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Week 6: Pneumonia and Cough > Lower RT Infections Part 1 > Flashcards

Lower RT Infections Part 1 Flashcards

1
Q

4 pathogens of CAP found in the mouth and URT

A

Strep pneumoniae
Haemophilus influenzae
Moraxella
Mycoplasma

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2
Q

2 ways pneumonia happens

A

Lower RT is usually sterile
Aspiration
Inhalation by droplet/aerosol transmission

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3
Q

3 defence mechanisms of the lungs

A

Mucus and mucociliary clearance
Cough
Humoral and cellular immunity

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4
Q

4 droplet bacteria vs 3 droplet nuclei bacteria

A

Droplet: Influenza, Group A strep, Mycoplasma, Neisseria meningitidis
Nuclei: Measles, TB, Varicella

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5
Q

Top 3 typical bacteria that cause CAP (and what is their morphology)

A 
Strep pneumoniae (gram + cocci in pairs)
H. influenzae (gram - coccobacilli)
Moraxella catarrhalis (gram - diplococci)
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6
Q

Top 2 atypical causes of CAP

A 
Mycoplasma pneumoniae
Chlamydophila pneumoniae (gram - obligate intracellular bacteria)
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7
Q

Legionella pneumoniae

A

Rare cause of pneumonia
Can be severe though!
Causes outbreaks
Doesn’t gram stain well

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8
Q

Most common cause of pneumonia in children 1mo to 5yrs

A

Viral!!

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9
Q

Hospital acquired pneumonia

  1. what is it
  2. what pathogens are most likely
A

Pneumonia occurring >48 hours after hospital admission
Strep pneumo and Haemophilus are still most likely
Also S aureus, Pseudomonas, and Enterobacteraciae

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10
Q

Ventilator associated pneumonia

A

Pneumonia occurring >48 hours after intubation

Even more likely to be resistant to nosocomial organisms

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11
Q

What two categories are usually found in
1. acute
2. chronic
pneumonias

A
  1. Bacterial or viral

2. Mycobacterial, fungal

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12
Q

4 things to look for on clinical presentation for pneumonia

A

Cough (+/- purulent sputum)
Fever
Shortness of breath (decline in oxygenation)
Abnormal lung exam (rales, rhonchi, dullness to percussion)

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13
Q

3 things to look for on Lab data for pneumonia

A

Elevated WBC count
Abnormal chest x-ray
Resp sample: sputum, bronchoalveolar lavage, tracheal aspiration

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14
Q

2 problems with sputum

A

Obtaining a good lower RT sample is difficult

Good samples can show more than one organism or no organism (doesnt stain)

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15
Q

2 things you should have in a good sputum sample

A

Less than 10 squamous epithelial cells

Many polymorphonuclear lymphocytes

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16
Q

Sputum gram stain and culture should only be performed in which 4 conditions

A

When a good quality sample can be obtained
For hospitalized patients with severe underlying lung disease
For patients who have failed antibiotic therapy, or in whom antibiotic resistance is suspected
For patients with suspected TB

17
Q

When do you do blood cultures?

A

Only for hospitalized patients with severe CAP

Because they have low sensitivity after antibiotics are started

18
Q

3 problems with serology

A

Delay in diagnosis
Variable sensitivity
Cross-reactivity

19
Q

2 pathogens that have urine antigen testing

A 
Legionella
Strep pneumo (not routine)
20
Q

Pros and cons to urine antigen testing

A

Pros: more sensitive and specific than sputum gram stain and culture, urine more readily available, immediate results, still works after antibiotics started
Cons: sensitivity less in patients without bacteremia, can’t do antibiotic susceptibility testing

21
Q

3 times that identifying the specific organism actually becomes important

A

Resistant bacteria
Bacteria not covered by standard empiric therapy (staph, pseudomonas)
Non-bacterial pathogen (influenza season, immune suppressed)

22
Q

Antibiotics that work against common bacteria

  1. which bacteria
  2. 6 drugs
A
  1. Strep pneumo, H influenzae (+ or - beta lactamase), Moraxella
  2. Amox-clav, Cefuroxime, Ceftriaxone, Doxy, Levofloxavin, and Moxifloxacin (but the fluoros are second line)
23
Q

5 antibiotics that work against bacteria without a cell wall or intra-cellular organisms

A 
Clarithromycin
Azithromycin
Doxycycline
Levofloxacin
Moxifloxacin
NO BETA LACTAMS
24
Q

CAP

  1. Mild/moderate drugs
  2. Severe drugs
A
  1. Doxy, or Amox-clav and macro/doxy

2. Ceftriaxone and doxy or ceftriaxone and azithromycin

25
Q

How long do you treat

  1. CAP
  2. HAP or VAP
A
  1. 5 days

2. 7 days

26
Q

6 main bacteria that cause HAP or VAP

A 
Strep pneumo
H influenzae
Staph aureus (including MRSA)
Pseudomonas
Enteric gram - bacteria
Anaerobes
27
Q

Drugs for VAP or HAP

A 
Pip-taxo
Meropenem/imipenem
Cefepime/ceftazidime
Ciprofloxacin/levofloxain
One of those plus or minus Vancomycin (MRSA) or Linezolid
28
Q

CRB-65 Score

A

Prognosis score
Confusion, resp rate (> 30), BP ( < 90/60), age (> 64)
All those are 1 point
If you get greater than 1, hospitalize

Week 6: Pneumonia and Cough (9 decks)

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