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Clinical 2.0 > CAP - LRTI > Flashcards

CAP - LRTI Flashcards

1
Q

clinical signs and symptoms of pneumonia

A 
cough 
sputum production 
crackles
consolidation
tachypnea
dyspnea
hypoxia
hemoptysis 
pleural pain 
fever
chills
tahcycardia 
leukocytosis
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2
Q

elderly presentation of pneumonia

A

wihtout cough sputum or leukocytosis
fever not as common
more difficult to diagnose

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3
Q

most common pathogen in pneumonia

A 
strep pneumoniae 
COPD
cardiovascular or renal disease
asplenic
diabetes 
immunocompromised
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4
Q

mycoplasma pneumoniae

chlamydophilia pneumoniae common pathogens in

A

adolescents

young and elderly adults

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5
Q

saureus common pneumonia pathogen in

A

immunocompromised

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6
Q

hinfluenza and moraxella catarrhalis common pneumonia pathogens in

A

COPD

smokinh

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7
Q

klebsiella pneumoniae, ecoli, enterobacter common pneumonia pathogen in

A

COPD
smoking
diabetes
alcoholism

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8
Q

paeruginose common pneumonia pathogen in

A

cystic fibrosis
COPD
corticosteroids
immunocompromised

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9
Q

anaerobes common pneumonia pathogens in

A

aspiraion
cerebrovascular disease
neurological disease
alcoholism

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10
Q

how is community acquired pneumonia diagnosed

A

clinical signs and symptoms
lung infiltrate on xray
low culture yield in sputum due to poor quality sampling and fastidious or slow growing pathogens
improved yield in endothelial lining fluid obtained by bronchoaveolar lavage
postive blood culture in 25% of cases
ie. very hard to determine pathogen

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11
Q

mycoplasma pneumoniae infection characteristics

A

peak incidence in older children young adults and elderly
incubation 2-3 weeks
pharyngitis, tracheobronchitis, pneumonia
gradual onset fever, headache, GI, malaise, arthralgia,, myalgia, rash for 1-2 weeks followed by nonproductive cough for 3-4 weeks

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12
Q

chlamydophila pneumoniae infection presentation

A

young adults

mild resp symptoms, fever, headache

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13
Q

legionella pneumophilia infection presentation

A

ubiquitous in water and soil
outbreaks wiht peak in summer and fail, associated with air ventilation systems
rapidly progressiv epneumonia with multisystem involvement
fever, malaise, arthralgia, pleuritic pain, cns and gi symptoms

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14
Q

what AM classes are effective against atypical pathogens

A

fluoroquinolones
macrolides
tetracyclines

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15
Q

empiric treatment for mild-mod infection

A

amox +/- macro or doxy
*macro or doxy for moderate illness or no improvement with amox after 3 days
macro - resistance concerns
doxy - less clinical dat

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16
Q

what are some risk factors for resistance or poor outcomes

A

prior AM or hospitalization within 3 months
chronic lung, heart, liver, or renal dysfunction
diabetes
alcoholism
malignancy
asplenia
IC

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17
Q

empiric treatment for patients with risk factors for resistance or poor outcomes

A

amoxi -clav +macro or doxy (want to cover atypicals)
cefproz/cefurox + macro or doxy
levo/moxi only in serious illness, treatment failure, or in allergy

18
Q

why do we restrict the use of fluoroquinolones

A

concern of resistance
increase AE: CNS, hypersensitivity, QT prolongation, tendinitis
cant be used in pregnant women or children

19
Q

empiric treatment for severe infection requiring hospitalization

A

levo/moxi
cefotax/cetriax + azithro
if ICU cefotax/ceftriax + levo/moxi

20
Q

response to mild mod CAP

A

clinical improvement in 2-3 days

complete resolution in weeks

21
Q

duration of therapy for mild-mod CAP

A

5-7 days

based on clinical response and resolution

22
Q

risk factors for LRTI

A 
elderly 
copd 
congestive heart failure
end stage renal disease
diabetes 
smoking
alcoholism 
cerebrovascular or neurological disease
IC
23
Q

what is used to stratify risk mortality

A

PSI - pneumonia severity index

CURB65

24
Q

in CAP that requires hospitalization what should you monitor

A

cough improve or is absent 2-3/7+ days
HR,RR, temp twice daily every 2-3 days
WBC every other day for 5-7days
chest xray repeat if deterioration >6wks

25
Q

step down plan for CAP that requires hospitalization

A

clinical improvement and hemodynamically stable
afebrile for 24-48 hours
choose agent with appropriate spectrum , reliable bioavailability, adequate concentrations, good tolerability

26
Q

CAP s.pneumoniae treatment oral pen s

A

po - amox

altern - levo/moxi

27
Q

CAP s.pneumoniae iv pen s

A

Pen G

altern - cefotax/ceftriax, vanco, linez

28
Q

CAP s.pneumoniae pen IR po

A

levo/moxi

alter: linez

29
Q

CAP s.pneumonia pen IR iv

A

HD pen G 24MU/d given q4h
or
cefotax/caftriax
alter: vanco, linez

30
Q

CAP h.influenzae oral

A

amox or amox-clav

alter: cefproz/cefurox, levo/moxi/cipro

31
Q

CAP h.influenzae iv

A

cefurox or cefotax/caftriax

alter: moxi/levo/cipro

32
Q

what is suggested for seriously ill patients with bacteremic pneumococcal pneumonia

A

combo therapy with a beta lactam plus a macrolide or levo/moxi

33
Q

most commone CAP pathogen in children

A

viral 80%

if bacterial likely s pneumoniae

34
Q

what is a good way for children to decrease the risk of CAP

A

routine immunization

35
Q

po option for mild moderate CAP in infants and pre school children fully immunized empiric

A

amox 90mg/kg/d every 8-12hr

alternative if failure or previous beta lactam in previous month amox clav

36
Q

po empiric option for school aged immunized children for mild-mod CAP

A

amox 90mg q 12hr /- Macro for mycoplasma coverage

alternatives: cefprozil, clinda, linez

37
Q

response for CAP in children

A

clinical improvement in 2-3 days

38
Q

duration of therapy for CAP in children

A

10 days, shorter may be just as effective

39
Q

how should you use antimicrobials to min resistance

A

only when necessary and beneficial targeted at a known or suspected pathogen
in appropriate doses which optimize efficacy and min resistance
for shortest effective duration

40
Q

when should antiviral therapy be considered for treating CAP in infants and children

A

mod-sev

particularly worsening disease consistent with influenza infection during widespread circulation

41
Q

if viral therapy for cap in children initiated what are some choices, when to start, and AE

A

neuraminidase inhibitors - oseltamivir
initiated 48hrs within onset of illness
precaution for neuropsychiatric disturbances

Clinical 2.0 (24 decks)

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