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Kendigs > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

most prevalent cause throughout childhood

A

viruses

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2
Q

confection rate

A

75%

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3
Q

pneumonia that is acute, severe
secondary to inhalation of pathogen
rarely bacteremic

A

Staph pneumonia

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4
Q

Radio fx of staph aureus pna

A

60% effusion or empyema
30% pneumatocele
mostly UNILATERAL alveolar infiltrates

consolidation
cavitation
air trapping

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5
Q

Usually affects younger px vs HA MRSA

A

CA MRSA

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6
Q

CA MRSA carries thus gene
an exotoxic gene
lethal to leukocytes causing necrosis, skin lesions, nec pna

A

Panton-Valentine Leucocid

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7
Q

Meds for CA MRSA

A

Clinda
Co tri
tetracyclines

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8
Q

pathogenesis

A
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9
Q

Insidious onset

A

Hib

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10
Q

Gradual
Malaise, headache, non productive, low grade OR no fever

A

Mycoplasma (Atypical)

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11
Q

MORE SENSITiVE AND SPECIFIC than crackles

A

Tachypnea

Cut off points:
<2 months 60
2 to 12 months 50 cpm
1-5 yo 40cpm
>5 yo 30

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12
Q

Gold standard

A

Lung puncture specimen OR
BAL

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13
Q

Alternative to BAL

A

Sputum

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14
Q

Blood culture is positive in

A

<10%

*hospitalized
*complicated pna

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15
Q

pleural fluid

A

If accessible unless too small

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16
Q

Viral pna

A

PCR (specimen: lung aspirate, blood, pleural fluid, respi secretions)

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17
Q

Antigen and Serologic tests can be tested in

A

Influenza, RSV (Rapid immunoassay)

Myco, chlamydia, strep pna (serology) - GOLD STD is PAIRED acute and convalescent titers

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18
Q

Lobar or alveolar pna

A

Bacterial

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19
Q

Intersitial pna

A

Chlamydia / Mycoplasma (atypical)
Viral

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20
Q

CXR NOT recommended in ____ yrs as OPD basis

A

> 2 months

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21
Q

When to do repeat CXR

A

ROUND pna
Lobar collapse
Clinically deteriorating

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22
Q

Lung UTZ (Bedside) vs CXR

A

Accuracy SIMILAR or HIGHER

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23
Q

Non resolving pna with persistence OR recurrent radiologic findings

A

TB

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24
Q

Viral pneumonia high likely if

A

BILATERAL interstitial OR
Atelectasis

Wheeze

GENERALIZED hyperinflation

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25
Q

CAP without danger signs should be examined within ___ hrs

A

48 hrs

26
Q

indications for admission
<2 months vs older children

A

RR >70. (Vs >50 in older children)
O2 sat 90% to 92% (vs <92% in older children)

Intermittent apnea
Inability to feed
Failure after oral therapy
Severe malnutrition

(Older children: signs of dehydration)

Common:
DOB
Grunting

27
Q

O2 supplementation in pna should mt o2 sat

A

> 92%

28
Q

1st choice

A

ORAL AMOXICILLIN
80 to 90 mg/kg/DAY in 2 doses

29
Q

For ill patients when considering HIGHLY RESISTANT PNEUMOCOCCUS

A

Vanco OR TEICOplanin

30
Q

Best for Staph aureus

A

(OM)
Oxacillin/Methicillin

31
Q

3 weeks to 3 months old
*not viral in etiology

A

MACROLIDE
*Chlamydia, Bordatella, U. Urealyticum

(BUC)

32
Q

4 months to 5 yo
*pneumococcus high likely or VIRAL

A

AMOXICILLIN
Penicillin or Ampicillin
Or 3rd gen ceph

*some says MACROLIDES

33
Q

If Hib status n/a

A

CO AMOX
CEFU

Ceftri
Cefu
CefPODOXIME
CefPROZIL
cefDINIR

34
Q

MRSA strain
Antibiotic

A

Vanco

35
Q

CA-MRSA pneumonia

A

CEFTRIAXONE

36
Q

Meds by age

A
37
Q

Choice of antibiotic if typical bacteria are identified

A
38
Q

Moraxella

A

1st choice: CO AMOX

Alt: Cefuroxime

39
Q

Strep
Penicillin susceptible or intermediate

A

AMPI PENICILLIN
HIGH DOSE AMOXICILLIN

Alt:
Cefu, Ceftri, AZITH

40
Q

Strep
Penicillin RESISTANT
MIC > 4 ug/mL

A

CEPHALOSPHORINS (2nd or 3rd)
VANCOMYCIN

**no alternative *CEPH REST VAN”

41
Q

Staph auresus

A

OM
Oxa/Methicillin

MRSA: Vanco or Teico

42
Q

Antibiotic dose

A
43
Q

In slowly resolving pneumonia, there is persistence of clnical or radio fx after ___ hrs

A

48 to 96 hours of empiric antibiotic

44
Q

Necrotizing pneumoia, most are confined to _____ lobe

A

SINGLE lobe

45
Q

Usual etiologic agen in necrotizing pneumonia

A

Pneumococcus
S aureus
CA-MRSA —-> PANTON VALENTIN LEUCOCIDIN
Pseudomonas (less common)

46
Q

Persistent fever
Persistent distress

A

Pleural effusion and Empyema

Outcome: good
Full recovery

47
Q

This test is recommended in pleural effusion px but positive only in 10-22%

A

BLOOD CULTURE

48
Q

Empyema radio fx

A

ConCAVE to the side of collection (protective position to avoid pain)
Scoliosis

49
Q

Small effusion is ___ mm
And its management

A

<10 mm thick
*antibiotics to be continued 1 to 4 weeks after discharge

50
Q

Antibiotics for effusion

A

CO AMOX, CEFUROXIME

Penicillin plus fluCLOXAcillin
AMOXICLLIN plus fluCLOXAcillin

Clindamycin when effusion follows CAP

51
Q

First choice of treatment for empyema requiring drainage

A

Fibrinolytics
*shortens treatment length and hospital stay

52
Q

Lobes prone to aspiration

A

UPPER LOBE
Apical lob of LOWE LOBE

53
Q

PRIMARY vs SECONDARY ABSCESS

A

PRIMARY
Gram (+) strep, staph, ***s. Pyogenes
Gram (-) pseudomonas, kleb ———————-(PK)

Secondary:
Strep, staph, pseudomonas
Anaerobic, bacteria, fungi

54
Q

Sx vs pneumonia

A

Cough progress indolently

55
Q

Other pe findings:

A

Tachypnea,
LOCALLY REDUCED air entry
LOCALIZED inspiratory crackles

56
Q

Characteristic xray

A

Thick walled
Air fluid level

57
Q

Investigation of choice in abscess

A

CT Scan

58
Q

Mainstay of tx for abscess
Duration

A

IV 4-6 weeks
*Ampi sul
*Cephalosphorin with Clindamycin *if CA MRSA is suspected

Vancomycin - if MRSA resistant to Clinda

59
Q

Decreases hospital stay in lung abscess

A

Drainage

60
Q

Viral co infection %

A

25-30%

61
Q

Associated with reduction in lung function at 1 yo

A

Pneumonia or LRTI in the 1st yr of life

62
Q

Associated with increased risk of wheezing

A

Human rhinovirus C or RSV

Kendigs (24 decks)

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