Commonly Used Resp Abx

Question 1

atypical pneumo

Answer 1

mycoplasma pneumoniae

chlamydia pnuemoniae

chlamydia tachomatis (newborns)

Legionella penumophila

Question 2

PCN resistant and drug resistant pneumococci risk factors

Answer 2

>65

Beta lactam in last 3 months

alcoholism

immunosuppresed

comorbiditieis

exposure to child at daycare

Question 3

nursing home

cardiopulmonary disease

multiple medical comorbidities

recent ABx therapy

infection most likely

Answer 3

enteric gram negatives

Question 4

bronchiectasis

steroids > 10mg/d

BSA >7d in past month

malnutrition

infection most likely

Answer 4

P aeruginosa

Question 5

CAP in outpatient without modifying risk factors or cardiopul disease
infection most likely

Answer 5

S pneuo

Mycoplama pneumo

H influenza

virus

Legionell,

mycoplasma TB

endemic fungi

Question 6

Outpation CAP with modifying risk factors or cardiopulmonary disease
add in ___ for ddx

Answer 6

DRSP

enteric gram negatives

moraxella catarrhalis

aspiration

Question 7

outpatient without modifying risk factors or cardiopulmonary disease CAP

treat with

Answer 7

Advanced generation macrolide or doxycycline

Question 8

outpatient CAP with modifying risk factors or cardiopulmonary disease

treat with

Answer 8

Oral beta-lactam plus macrolide or doxycycline

OR

antipneumococcal flouroquinolone

Question 9

CURB criteria for CAP

Answer 9

Confusion

Urea (>19.1mg/dL)

Resp Rate >30/min

BP <90 Systolic or <60mm diastolic

Age >65

Question 10

in CAP, if first dose of Abx is given ___ after presentation, mortalitiy decreased

Answer 10

<8hours

Question 11

diagnositc evaluations for CAP

Answer 11

CXR

2 sets of pre-treatment cultures

Sputum gram stain with culutre if productive cough

Question 12

Hospitalized nonICU CAP with and without risk factors

treat with

Answer 12

IV macrolid (or Beta lactam plus doxy)

or Antipneumococcal flouroquinolone

IV beta lactam plus macrolid or doxy

or antipneumococcal flouroquinolone

Question 13

ICU patient with and without pseudomonas risk factors

treat with

Answer 13

IV Beta-lactam (cefotaxime, ceftriaxone) AND IV macrolide

Antipnuemococcal Flouroquinolone

UVa - if MRSA gram stain pos > IV VANCO

With risk factors

IV beta-lactam AND flouroquinolone (both with antipseudomonal)

IV beta lactam with antipseudomonal AND aminoglycoside AND IV atypical

Question 14

signs of resolved CAP in uncomplicated patients after 72 hours

Answer 14

Fever resolves 2-4d after Abx

WBC resolves by 4 days after ABx

PEx findings can persist 7d in 20-40%

Opacities 75% cleared on CXR in 6 weeks

Question 15

move pt to oral therapy in CAP if

Answer 15

improvement of fever

improvement in cough and resp distress

improvement in leukocytosis

normal GI tract

Question 16

Lights criteria for transudate vs eduate

Answer 16

PF-LDH > 2/3 of upper serum normal limit

PF/S-LDH?0.6

PF/S-Protein > 0.5

(Any ONE of three)

Question 17

interstitial causes of dypsnea

Answer 17

Sarcoidosis
Hypersensitivity pneumonitis
idiopathic pulmonary fibrosis
tuberculosis and tumor
Fungi
Absestosis
collagen vascular disease
eosinophilic granuloma
drug induced lung disease

Question 18

differential alveolar disease dypsnea

Answer 18

Pus - infectious pneumonia
Cells - eosinophils, blood, tumor

Proteins - pulmonary alveolar proteinosis
Inflammatory process - AIP, BOOP
Edema