Infectious Disease Pt 2 Flashcards
Your imaging is showing an entire lobe has been “wiped out”. What is your first thought?
PNA. And inversely, if you thought your patient had PNA, but you see capsules or some diffuse process, EXPAND your DDx
if you smoke or have COPD, you are at risk for infection by what pathogens?
h.flu and strep
if you live in a SNF, you are at risk for infection by what pathogens?
strep, TB, hflu, gram negatives
If you have h/o ETOH abuse, you are at risk for infection by what pathogens?
strep, gram negs, anaerobes
If you have exposure to bats, you are at risk for infection by what pathogens?
histoplasma capsulatum
if you have exposure to birds, you are at risk for infection by what pathogens?
Cryptococcus neoformans and chlamydia
If you have recently had the flu, you are at risk for infection by what pathogens?
staph, strep, hflu
If you have CF, you are at risk for infection by what pathogens?
pseudomonas infections
If you are an IV drug user, you are at risk for infection by what pathogens?
staph, TB, anaerobes
If you aspirated, you are at risk for infection by what pathogens?
anaerobes
If you have HIV, you are at risk for infection by what pathogens?
pneumocystis carinii
What is the #1 cause of CAP (community acquired pna)?
strep. pna
What pna causing germ causes dyspnea and diarrhea and is associated with a water source?
Legionella
What pna causing bug also causes abscesses to form in the lungs. It is characterized by a dry cough and headache. Often, it is associated with IV drug abusers
staph aureus
Which PNA causing germ presents with a fever and a rusty colored sputum?
strep. PNA
Which PNA causing germ is most common amoung alcoholics and diabetic patients? It presents with hemoptysis and currant jelly colored sputum. CXR’s often reveal lobar consolidation
K. PNA
You have PNA and you have COPD second to smoking. Your PNA is most likely caused by what germ?
H. PNA
You have a patient with CAP. She is a healthy 29 yof with no risk factors. What is the BEST way to treat her?
as an outpatient using either 1) MACROLIDE 2) FLOROQUINOLONE, or 3) DOXYCYCLINE
Your healthy 29 yo patient with CAP is allergic to one of the preferred medications. What the heck are you going to do now?
AUGMENTIN or BETA LACTAM
Uh oh, you have a 53 year old female patient with HTN, DM, and COPD. She is in your office coughing up sputum. You detect crackles in her lungs. Vitals: temp 102.1 HR 103 BP 150/95 resp 18 O2sat–94. She is A&Ox4. Her CBC and CMP show elevated WBC, otherwise wnl. You don’t need a CXR to know this is PNA. How will you treat?
MACROLIDE, FLOROQUINOLONE, or DOXY
Patient has comorbidities, so you have to determine her “prognostic index”. Meaning…how severe is this? Using the CURB65, you determine she is actually low risk (1/5 risk factors). So she can be treated as an outpatient.
What types of symptoms typically occur with a CAP infection?
fever (90%), cough, tachycardia, crackles/rales, tachypnea (>24), tachycardia
You suspect your patient has PNA because they have a cough and crackles. Your patient’s vital signs are stable. Do you need to do a CXR?
No. The absence of v/s abnormalities (fever, tachypnea, tachycardia) has a 99% negative predictive value of PNA. But of course, you want to follow up with your patient to make sure none of these things have developed.
What kinds of tests can you use to make a definitive diagnosis?
CXR is standard. sputum culture or staining. labs (CBC, chem panel), blood cultures
What is a simple way to measure severity of a PNA infection?
CURB-65. Evaluate for confusion, Urea (BUN), Respirations, Blood Pressure, Age>65. Assign 1 point to each abnormal finding. If score is 0-1 treat as outpatient. Score of 2 use clinical judgment, score 3+ requires admission
