Infectious Disease- UTI and Pneumonia Flashcards

1
Q

Fever, productive cough, and consolidation on CXR

what is it?

what else do we need to consider?

A

Fever, productive cough, and consolidation on a CXR is the classic presentation of

PNEUMONIA

The next step is to determine if hte pneumonia is

CAP or HCAP.

If a patient has not had an x-ray, fever, chest pain, and a productive cough can indicate CAP.

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2
Q

What is CAP?

A

CAP is fever, productive cough, and consolidation on CXR

WITHOUT an association with healthcare facilities.

The most common cause of CAP is strep pneumo.

One must consider risk factors to determine the second most common cause.

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3
Q

Fever, productive cough, and consolidation on a CXR in a

pt with COPD or a smoker?

what is the most likely bug?

A

Fever, productive cough, and consolidation on a CXR in a

pt with COPD is caused by

H. flu

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4
Q

Fever, productive cough, and consolidation on a CXR in a

pt at risk for aspiration

what is the most likely causative organism?

A

The most likely organisms causing pneumonia in a

pt at risk for aspiration are

Klebsiella and other anaerobes

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5
Q

What is the most likely cause of CAP in a patient recovering from a viral illness

A

The most likely cause of CAP in a patient recovering from a viral illness is

S. Aureus

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6
Q

What is the most likely cause of CAP in an immunosuppressed patient?

A

pneumonia

+

immunosuppression

=

Legionella

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7
Q

How do you treat CAP?

A

Treat CAP with

moxifloxacin

or

3rd gen cephlasporin + macrolide

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8
Q

What are the most likely causes of HCAP?

A

The most likely causative organisms in HCAP are

Pseudomona

and

MRSA

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9
Q

How do you treat HCAP?

A

Treat HCAP with

piperacillin + tazobactam

and

Vancomycin

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10
Q

Fever + productive Cough + normal CXR

A

Bronchitis

treat bronchitis with

macrolide OR doxycycline OR moxifloxacin

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11
Q

Fever + productive cough + foul breath + cavitation on CXR

A

Abscess

treat an abscess with a

3rd generation cephalosporin + clindamycin

No need to drain

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12
Q

Fever + cough + immunocompromised

A

PCP

you may also see hypoxemia and an elevated LDH

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13
Q

Fever + Cough + myalgias/arthralgias/body aches

A

Fuckin’ flu.

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14
Q

How do you diagnose PCP?

A

diagnose PCP with a silver stain.

treat with Bactrim

(+) steroids IF patient has a low SPO2 or is hypoxic

remember- PCP will also have an elevated LDH

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15
Q

How do you treat the Flu?

A

treat the flu with

OSELAMIVIR

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16
Q

Cystitis + Urethral Discharge

=

?

A

Cystitis + Urethral Discharge =

Urethritis

Urethritis is an STD. do a urinary Gc/Chla

17
Q

What is the treatment for urethritis?

A

Urethritis is characterized by cystitis + urethral discharge- especially if the patient is sexually active.

Treat for Gonorrhea and Chlamydia with

Ceftriaxone 250 mg IM x1

and Doxy 100mg x 7d or azithromycin 250 x 1

18
Q

Which asymptomatic patients are screened for bacteriuria?

A

Pregnant women and anyone with a urologic procedure are screened for bacteriuria.

Do not treat asymptomatic bacteriuria unless there is a reason (Pregnancy or proceedure)

19
Q

What is the abx of choice for asymptomatic bacteriuria in a pregnant female?

A

treat asymptomatic bacteriuria in a pregnant female with

AMOXICILLIN

if the patient is allergic to penicillins use

NITROFURANTOIN

20
Q

frequency + urgency + dysuria

how do you treat it?

A

Cystitis

choose TMP-SMX, Nitro, or Fosfomycin

treat uncomplicated cystitis for 3 d

complicated cystitis for 7 d

21
Q

What is complicated cystitis?

A

Complicated cystitis =

Penis

Plastic

Procedure

Pyelo

uncomplicated cystitis is a non-pregnant female

22
Q

Signs of cystitis + CVA tenderness and a fever

what will you see on a UA that is pathognomonic for this condition?

A

WBC casts are pathognomonic for PYELONEPHRITIS.

make sure to get a UC to determine the type of abx used.

An inpatient with pyelonephritis will get

IV Ceftriaxone or IV Amp + Sulbactam.

Ambulatory pyelo pts will get PO Cipro.

23
Q

A patient who has pyelonephritis but does not respond after 72 hrs to abx therapy.

what is the next step?

A

this patient probably has an abscess. Do a CT scan (unless the pt is pregnant or has renal failure- then do an US)

Drain the abscess and continue IV abx.

24
Q

Asplenic patients need to be vacinated against which organisms?

A

Asplenic patients need to be vaccinated against encapsulated bacterina.

The only encapsulated bacteria with widely used vaccines are

Strep pneumo (pneumococcus)

PCV13 if immunization status is unknown

N. meningitides (meningococcal)

MCV4 if pt is under 55, otherwise give polysaccharide

H. influenza