Clinical and Pathological Correlation of Pneumonia Flashcards
What is rusty sputum characteristic for?
What is current jelly characteristic for?
Pneumococcal pneumonia
Klebsiella
When the patient says E but it is heard as A, what does this indicate?
Consolidation
What are the causes of fluffy CXR?
Mnemonmic device?
Alveolar
PeCanPIE
Etiology of CAP most common?
Technically NOT IDENTIFIED IS MOST COMMON. When there is an organism, it is Streptococcus pneumoniae
What is pneumonia vs. pneumonitis?
Pneumonia means INFECTION OF THE LUNG PARENCHYMA!. Pneumonitis can JUST MEAN INFLAMMATION. can be infection or something else.
Why is Atypical pneumonia atypical?
What are the associated organisms?
ATYPICAL BECAUSE OF THE PATHOGEN
Can be moderate to no sputum, no physical findings of lung consolidation with moderate to no elevation in WBCs and lack of alveolar exudate.
Atypicals are
Mycoplasma pneumoniae
Chlamydia pneumoniae
Chylamydia trachomatis (newborns)
Legionella pneumophila
.
What would not cause you to suspect pseudomonas and why?
bronchiectasis
steroids greater than 10mg/day
alcoholism
Broad specturm abx >7 days in past month
malnutrition
Alcoholism because while it is an immunosuppressant, just not for pseudomonas aeruginosa
What is the characteristic for pseudomonas aeruginosa
cystic fibrosis patients
What organism should you suspect in alcoholics?
ALPS, alcoholic low white count Sepsis
SUSPECT KLEBISELLA AND PNEUMONCOCCAL PNEUMONIA.
What are the modifying factors for PCN resistant and drug resistant pneumococci
age>65
betalactam within past 3 months
alcoholism
immunosuppression
multiple medical comorbidities
exposure to child at a day care
when should you suspect enteric gram negatives?
nursing home resident
cardiopulmonary disease
multiple medical comorbidities
recent antibiotic therapy
When should you suspect pseudomonas aeruginosa?
Bronchiectasis
steroids>10mg/day
BSA>7days in past month
malnutrition
Treatments for:
Outpatient without modifying risk factors or cardiopulmonary disease
vs.
Outpatient with modifying risk factors or cardiopulmonary disease
Advanced generation macrolide or doxycycline
vs.
Oral beta lactam plus (macrolide or doxycycline)
or Antipneumoncoccal fluoroquinolone alone
WHen should you admit a patient?
CURB-65
Confusion
Urea (>19.1 mg/dl)
Respiratory rate>30 breaths/min
Blood pressure <90 systolic or (<or></or>
<p>Age greater than or equal to 65.</p>
</or>
What to do for diagnostic evaluation?
Time to first dose of antibiotic?
CXR, 2 sets of pre treatment blood cultures.
Sputum gram stain and culture. if patient has productive cough, do not withold antibiotics.
Give first dose abx before 8 hours after presentation
What do you want for a sputum?
no squamous cells and lots of white cells. (25 and less than 3 epithelial cells)
Treatments for
Hospitalized non icu without c-p disease or modifying risk factors
vs.
Hospitlaized non icu with c-p diseae or modifying risk factors
IV macrolide alone (if intolerate, iv beta lactam plus doxycycline)
or antipneumococcal fluoroquinolone alone
vs.
IV beta-lactam plus (macrolide or doxycycline)
Antipneumococcal fluoroquinolone alone
Treatment if
ICU admited without risk factor for pseudomonas aeruginosa
vs.
Hospitalized non ICU w/ risk factor for pseudomonas aeruginosa
IV beta lactam (cefotaxime, ceftriaxone) plus IV macrolide
or Antipneumococcal fluoroquinolone alone.
UVa- if MRSA colonized, gram + cocci in sputum can give IV vancoymycin
vs.
IV beta-lactam with antipseudomonal activity plus antipseudomonal fluoroquinolone (cipro)
IV beta-lactam with antipseudomonal activity plus aminoglycoside plus IV atypical coverage
When can you say resolution of CAP?
in uncomplicated stable patient 72 hrs permitted for response.
- fever resolves 2-4 days after onset of abx
- WBC resolves by 4 days after onset of ABX
- PEx findings can persist >7 days in 20-40%
Clearing of opacities on CXR, 50% by 2 weeks, 67% by 4 weeks, 75% by 6 weeks (so if you don’t think theres a high likelihood of a cancer you would wait 6 weeks for a follow up with specialist otherwise you’re wasting their time and money)
What is the criteria to be met for IV to oral therapy?
Improvement of fever
improvement in cough and respiratory distress
Improvement in leukocytosis
Normal GI tract absorption
How long for therapy to be in uncomplicated stable patients?
When to arrange followup?
Anything else?
Total course of therapy 7-14 days (or 10 to make it simpler)
Arrange follow up in 2-3 days
Pneumovax and influenza vaccines
