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Medicine > ID - Pneumonia > Flashcards

ID - Pneumonia Flashcards

1
Q

Most common pathogen for community community acquired pneumonia? For nosocomial pneumonia?

A

Strep pneumonia

Gram-negative rods (E. coli, Pseudomonas) and staph aureus

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2
Q

Definition of Community acquired pneumonia versus Nosocomial pneumonia?

A

Acquired before or within 48-72 hours of hospitalization versus later

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2
Q

Infection from community acquired pneumonia result from what mechanism?

A

Aspiration of oropharyngeal secretions

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4
Q

Sputum in bacterial PNA?

PE sIgn bacteremic pneumonia?

A

Rust colored

Rigors

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5
Q

Main Types of lower tract infection?

Next test to order?

A

Pneumonia and acute bronchitis.

Chest x-ray

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6
Q

Test to order invitations with suspected pneumonia?

A
  1. Chest x-ray
  2. Labs – CBC, BUN, creatinine, glucose, electrolytes
  3. O2 sat
  4. 2 pretreatment blood cultures
  5. Gram stain and culture of sputum
  6. Antibiotics
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7
Q

Most common causes of atypical pneumonia if bacterial?

Viral?

A
  1. Mycoplasma
  2. Chlamydia pneumonia
  3. Chlamydia psittaci
  4. Coxiella (Q fever)
  5. Legionella
  6. Influenza
  7. adenovirus
  8. parainfluenza
  9. RSV
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8
Q
  1. Alcoholic pneumonia?
  2. Immigrants with pneumonia?
  3. Nursing home resident with pneumonia?
  4. HIV-positive patient with pneumonia?
  5. COPD pt?
  6. Post-flu?
  7. Young, healthy pts?
  8. Birds?
  9. Farmer/Veterinarian?
A
  1. Klebsiella
  2. TB
  3. Pseudomonas
  4. PCP and TB
  5. H flu
  6. Strep Peumo
  7. Mycoplasma
  8. Chlamydia
  9. Coxiella
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9
Q

Test if suspect Legionella?

If suspect and need to confirm PCP?

A

Urinary antigen assay (antigen persists in urine for weeks)

Bronchoalveolar lavage

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10
Q

Considered admitting to hospital if?

A 
CURB65 of 2+
Confusion
Uremia>20
RR>30
BP under 90
Age>65
OR 
#pH under 7.35
#HR>125
#Temp > 104
#Cancer, COPD, CHF, Renal failure, Liver disease
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11
Q

If pneumonia becomes empyema, need to?

A

Place chest tube for drainage

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12
Q

Areas of the lungs that may developed abscesses from aspirated contents?

A

Posterior segments of upper lobes and superior segments of lower lobes

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13
Q

Pts with high risk of pneumonia: history?

A 
Age >50
History of cancer
CHF
Cerebrovascular disease
Renal/liver disease
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14
Q

Every patient with pneumonia will have a visible pulmonary infiltrate on chest x-ray except?

A 
#Immunosuppressed patients
#severe neutropenia, 
#very early pneumonia
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15
Q

Diffuse interstitial infiltrates are common in pneumonia caused by?

A 
PCP
Coxiella
Mycoplasma
Chlamydia
Viruses
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16
Q

PCP PNA can be ruled out if?

PCP much less likely if?

A

Pleural effusion is present

17
Q

Appearance of cavitation suggests?

A

TB, staph aureus, gram-negative organisms (Klebsiella)

18
Q

With sputum results, how to determine if it is uncontaminated?

A

> 25 PMNs and <10 epithelial cells

19
Q

Outpatient therapy of community acquired pneumonia?

When to add fuoroquinolone?

Hospitalized patients with community acquired pneumonia are treated with?

A

Macrolides (azithromycin) or Doxycyclne

ABx in last 3 months or comorbidities

Fluoroquinolone OR Ceftriaxone+Azithromycin

20
Q

Treatment for immunocompetent patient with hospital-acquired or ventilator-associated pneumonia?

A

Antipseudomonal beta-lactam (Zosyn/cefepime) plus aminoglycoside (may also add clindamycin)

21
Q
  1. Pt with hemoptusis and cureant jelly suputum?
  2. Foul-smelling sputum?
  3. Mryingitis (infx and vesicles on tympanic membrane)
  4. Legionella presents with hypoNa, GI sx and?
A
  1. Klebsiella
  2. Anerobes
  3. mycoplasma
  4. Headache/confusion
22
Q

Who should get pneumovax?

A 
#Age>65
#Heart, lung, liver, kidney disorders
#Sickle cell
#Cancer/HIV/immunosuppressed
#CSF leak, cochlear implants
23
Q

HCAP treatment?

VAP?

A

Cefepine/Cedrazidime

OR #Zosyn
OR #Cabapenems

AND #Aminoglycoside/Fluoroquinolone
AND #Vanc/Linezolid

24
Q

Abx can can cause seizures and renal failure?

25
Q

Do not order this test if suspect aspiration PNA?

A

Sputum culture (everyone’s sputum has anaerobes from mouth)

26
Q

Suspect lung abscess - imaging? tx?

A

CXR/CT for cavitation

Clindamycin or Penicillin

27
Q

Drugs to treat PCP PNA if reaction to bactrim?

If pt develops neutropenia and hemolytic anemia

A

Pentamidine (Primaquine contraindicated in G6PD)

#Pentamidine
#Clindamycin + Primaquine

Medicine (106 decks)

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