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PPS Diplomate Exam > Clinical Practice Guidelines - PCAP > Flashcards

Clinical Practice Guidelines - PCAP Flashcards

1
Q

Predictors of PCAP:

3 mos. - 5 yrs.

A

tachypnea

chest indrawing

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2
Q

Predictors of PCAP:

5-12 yrs.

A

fever
tachypnea
crackles

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3
Q

Predictors of PCAP:

> 12 yrs.

A

fever (> 37.8°C)
tachypnea (> 20 bpm)
tachycardia (> 100 bpm)
at least 1 abnormal chest finding (rhonchi, crackles, wheezes, ↓BS)

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4
Q

_____ is still the best predictor of pneumonia.

A

Tachypnea

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5
Q

Tachypneic RR for 2-12 mos.

A

≥ 50 bpm

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6
Q

Tachypneic RR for 1-5 yrs.

A

≥ 40 bpm

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7
Q

Tachypneic RR for > 5 yrs.

A

≥ 30 bpm

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8
Q

Who will require admission?

A

mod.-high risk for pneumonia-related mortality

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9
Q

Patients with minimal-low risk can be managed on an _____.

A

outpatient basis

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10
Q 
PCAP A (Minimal Risk):
Co-Morbidities
A

none

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11
Q 
PCAP A (Minimal Risk):
Compliant Caregiver
A

yes

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12
Q 
PCAP A (Minimal Risk):
Able to Follow-Up
A

yes

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13
Q 
PCAP A (Minimal Risk):
Dehydration
A

none

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14
Q 
PCAP A (Minimal Risk):
Able to Feed
A

yes

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15
Q 
PCAP A (Minimal Risk):
Age
A

> 11 mos.

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16
Q 
PCAP A (Minimal Risk):
Respiratory Rate
A

2-12 mos. - ≥ 50 bpm
1-5 yrs. - ≥ 40 bpm
> 5 yrs. - ≥ 30 bpm

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17
Q 
PCAP A (Minimal Risk):
Signs of Respiratory Failure
A

none

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18
Q 
PCAP A (Minimal Risk):
Sensorium
A

awake

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19
Q 
PCAP A (Minimal Risk):
Complications
A

none

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20
Q 
PCAP A (Minimal Risk):
Management
A

OPD

follow-up at the end of treatment

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21
Q 
PCAP B (Low Risk):
Co-Morbidities
A

present

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22
Q 
PCAP B (Low Risk):
Compliant Caregiver
A

yes

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23
Q 
PCAP B (Low Risk):
Able to Follow-Up
A

yes

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24
Q 
PCAP B (Low Risk):
Dehydration
A

mild

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25
Q 
PCAP B (Low Risk):
Able to Feed
A

yes

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26
Q 
PCAP B (Low Risk):
Age
A

> 11 mos.

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27
Q 
PCAP B (Low Risk):
Respiratory Rate
A

2-12 mos. - ≥ 50 bpm
1-5 yrs. - ≥ 40 bpm
> 5 yrs. - ≥ 30 bpm

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28
Q 
PCAP B (Low Risk):
Signs of Respiratory Failure
A

none

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29
Q 
PCAP B (Low Risk):
Sensorium
A

awake

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30
Q 
PCAP B (Low Risk):
Complications
A

none

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31
Q 
PCAP B (Low Risk):
Management
A

OPD

follow-up after 3 days

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32
Q 
PCAP C (Moderate Risk):
Co-Morbidities
A

present

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33
Q 
PCAP C (Moderate Risk):
Compliant Caregiver
A

no

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34
Q 
PCAP C (Moderate Risk):
Able to Follow-Up
A

no

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35
Q 
PCAP C (Moderate Risk):
Dehydration
A

moderate

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36
Q 
PCAP C (Moderate Risk):
Able to Feed
A

no

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37
Q 
PCAP C (Moderate Risk):
Age
A

< 11 mos.

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38
Q 
PCAP C (Moderate Risk):
Respiratory Rate
A

2-12 mos. - ≥ 60 bpm
1-5 yrs. - ≥ 50 bpm
> 5 yrs. - ≥ 35 bpm

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39
Q 
PCAP C (Moderate Risk):
Signs of Respiratory Failure
A

intercostal retractions
subcostal retractions
head bobbing
cyanosis

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40
Q 
PCAP C (Moderate Risk):
Sensorium
A

irritable

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41
Q 
PCAP C (Moderate Risk):
Complications
A

present

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42
Q 
PCAP C (Moderate Risk):
Management
A

ward

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43
Q 
PCAP D (High Risk):
Co-Morbidities
A

present

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44
Q 
PCAP D (High Risk):
Compliant Caregiver
A

no

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45
Q 
PCAP D (High Risk):
Able to Follow-Up
A

no

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46
Q 
PCAP D (High Risk):
Dehydration
A

severe

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47
Q 
PCAP D (High Risk):
Able to Feed
A

no

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48
Q 
PCAP D (High Risk):
Age
A

< 11 mos.

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49
Q 
PCAP D (High Risk):
Respiratory Rate
A

2-12 mos. - ≥ 70 bpm
1-5 yrs. - ≥ 50 bpm
> 5 yrs. - ≥ 35 bpm

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50
Q 
PCAP D (High Risk):
Signs of Respiratory Failure
A 
supraclavicular retractions
intercostal retractions
subcostal retractions
head bobbing
cyanosis
grunting
apnea
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51
Q 
PCAP D (High Risk):
Sensorium
A

lethargic
stuporous
comatose

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52
Q 
PCAP D (High Risk):
Complications
A

present

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53
Q 
PCAP D (High Risk):
Management
A

ICU

refer to specialist

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54
Q

_____ on admission was the best predictor of death.

A

Retractions (23x ↑)

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55
Q

The risk of death in children was highest among those with _____.

A

intercostal and subcostal retractions

56
Q

Cyanosis and head bobbing correlates well with _____.

A

hypoxemia

57
Q

Best Predictors of Hypoxemia

A

inability to cry
head bobbing/nodding
RR > 60 bpm

58
Q

Diagnostic Aids for PCAP A and B

A

none

59
Q

Diagnostic Aids for PCAP C and D

A 
CXR PAL
WBC Count
Blood CS (PCAP D)
Pleural Fluid CS
Tracheal Aspirate CS
ABG
Pulse Oximetry
Sputum CS (older children)
60
Q

_____ on CXR is sensitive for bacterial pneumonia.

A

Alveolar Consolidation

61
Q

CXR serves 2 functions in PCAP:

A
  1. stronger basis for stratification of risk

2. therapeutic intervention

62
Q

Children who are _____ of age with a fever _____ of unknown origin may need a CXR.

A

< 5 years, > 39°C

63
Q

CXR as a baseline study for PCAP is _____.

A

not warranted

64
Q

PCAP is more likely when WBC count is _____.

A

> 15,000

65
Q

Acute phase reactants _____ and _____ cannot differentiate between viral and bacterial PCAP.

A

ESR, CRP

66
Q

Culture Studies for PCAP

A

Blood CS x 2 sites
Pleural Fluid CS
Tracheal Aspirate CS (1st intubation)
Sputum CS

67
Q

ABG and pulse oximetry must be done for _____.

A

all patients being considered for admission

68
Q

When is antibiotic therapy recommended in PCAP A or B?

A

> 2 y.o.

high grade fever without wheeze

69
Q

When is antibiotic therapy recommended in PCAP C?

A

> 2 y.o.
high grade fever without wheeze
alveolar consolidation
WBC > 15,000

70
Q

When is antibiotic therapy recommended in PCAP D?

A

always

71
Q

_____ is the best predictor of the underlying etiology of PCAP.

A

Age

72
Q

During the first 2 years of life, pneumonia is usually _____ in etiology.

A

viral

73
Q

As age increases, bacterial pathogens such as _____ become more prevalent.

A

Streptococcus pneumoniae - most common
Haemophilus influenzae Type B
Mycoplasma sp.
Chlamydia sp.

74
Q

Features of Bacterial PCAP

A

fever > 38.5° C

(-) wheeze

75
Q

Features of Viral PCAP

A

fever < 38.5° C

(+) wheeze

76
Q

What should be given for bacterial PCAP A or B?

A

Amoxicillin 40-50 mkday TID x 7 days

77
Q

What should be given for bacterial PCAP C?

A

Pen G 100K ukday QID (complete HiB immunization)
Ampicillin 100 mkday QID

*given for 7 days

78
Q

What should be given for bacterial PCAP D?

A

consult a specialist

79
Q

Oral Antibiotics for PCAP

A

Amoxicillin
Cotrimoxazole
Chloramphenicol

80
Q

IV Antibiotics for PCAP

A 
Pen G
Ampicillin
Chloramphenicol
Cefuroxime
Ampicillin-Sulbactam
81
Q

What should be given for laboratory confirmed viral PCAP?

A

Oseltamivir 2 mkdose BID x 5 days

Amantidine 4.4-8.8 mkday x 3-5 days

82
Q

Neuraminidase inhibitors, Zanamivir and Oseltamivir, have been shown to reduce the duration of illness by _____.

A

1-1.5 days

83
Q

Anntivirals for PCAP should be given within _____.

A

48 hours

84
Q

Propylaxis of household contacts with antivirals for children _____ of age.

A

≥ 12 years

85
Q

When can a patient be considered responding to the current antibiotic?

A

decrease in respiratory signs (tachypnea) and defervescence within 72 hours

86
Q

If PCAP A or B does not improve within 72 hours, an _____ may be started.

A

oral macrolide

87
Q

If PCAP C does not improve within 72 hours, _____ should be suspected.

A

Penicillin Resistant Streptococcus Pneumoniae

complications

88
Q

2nd-line Antibiotics for PCAP A or B

Penicillin Resistant Streptococcus Pneumoniae

A

Cefuroxime Axetil
Co-Amoxiclav
Sultamicillin
Cepfodoxime

89
Q

2nd-line Antibiotics for PCAP A or B

Mycoplasma sp or Chlamydia sp

A

Erythromycin (oral macrolide)

90
Q

When can IV antibiotics be shifted to oral?

A

after 2-3 days

91
Q

Criteria for Step-Down Therapy

A

responding to initial treatment
able to feed
intact GI absorption
(-) complications

92
Q

How long should step-down oral therapy be given?

A

4-8 days

93
Q

Ancillary Treatment

A

oxygen (O2Sat ≥ 95% or pO2 ≥ 80 mmHg)
hydration
bronchodilator (wheezing)

94
Q

How can PCAP be prevented?

A

vaccines

zinc

95
Q

Zinc Dose for PCAP

A

infants - 10mg
> 2 y.o. - 20mg

*given for 4-6 mos.

96
Q

The 7-valent pneumococcal vaccine CRM 197 PCV contains S. pneumoniae serotypes _____.

A

4, 6B, 9V, 14, 18C, 19F, 23F

97
Q

_____ immunity is most affeced in protein-calorie malnutrition.

A

Cell-Mediated

98
Q

Complement levels are _____ in malnourished children.

A

low

99
Q

In malnourished children, immunoglobulin responses that are important for _____ of invading organisms are impaired.

A

opsonization

100
Q

Opportunistic pathogens such as _____ are found in malnourished children.

A

Acinetobacter
Corynebacterium sp
Streptococcus faecalis

101
Q

_____ causes viral pneumonia in well-nourished children.

A

Respiratory Syncytial Virus (RSV)

102
Q

_____ causes viral pneumonia in malnourished children.

A

Herpes Simplex Virus (HSV)

103
Q

A child with tuberculosis can be malnourished and may thus be presumed to be _____.

A

immunocompromised

104
Q

In the presence of _____ secondary to tuberculosis, patients may be predisposed to infection.

A

extensive pulmonary parenchymal damage

105
Q

CHD with _____ increases the risk of developing PCAP.

A

large volume L→R shunt

chamber enlargement that causes extrinsic airway obstruction

106
Q

_____ and _____ are the most common pathogens causing pneumonia in patients with CHD.

A

RSV, Influenza

107
Q

_____ has been associated with persistent type of asthma but not with acute exacerbation.

A

Chlamydia pneumoniae

108
Q

Use of antibiotics in early childhood is associated with an increased risk of developing _____.

A

asthma

allergic disorders

109
Q

A simple _____ with concomitant _____ secondary to _____ because of asthma is often misdiagnosed as pneumonia.

A

Viral URTI, atelectasis, mucus plug

110
Q

_____ is the most common cause of recurrent or persistent infiltrates on CXR.

A

Asthma

111
Q

Treatment of PCAP:

Amoxicillin

A

40-50 mkday TID x 7 days

adult dose: 750-1500 mg

112
Q

Treatment of PCAP:

Azithromycin

A

10 mkday OD x 3 days

adult dose: 600 mg

113
Q

Treatment of PCAP:

Cefpodoxime Proxetil

A

20 mkday BID x 7 days

adult dose: 800 mg

114
Q

Treatment of PCAP:

Cefuroxime Axetil

A

20-30 mkday BID x 7 days

adult dose: 1-2 g

115
Q

Treatment of PCAP:

Chloramphenicol Palmitate

A

50-100 mkday QID x 7 days

adult dose: 2 g

116
Q

Treatment of PCAP:

Clarithromycin

A

15 mkday BID x 7 days

adult dose: 1 g

117
Q

Treatment of PCAP:

Co-Amoxiclav

A

40-50 mkday of Amoxicillin BID x 7 days

118
Q

Treatment of PCAP:

Cotrimoxazole

A

8-10 mkday of TMP BID x 7 days
adult dose: 320 mg

40-60 mkday of SMX BID x 7 days
adult dose: 1.6 g

119
Q

Treatment of PCAP:

Erthromycin

A

30-50 mkday TID or QID x 7 days

adult dose: 1-2 g

120
Q

Treatment of PCAP:

Sultamicillin

A

25-50 mkday BID x 7 days

adult dose: 750-1500 mg

121
Q

Treatment of PCAP:

Ampicillin

A

100-200 mkday q6 x 7 days

adult dose: 2-4 g

122
Q

Treatment of PCAP:

Ampicillin Sulbactam

A

150-300 mkday q6 x 7 days

100-200 mkday of Ampicillin

123
Q

Treatment of PCAP:

Ceftriaxone

A

50-100 mkday OD or q12 x 7 day

adult dose: 2 g

124
Q

Treatment of PCAP:

Cefuroxime

A

75-100 mkday q8 x 7 days

adult dose: 2-4 g

125
Q

Treatment of PCAP:

Penicillin G

A

100K-200K ukday q6 x 7 days

adult dose: 8-12M units (max 24M units/day)

126
Q

Treatment of PCAP:

Amantidine

A
  1. 4-8.8 mkday BID x 3-5 days

max: 150 mg

127
Q

Treatment of PCAP:

Oseltamivir

A

4 mkday BID x 5 days

128
Q

Antitussive Side Effects:
somnolence, ataxia, miosis, nausea, vomiting, rash, facial swelling, pruritus, addiction, respiratory depression, obtundation

A

Codeine

129
Q

Antitussive Side Effects:

confusion, excitation, nervousness, irritability, addiction, respiratory depression, behavioral disturbances

A

Dextromethorphan

130
Q

Expectorant Side Effects:

GI disturbance, nausea, vomiting, dizziness, headache, rash, diarrhea, drowsiness, abdominal pain

A

Guaifenesin

131
Q

Mucolytic Side Effects:

GI discomfort, increased transaminases

A

Bromhexine

132
Q

Mucolytic Side Effects:

nausea, headache, GI discomfort and bleeding, diarrhea, rash

A

Carbocisteine

133
Q

Antihistamine Side Effects:
loss of appetite, nausea, vomiting, epigastric pain, constipation, diarrhea, hallucinations, excitement, insomnia, drowsiness, incoordination, dizziness, tinnitus, blurred vision, diplopia, athetosis, fixed dilated pupil, sinus tachycardia, urinary retention

A

Diphenhydramine

134
Q

Decongestant Side Effects:

headache, hypertensive crisis, seizures, arrhythmias, psychosis, insomnia, psychiatric disorders, hemorrhagic stroke

A

Phenylpropanolamine

135
Q

Decongestant Side Effects:

hypertension, pulmonary edema

A

Phenylephrine

PPS Diplomate Exam (38 decks)

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