Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

phm603 > LRTIs > Flashcards

LRTIs Flashcards

1
Q

what are common causes for pneumonia?

A
  • aspiration of upper airway microbiota
  • inhalation of aerosolized material
  • metastatic seeding from the blood to the lung (rare; surgery, trauma, catheterization)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are some clinical signs of pneumonia?

A

RR > 30
HR > 100
temp > 100
also
purulent sputum, leukocytosis, decrease O2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

signs and symptoms of pneumonia?

A
  • cough
  • sputum production
  • dyspnea
  • fever and chills
  • hemoptysis (blood in sputum)
  • pleuritic chest pain
  • tachypnea
  • tachycardia
  • diminished breath sounds
  • egophony (E sounds like A)
  • increased WBC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

pneumonia on a CXR?

A

uni=lobe and middle lung infection with lower lobe infiltrates (most common)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

gram stain

A
  • used for severe cases
  • gram + diplococci = strep. pneumoniae
  • cluster of gram + cocci = staph. aureus
  • gram - coccobacilli = H. influenzae
  • gram - dipplococci = M. catarrhalis
  • plump gram - rods = Klebsiella pneumoniae
  • thin gram - rods = pseudomonas aeruginosa
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what color is the gram stain for gram NEGATIVE bacteria?

A

PINK (gram positive = PURPLE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

sputum culture

A
  • generally expectorated sputum
  • reserved for severe cases (hospitalized)
  • try to obtain BEFORE ABX so still get high yield of gram stain and culture
  • will present with normal flora a lot of the time
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are some other diagnostic tests?

A
  • BAL (bronchoalveolar lavage)
  • blood cultures (admitted and severe)
  • procalcitonin (only in severe/sepsis)
  • O2 saturation
  • urinary antigen testing (pneumococcal and legionella)
  • viral panel
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

CURB-65

A

another test, get a certain score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

community-acquired pneumonia

A

no exposure to the healthcare system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

hospital-acquired pneumonia

A

pneumonia not incubating at time of hospital admission and occurring ≥ 48 hours AFTER admission
- can also include patients coming from the community who have received IB ABXs within 90 days of admission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

ventilator=associated pneumonia

A

pneumonia occurring > 48 hours after endotracheal intubation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is the most common pathogen for pneumonia regardless of CAP, HAP, or VAP?

A

Streptococcus pneumoniae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

atypical pathogens

A
  • legionella pneumophila
  • mycoplasma penumoniae
  • chlamydophila pneumoniae
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are some characteristics of pneumonia caused by legionella pneumophila?

A

mild to rapidly progressing pneumonia
- water exposure
- males > females
- smokers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how to treat pneumonia caused by legionella pneumophila?

A
  • fluoroquinolone
  • azithromycin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

typical pneumonia

A
  • abrupt onset
  • unilateral well-defined infiltrate
  • significant fever, chills, sweats, dyspnea
  • purulent sputum production
  • primary pulmonary symptoms: pleuritic chest pain
18
Q

atypical pneumonia

A
  • gradual onset
  • diffuse infiltrates, ground-glass appearance
  • mild fever, mild dyspnea
  • dry cough
  • extrapulmonary symptoms common: myalgias, diarrhea, abdominal pain
19
Q

outpatient treatment of CAP for someone who was previously healthy with no risk factors for drug resistance

A
  • PO amoxicillin
  • PO doxycycline (alternative)
  • PO macrolide (azithro and clarithromycin ONLY)
20
Q

comorbidities

A
  • age < 2 or > 65
  • beta-lactam within prior 3 months
  • alcohol abuse
  • immunosuppression
  • exposure to daycare
  • cancer
  • chronic respiratory disease
21
Q

outpatient treatment of CAP for someone with comorbidities

A
  • PO amoxicillin/clavulanate OR cephalosporin (cefpodox, cefdinirm cefurox) PLUS macrolide (azithro or clarithro)
  • PO respiratory quinolone (levo, moxifloxacin) IF ALLERGY or RESISTANCE HX
22
Q

inpatient treatment of NON-SEVERE CAP

A
  • IV Beta-Lactam (ampicillin/sulbactam, ceftriaxone) PLUS macrolide OR respiratory fluoroquinolone
23
Q

inpatient treatment of SEVERE CAP

A
  • IV Beta-lActam PLUS Macrolide OR
  • IV Beta-Lactam PLUS respiratory fluoroquinolone
  • give anti-MRSA or anti-pseudomonal IF prior respiratory cultures
24
Q

duration of ABXs for CAP

A

treat for a MINIMUM of 5 days (generally 7 days/1 week)
- patients should be afebrile for 48-72 hours

25
Q

what are some pretreatment tests

A
  • blood cultures and expectorated sputum samples for gram stains and culture should be sent for all patients with anti-MRSA or anti-pseudomonal ABX orders
  • patients with SEVERE CAP should have urinary antigen test for legionella and strep pneumoniae
26
Q

antibiotic assessments

A
  • check for allergies!!
  • check for QTc prolongation (quinolones and azithromycin can both prolong the ATc)
27
Q

what are some signs and symptoms of HAP

A
  • same as CAP but more SEVERE
  • respiratory complications more common
  • SIRS(systemic inflammatory response syndrome)/Sepsis more common
28
Q

how should we treat patients if HAP or VAP are suspected (all disease severity)

A

if there is late onset (≥5 days) OR risk factors for MDR pathogens, prior ABX, colonization, hospitalization, or chronic care, immunosuppression/therapy
-> use BROAD spectrum initial ABX therapy for MDR pathogens

if not, just use limited-spectrum initial ABX therapy

29
Q

what are some potential pathogens for VAP and what are some recommended ABXs?

A
  • streptococcus pneumoniae
  • H. influenzae
  • MSSA

-> ceftriaxone OR levofloxacin, moxifloxacin, OR ampicillin/sulbactam, OR ertapenem

30
Q

recommended ABX therapy for VAP?

A
  • ceftriaxone OR
  • levo, moxi OR
  • amp/sul OR
  • ertapenem
31
Q

when should we empirically cover for pseudomonas?

A
  • prior IV ABX use within previous 90 days
  • severe presentation (septic shock, need for ventilator support)
  • previous infection/colonization
  • immunosuppression
32
Q

how should we empirically cover for pseudomonas?

A
  • ONE anti-pseudomonal ABX
33
Q

pseudomonas ABX recommendations

A
  • piperacillin/tazobactam
  • cefepime
  • ceftazidime
  • imipenem, meropenem (reserved due to potency)
  • aztreonam (reserved for alternate combinations
  • ciprofloxacin (reserve for PO availability, renal considerations)
  • levofloxacin (limited data; reserve for only moderate infections or less)
  • aminoglycosides
  • colistin, polymixin B (last resort)
34
Q

what are some targeted treatments?

A

CULTURES
- HAP: patients treated should have a sputum sample obtained noninvasively, then BAL if possible
- VAP: noninvasive sampling of semi-quantitative cultures preferred over invasive sampling of quantitative cultures

35
Q

noninvasive sampling

A

endotracheal aspiration

36
Q

invasive sampling

A

BAL

37
Q

duration of ABX therapy

A

7 day duration for both HAP and VAP regardless of pathogen!

38
Q

CAP treatment for healthy patients

A

oral monotherapy with amoxicillin (or macrolide or doxycycline)

39
Q

CAP treatment for patients with comorbidities

A

oral combo therapy with beta-lactam (only amox/clav) + macrolide
-> OR respiratory quinolone (levo, moxi if allergy or resistance hx)

40
Q

inpatient CAP treatment

A

IV therapy; combo (BL + MAC or BL + FQ)

41
Q

treatment for HAP/VAP

A

combo therapy
-> anti-MRSA or pseudomonal agent (1 BL - cefepime, pip/tazo, most carbapendems)
- duration 7 days

phm603 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions