Pneumonia Flashcards

1
Q

Gold standard for pneumonia diagnosis

A

CXR

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

Common symptoms of pneumonia

A

Fever/Chills
Dyspnea
Purulent Sputum
CXR signs

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

Three classifications of pneumonia (as per dr. islam)

A

Major Immunodeficiency
Tuberculosis
Relatively normal hosts w/out active TB

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

Four types of pneumonia seen in non TB, IC patients

A

HAP
VAP
HCAP
CAP

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

Criteria for hospital acquired pneumonia

A

48+ hours following admission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Criteria for VAP

A

48 hours following endotracheal intubation

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

Criteria for HCAP

A

Long term care facility
Dialysis
Outpatient Chemo
Health Care Worker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Criteria for CAP

A

Outside hospital or extended care facility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Suspect TB and isolate with two+ of the following symptoms…

A

Hempptysis
Cough more than 2 weeks
Night sweats
More than 10 lbs lost in 10 months

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

If suspecious CXR for TB, what do you do?

A

Order AFB smears

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

How to determine if a pneumonia patient should be hospitalized?

A

CURB 65. Hospitalize with a score of 2+

Confusion, Urea, RR, BP, 65

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

A SMART COP score of ___ indicated need for respiratory (probs ventilator) support

A

3 or more

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

A higher PIRO score indicates that a patient will require…

A

A longer ICU stay and more mechanical ventillation days

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

Two major indicators for ICU admission/Severe CAP

A

Invasive mechanical ventilation

Septic shock with the need for vasopressors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Three minor indicators for ICU admission/Severe CAP

A

BP over 90
PaO2/FiO2 under 250
Multilobar Disease

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

Risk factors for severe pneumonia

A
Alcoholism
COPD
Immunosuppression
Heart Disease
Institutionalization
Over 70 yo
Inhaler/PPI use
17
Q

Important physical exam findings in pneumonia

A

Irregular vitals + Confusion

High RR over 30, Low BP, Pulse over 125, irregular temp

18
Q

Three mechanisms by which bacteria reaches the lungs

A

Inhalation
Aspiration
Hematogenous

19
Q

If a pneumonia is bad enough to send a patient to the ICU, what bonus tests should you run

A

Legionella and pneumococcal UAT

20
Q

Six ost common causes of bacterial pneumonia

A
S pneumo
H influenzae
Chlamydia pneumo
Myco pneumo
Legionella
S aureus
21
Q

Criterion for a good sputum sample

A

under 10 squamous cells
over 25 WBC
Low Powered Field

22
Q

What should you look for to IS a lingular pneumonia?

A

Obscuration of the cardiac apex

23
Q

Effect of bacterial and viral pneumonia on procalcitonin levels?

A

Bacterial – Rises

Viral – Lowers via IFN-g

24
Q

Practical use for watching the PCT levels?

A

Use to assess duration of antibiotic therapy

25
Consider ABs with a PCT above...
0.25 ug/L
26
Who needs a follow up Chest X ray in 4-6 weeks
Everyone over 40 | All Smokers, Former Smokers
27
General guidelines for antibiotic management of CAP
Give empiric treatment within 4-8 hours
28
Increased risk of pseudomonas with ...
structural lung disease (bronchiectasis) Corticosteroid Therapy Broad spectrum AB activity for a week in the past month Malnutrition
29
Drug treatment for an overall healthy outpatient with no ABs in the past 3 months...
Macrolide OR Doxy
30
Drug treatment for outpatient patient with cardiopulmonary disease, beta-lactam reaction in past 3 mos, alcoholism, immunosuppressive rx, or day care exposure
Respiratory Quinalone OR beta-lactam AND macrolide/doxy
31
How long should an outpatient pneumonia patient be on antibiotics
5-7 days
32
Rx for inpt. CAP
Resp. Quinolone OR (Ceftriaxone/Ceftazimide) + Azithro/Doxy
33
ICU treatment for CAP
(Ceftriaxone/Ceftazimide) + Azithro/Respiratory Quinalone
34
How to treat suspected aspiration pneumonia
Unasyn/Zosyn Augmentin/Clindamycin Respiratory Quinalone
35
Important considerations if CAP pneumonia treatment isn't effective
Bronchoscopy Further Diagnostic Testing Escalation/Change of Therapy
36
When can you switch from IV to PO
Improved cough, dyspnea Afrbrile on two occasions 8 hrs apart Decreasing WBC count Fxnal GI tract
37
Criteria for discharge.. | In the past 24 hours, no more than one of...
Fever, Tachycardia, tachypnea (over 24) Drop in BP, O2 Sat Can't maintain oral intake Altered Mental Status
38
Which risk stratification determines outpatient vs inpatient
CURB 65
39
Treatment for HCAP
Vancomycin