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Clinical Medicine II > Infections of the Lower Respiratory Tract > Flashcards

Infections of the Lower Respiratory Tract Flashcards

1
Q

What is the most common route of infection for pneumonia?

A

Micro aspiration of oropharyngeal secretions

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2
Q

What is the most common bacterial cause of CAP?

A 
Steptococcus pneumoniae (Gram + cocci in pairs)
65%
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3
Q

What is the second most common bacterial cause of CAP?

A

Haemophilus influenzae (Gram - bacilli/rods)

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4
Q

What underlying pulmonary disease puts patients at an increased risk of getting pneumonia caused by h. influenza?

A

COPD! Cystic fibrosis!

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5
Q

What bacteria are responsible for hospital acquired pneumonia?

A

Gram negative rods: Pseudamonas*, klebsiella, enterobacter, serratia, achinetobacter, s. aureus

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6
Q

Pneumonia acquired OUTSIDE of the hospital setting and patient is not a resident of LTCF OR a patient who was ambulatory prior to admission who develops pneumonia within 48 hours of initial admission to hospital

A

Community acquired pneumonia

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7
Q

Pneumonia occurring >48 hours after hospital admission. Often caused by pseudomonas and other organisms found in the hospital.

A

Hospital acquired pneumonia (nosocomial)

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8
Q

Sudden onset of fever, productive cough with purulent sputum, pleuritic chest pain, rigors, tachycardia, tachypnea

A

Symptoms of pneumonia (typical)

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9
Q

Bronchial breath sounds
Dullness to percussion
Increase in tactile remits, ego phony
Inspiratory rales and crackles

A

Signs of consolidation on PE of pneumonia

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10
Q

Chlamydia, legionella, and viruses are all causes of which type of pneumonia?

A

atypical

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11
Q

What should you expect to see on a CXR of a patient with pneumonia?

A

Lobar pneumonia

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12
Q

If you look at an CXR of a patient who you suspect has pneumonia and you see diffuse, patchy infiltrates (reticulonodular or interstitial), what should you suspect?

A

Atypical pneumonia

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13
Q

Low grade fever, dry, non productive cough, and extrapulmonary sxs like myalgias, malaise, sore throat, HA, and NVD

A

Symptoms of atypical pneumonia

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14
Q

What does the PE of a patient with atypical pneumonia look like?

A

Often normal without signs of consolidation

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15
Q

Which type of atypical organisms causes hoarseness and fever which then turns to respiratory symptoms a few days later?

A

Chlamydia

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16
Q

Which type of atypical organisms causes ear pain, bullous myringitis, a persistent nonproductive cough, and an erythematous pharynx?

A

Mycoplasma

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17
Q

Which type of atypical organisms causes GI and neuro symptoms, increased LFTs, and hyponatremia?

A

Legionella

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18
Q

If you see abscess formation on a CXR, what organism could be causing it?

A

S. aureus
Klebsiella
Anaerobes

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19
Q

If you see that the upper lobe (esp RUL) has a bulging fissure or cavitations, what organism could be causing that type of pneumonia?

A

Klebsiella

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20
Q

What organism causes rust blood tinged sputum?

A

Strep pneumonia

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21
Q

What organism causes currant jelly sputum?

A

Klebsiella

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22
Q

What organism causes green sputum?

A

H flu, pseudomonas

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23
Q

What organism causes foul smelling sputum?

A

Anaerobes

24
Q

With pneumonia, there is:

_____ on perussion
_____ tactile fremitus
___ and ____ breath sounds

A

Dullness on percussion
Increased tactile fremitus
Bronchial and egophony breath sounds

25
Q

What is the DOC for Outpatient CAP treatment?

A

Macrolide or doxycycline*

26
Q

What is the DOC for Inpatient CAP treatment?

A

Beta lactam + macrolide (or doxy)

OR broad spectrum floroquinolone

27
Q

What is the DOC for inpatient CAP in the ICU?

A

B lactam + macrolide OR

B lactam + broad spectrum FQ

28
Q

What is the DOC for treatment of hospital acquired PNA?

A

Anti-pseudomonal beta lactam and anti-pseudomonal AG or FQ

29
Q

What do you add to the treatment of hospital acquired pneumonia (Anti-pseudomonal beta lactam and anti-pseudomonal AG or FQ) if you suspect MRSA?

A

Vanco

30
Q

How do you treat aspiration pneumonia?

A

Clindamycin or augmentin +/- metronidazole

31
Q

When should you change inpatient pneumonia therapy from IV abx to oral?

A

When clinically responding and able to take PO for 7-10 days

32
Q

What is the pneumococcal vaccine for children?

A

PCV13

33
Q

When should doses of pneumococcal vaccine be given to children?

A

2 months, 4 months, 6 months, after 4 years

34
Q

What ist he adult pneumococcal vaccine?

A

PCV23

35
Q

The PCV23 vaccine is a capsular _____

A

polysaccharide

36
Q

Borders of the heart lost when similar density (pneumonia) lies adjacent?

A

Silhouette sign

37
Q

Your patient presents with a 10 days history of increasing cough, purulent sputum, SOB, pleuritic chest pain, hypothermia, sweats, and rigors. What do you suspect?

A

CAP

38
Q

Is a PE enough to diagnose pneumonia?

A

NO

39
Q

What specific level would lead you to believe a pneumonia was caused by a bacterial origin vs a viral one?

A

Procalcitonin

40
Q

When should you hospitalize a patient who has pneumonia?

A

When they have neutropenia, involvement of more than one lobe, or poor host resistance

Consider for those over 50 with comorbidities, etc.

41
Q

How many strains does PCV23 or Pneumovax contain of pneumonia?

A

23

42
Q

Who is at the highest risk of hospital acquired pneumonia?

A

Vent patients

43
Q

What is the second most common cause of hospital acquired infection?

A

Hospital acquired pneumonia

44
Q

What is the most likely pathogen to cause pneumonia in the ICU?

A

Pseudomonas

45
Q

With hospital acquired pneumonia, what bacterial should you always treat against?

A

Pseudomonas

46
Q

Inflammation of trachea/bronchi (conducting airways)

A

Bronchitis

47
Q

What is bronchitis most commonly caused by?

A

Viruses

48
Q

Which viruses commonly cause bronchitis?

A

Rhinovirus
adenovirus
coronavirus
RSV

49
Q

What are some bacterial causes of bronchitis?

A

S. pneumonia
H. influenzae
M. catarrhalis
Mycoplasma

50
Q

Bronchitis often follows a ____

A

URI

51
Q

What is hallmark symptoms of bronchitis?

A

Cough that can be productive but doesn’t have to, lasts 1-3 weeks

52
Q

How do you diagnose bronchitis?

A

Clinically

53
Q

Is a CXR usually indicated for bronchitis?

A

Nah

54
Q

How do you manage bronchitis?

A

Symptomatic tx of choice

Fluids, rest, antitussives, bronchodilators

55
Q

Do antibiotics have any benefit at all in healthy patients with bronchitis?

A

NO don’t use them!

56
Q

Is sputum color predictive of bacterial involvement?

A

NO damnit

57
Q

Cough with or without sputum, dyspnea, fever, sore throat, headache, myalgia, substernal discomfort,

PE: Expiratory rhonchi or wheezes

A

Bronchitis

Clinical Medicine II (10 decks)

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