacterial Sinusitis Treatment

A

S. Pneumoniae, H. Influenzae, M. Catarrhali

51
Q

ABX of Choice for Bacterial Sinusitis

A

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
Q

Alternate ABX for Bacterial Sinusitis

A

FQ, Clindamycin + Cefpodxime/Cefuroxime for mild allergies, Doxycycline

53
Q

Bacterial Sinusitis ABX Duration

A

Adults: 5-7d
Kids: 10-14d

54
Q

Chronic Sinusitis

A

Sx persist >12w, most likely S. Pneumoniae or H. Influenzae, cultures rec

55
Q

Pharyngitis Common Pathogens

A

GROUP A STREP,

*if viral mainly rhinovirus

56
Q

Group A Strep Pharyngitis Characteristics

A

sudden onset sore throat, fever, HA, tonsilopharyngeal inflam, palatal petechiae, anterior cervical adenitis, scarlatinform rash

57
Q

Viral Pharyngitis Characteristics

A

Conjunctivitis, Coryza, Cough, DIarrhea, Hoarseness, Discrete ulcerative stomatitis, viral exanthema

58
Q

Pharyngitis Diagnosis

A

Throat Culture: sensitive, results in 24-48hrs

Rapid Antigen Test: specific, little less sensitive, 10-15 min results

59
Q

When to treat Pharyngitis?

A

+ RADT/Throat Swab in symptomatic adults/children, + throat culture in children after a - RADT/Throat Swab

60
Q

Pharyngitis ABX of Choice and Duration

A

Penicillin VK or Amoxicillin for 10d

61
Q

Pharyngitis ABX Alternatives

A

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
Q

Pharyngitis Adjunctive Treatment

A

APAP/NSAID, Lidocaine/Benzocaine

*DON’T USE CORTICOSTEROIDS

PHM 603 (4 decks)

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