Exam 3 - Lecture 1 (Lower respiratory tract infections)

Question 1

CAP common pathogenesis pathways

Answer 1

aspiration
aerosolization
bloodeborne

Question 2

common bacterial pathogens for CAP

Answer 2

strep pneumo (+)
H. flu (-)
staph aureus (+)

atypical: use FQ, tetra, macrolides
mycoplasma pneumo
legionella pneumophila
chlamydia pneumoniae

Question 3

strep pneumo considerations

Answer 3

penicillin resistance about 3%
macrolide resistance about 45-50%

Question 4

mycoplasma pneumoniae considerations

Answer 4

-spread person to person by contact
-no cell wall (can’t gram stain)
-slow onset of sx

Question 5

Legionella pneumophila considerations

Answer 5

-atypical found in soil and water
-spread by aerosolization
-those at risk are smokers, older males, chronic bronchitis, and immunocompromised
-multisystem involvement (bradycardia, LFTs elevated, high fever, etc.)

Question 6

staph aureus considerations

Answer 6

-low prevalence in CAP
-important to get MRSA nasal PCR
–if says its negative, right 99% of time
–if says its positive, right about 57% of time

Question 7

testing and labs to get

Answer 7

respiratory culture (controversial)
blood culture
WBC w dif.
SCr, BUN, electrolytes, LFTs
O2 sat.
urinary antigen tests
nasal PCR swab

Question 8

When are cultures used?

Answer 8

only in severe infections

Question 9

Tx of CAP (supportive measures)

Answer 9

humidifed O2
brochodilators
fluids
chest physiotherapy

Question 10

duration of CAP tx

Answer 10

continue therapy until clinical stability of 5 days

Question 11

HAP definition

Answer 11

pneumonia occurring greater than or equal to 48hrs after hospital admission

Question 12

VAP definition

Answer 12

pneumonia occurring greater than or equal to 48hrs after intubation

Question 13

typical MRSA coverage drugs

Answer 13

Vanco
Linezolid

Question 14

typical pseudomonas coverage drugs

Answer 14

zosyn
cefepime
imipenem
meropenem
levofloxacin

Question 15

duration for HAP/VAP therapy

Answer 15

7 days

Question 16

HAP low risk - need to cover MSSA and pseudo, so use 1 of:

Answer 16

-zosyn
-cefepime
-imipenem
-meropenem
-levo

Question 17

HAP low risk with MRSA risk - need to cover MRSA and pseudo, so use 1 and 1:

Answer 17

-zosyn
-cefepime
-imipenem
-meropenem
-levo

-vanco
-linezolid

Question 18

HAP high risk and MRSA risk - need to cover MRSA and pseudo, so use 2 drugs, dif classes:

Answer 18

-zosyn
-cefepime
-imipenem
-meropenem
-levo
-tobra/amikacin

-vanco
-linezolid

Question 19

VAP - need to cover MRSA and pseudo, so use 1, or if risk factors for pseudo, use 2:

Answer 19

-zosyn
-cefepime
-imipenem
-meropenem
-levo
-tobra/amikacin

-vanco
-linezolid