Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

3151 - nat > IC16 LRTI > Flashcards

IC16 LRTI Flashcards

1
Q

How does acute bronchitis develop?

A

Usually starts off with viral URTI

acute cough due to inflammation of trachea and lower airways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is Pneumonia?

A

Infection of lung parenchyma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the risk factors of Pneumonia (3 points) and how do they cause a susceptible host?

A

1) Smoking
Suppress neutrophil function, damage lung epithelium

2) Chronic lung conditions eg. COPD, Asthma, Lung cancer
Destroy lung tissue

3) Immune suppression eg. HIV, Sepsis, on glucocorticoids, Chemotherapy
Suppress immune response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Localised symptoms in Pneumonia (6 points)

A

Cough
Chest pain
Shortness of breath
Tachypnoea (> 22 breaths/min)
Hypoxia eg. 90-95% O2
Increased sputum production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What should be seen in chest xray?

A

New consolidations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which 2 bacteria can urinary antigen show?

What is the limitation of urinary antigen test?

A

Strep Pneumo
Legionella

Indicates both past and current infections also

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Where can collect samples to do gram stain and culture?

Pros and cons of both samples

A

Sputum or Lower respiratory tract samples

Sputum easier to get but easily contaminated
Lower RT sample is invasive eg. bronchoalveolar lavage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which populations should do pre-treatment blood and respiratory gram strain and culture be done?

A

1) Severe CAP

2) Have risk factor for MRSA, Pseudomonas
(previously infected in past 1 year, empirically treated, hospitalised or parenteral antibiotics in last 90 days)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Definition of Community Acquired Pneumonia

A

<48hrs after hospital admission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Risk factors for Community Acquired Pneumonia (4 points)

A

History of Pneumonia
Smoking
Chronic respiratory disease
Immunosuppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How to measure severity of Pneumonia?

A

CURB-65

Confusion
Urea > 7mmol/L
RR>30
BP (<90 OR <60)
Age > 65

0-1 = Outpatient
2 = Inpatient
3 or more = Consider ICU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the major criteria for Severe CAP based on IDSA guidelines? (2 points)

Minor criteria (not in CURB-65) (5 points)

A

Major
1) Need mechanical ventilation
2) Septic shock requiring vasoactive medications

Minor
PaO2/FiO2 < 250
Multilobar infiltrates
Leukopenia (WBC < 4 X 10^9)
Hypothermia (<36 deg)
Hypo and Require aggressive fluid resuscitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What to cover for Outpatient CAP with no comorbidities?

Hence what is the treatment?

A

Strep Pneumo only

All oral
Amoxicillin 1g q8
Levofloxacin or Moxifloxacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What to cover for Outpatient CAP with comorbidities

Hence what is the treatment?

A

Strep Pneumo
Haem Influenzae
Atypicals

All oral drugs

Strep Pneumo, Haem Influenzae coverage
Beta lactams
Amoxicillin Clavulanate
Cefuroxime

Atypical Coverage
Macrolides (Azithromycin, Clarithromycin)
Doxycycline

Have all 3 coverage
Respiratory quinolones
Moxifloxacin
Levofloxacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What to cover for Inpatient, non-severe

Hence what is the treatment?

A

Big 3

MRSA (if have resp isolation in past 1 year or hospitalisation or parenteral antibiotic in past 90 days + MRSA PCR Screen positive)

Pseudomonas (if have resp isolation in past 1 year)

Treatment - all IV

Cover Big 3
Same as Outpatient w comorbidities
Ceftriaxone now an option

MRSA
IV Vancomycin OR IV/PO Linezolid

Pseudomonas
Add on Ceftazidime
Does not cover Strep Pneumo
OR
Replace beta lactam (amox-clav, cefuroxime, ceftriaxone) with:
Pip-Tazo
Cefepime
Meropenem
Levofloxacin (Can even cover atypicals)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Need to cover what for Inpatient severe CAP?

Hence what is the treatment?

A

Big 3 + MSSA, Burkholderia
MRSA and Pseudomonas based on risk factors
MRSA and Pseudomonas risk factor: Resp isolation in past 1 year OR Parenteral antibiotic use in last 90 days

Treatment
Beta lactam (Strep, Haem, MSSA)
Amoxicillin Clavulanic
Penicillin G

Burkholderia
Ceftazidime

Macrolides (atypicals)
Azithromycin
Clarithromycin

Respiratory Fluoroquinolones (Strep, Haem, Atypicals, MSSA)
Levofloxacin
Moxifloxacin

MRSA
IV Vancomycin OR IV/PO Linezolid

Pseudomonas
Add on Ceftazidime
Does not cover Strep Pneumo
OR
Replace beta lactam (amox-clav) with:
Pip-Tazo
Cefepime
Meropenem
Levofloxacin (Can even cover atypicals)

17
Q

If have lung abscess or empyema, what to do?

A

Add anaerobic coverage
Metronidazole or Clindamycin

18
Q

What to do if suspect Influenza?

A

Add Oseltamivir within first 2 days

Stop antibiotics if Influenza PCR positive

19
Q

Why are respiratory fluoroquinolones not first line for CAP? (4 points)

A

Adverse effects
Tendonitis
Neuropathy
QTc prolongation
CNS disturbances
Hypoglycemia

Collateral damage

Reserve for Pseudomonas coverage with severe penicillin allergies

Delay diagnosis of TB

20
Q

When to de-escalate empiric cover of extra stuff eg. MRSA, Pseudomonas, Burk in CAP?

A

After 2 days if pathogen is not isolated and patient is improving

21
Q

Duration of therapy for CAP?

A

5 days minimum
7 days if suspect/proven MRSA, Pseudomonas

achieve clinical stability within first 2-3 days

22
Q

When de-escalating CAP, what must we still cover?

A

SHA

23
Q

What is the big 3 for HAP / VAP?

A

PME
Pseudomonas
MSSA
Enterobacterales

24
Q

Requirements to cover for MRSA in HAP / VAP (4 points)

A

1) IV antibiotics use within 90 days
2) Isolation of MRSA in last 1 year
3) Hospital has >20% of MRSA cases
4) Patient has high risk for mortality

25
Q

Empiric therapy for HAP / VAP? (3 classes and their drugs)

Which should only be used with MRSA coverage? and why?

A

Antipseudomonal Beta Lactam
Pip-Tazo
Cefepime
Meropenem
Imipenem

Antipseudomonal FQ
Levofloxacin

Aminoglycoside
Amikacin

Only with MRSA coverage (cos these do not cover MSSA)
Ceftazidime
Ciprofloxacin

26
Q

How to de-escalcate for HAP/VAP?

A

Similar to CAP
Use single agent according to Pseudomonas susceptibility
If no positive culture, cover big 3 (PME)

27
Q

Duration of therapy for HAP/VAP therapy?

A

7 days

will achieve clinical stability within first 2-3 days

28
Q

When to use 2 anti-pseudomonal agents? (5 points)

A

Prior IV antibiotic use
Acute renal replacement therapy
Isolation of Pseudomonas in past 1 year
>10% of Pseudomonas isolates resistant to monotherapy
Require ventilator

29
Q

What is the lowest gen Cephalosporin we can use? Why not any lower?

A

2nd gen (Cefuroxime, in Outpatient CAP with comorbidities)

Cos Cephalexin does not cover Strep Pneumo
whereas Cefuroxime can cover both Strep Pneumo and Haem Influenzae

30
Q

Ways to prevent VAP (3 points)

A
  1. Limit duration of mechanical ventilation
  2. Minimise duration and deep levels of sedation
  3. Elevate head of bed by 30 degrees

3151 - nat (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions