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Adult/Ped Medicine 3 > Community Acquired Pneumonia - Rupp > Flashcards

Community Acquired Pneumonia - Rupp Flashcards

1
Q

Characteristic Radiographic Appearance of Right-Sided Endocarditis

A

focal embolic lesion

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2
Q

Etiology of Community Acquried Pneumonia

Bird, Tick, Rodent Exposure; Rancher

A

Bird Exposure: Psittacosis, Histoplasmosis

Rancher: Q-fever, Brucellosis

Tick Exposure/Hunter: Tularemia

Rodent Exposure: sin nombre virus (hanta virus)

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3
Q

Characteristic Radiographic Appearance of Aspiration

A

superior segment of right middle lobe

or

posterior segment of right upper lobe

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4
Q

Outpatient Management of Community Acquired Pneumonia

A

Previously Healthy: macrolide or doxycycline

Comorbidities: respiratory fluoroquinolone or ß-lactam + macrolide

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5
Q

Urinary Antigen Detection

A

Pneumococcal Ag: rapid, simple, not affected by antibiotic administration, may stay positive for 2-3 months

Legionella Ag: detects serogroup 1

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6
Q

Characteristic Radiographic Appearance of Bacterial Pneumonia

A

Lobar of segmental consolidation

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7
Q

Community Acquired Pneumonia - Discharge Criteria

A

no more than 1 during prior 24 hours (unless it is a baseline status):

Temperature > 37.8 C

Pulse > 100 beats/min

Respiration > 24 breaths/min

Systolic blood pressure < 90 mm Hg

Blood O2 saturation < 90%

Inability to maintain oral intake

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8
Q

Characteristic Radiographic Appearance of Pneumonia - “atypical” pathogen

A

Diffuse or patchy interstitial pattern

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9
Q

Characteristic Radiographic Appearance of Tuberculosis

A

apical infiltrates, cavitation

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10
Q

Etiology of Community Acquried Pneumonia

CF/Bronchiectasis, COPD, Influenza, Cough > 2-3 Weeks

A

CF/Bronchiectasis: Pseudomonas, Burkholderia, S. aureus

COPD: H. influenzae, M. catarrhalis

Influenza: S. aureus, infleunza

Cough > 2-3 weeks: Pertussis, TB

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11
Q

Prevention of Community Acquired Pneumonia

A

Get flu vaccine

Pneumococcal vaccine

Covering coughs

Hand washing

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12
Q

Etiology of Community Acquired Pneumonia

Splenectomy, HIV, IV Drug Abuse, Alcoholism

A

Splenectomy: encapsulate organisms - H. influenzae, Pneumococcus

HIV: Pneumococcus, PCP, TB

IV Drug Abuse: right sided endocarditis (S. aureus)

Alchoholism: Pneumococcus, Klebsiella or other g(-) bacilli aspiration

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13
Q

Community Acquired Pneumonia - Duration of Therapy

A

treat for a minimum of 5 days

should be afebrile for 48-72 hours

should have no more than 1 CAP associated sign of clinical instability

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14
Q

Criteria for ICU Admissions for Community Acquired Pneumonia

Major Criteria & Minor Criteria

A

admit to ICU with 1 major or 3 minor

Major Criteria:

  • need for mechanical ventilation or pressors

Minor Criteria:

  • Respiratory rate > 30/min
  • PaO2/FIO2 < 250
  • Multilobar infiltrates
  • Altered mental status
  • Uremia (BUN > 20)
  • Leukopenia (
  • Thrombocytopenia (
  • Hypothermia (
  • Hypotension requiring fluid resuscitation
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15
Q

Etiology of Community Acquried Pneumonia

Travel, Hotel/Cruise Ship

A

Travel: Coccidioidmycosis, Histoplasmosis, Melioidosis

Hotel/Cruise Ship: Legionella

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16
Q

Inpatient Management of Community Acquired Pneumonia

A

Medical Ward: respiratory fluroquinolone or ß lactam

ICU: ß-lactam + either azithromycin or a respiratory fluoroquinolone

Special Concerns - could probably look this up in Sanford : )

Pseudomonas: antipneumococcal, antipseudomonal ß-lactam + cipfrofloxacin or levofloxacin ORa ntipneumococcal, antipseudomonal ß-lactam + aminoglycoside and azithromycin

Psedomonas and Penicillin Allergy: aztreonam

CA-MRSA: add linezolid or vancomycin

17
Q

Sputum Examination in Community Acquired Pneumonia

A

specimen should be from deep cough, purulent

immediately transported to laboratory

examine under microscope - report semiquantitatively

performed to optimize antibiotic selection

18
Q

CURB-65 Scoring System

A

C - confusion

U - BUN level > 7 mmol/L

R - respiratory rate > 30 breaths/min

B - low blood pressure (systolic < 90 mmHg or diastolic < 60 mmHg)

65 - greater risk if over 65 years of age

Adult/Ped Medicine 3 (13 decks)

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