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Clinical Medicine Lecture - Professor Kramer > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

CAP

A

acute, patient was not hospitalized or in long term care facility within the last 14 days or more before presentation

Typical , Atypical

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2
Q

HCAP

A

in hospital for 2 or more days within last 90 days

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3
Q

HAP

A

patient with infection occurring 48 or more hours after hospital admission

hospitalized for something different like HA or MI or stroke

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4
Q

VAP

A

patient with infection occurring 48 or more hours after endotracheal intubation

they are intubated or on a ventilator

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5
Q

Pediatric pneumonia

A

CAP

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6
Q

CAP typical pathogens

A
  1. Strep pneumo
  2. Haemophilus influenzae
  3. M. cat
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7
Q

CAP atypical pathogens

A
  1. Mycoplasma pneumonia
  2. Chlamydia
  3. Legionella
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8
Q

CAP - outpatient organisms and tx

A

Strep pneumo
Mycoplasma pneumonia

previously healthy then give them MACROLIDE (axithromycin, clarithromycin) OR DOXYCYCLINE

if other comorbids give fluoroquinolones ( levofloxacin, moxifloxacin), azithromycin + augmentin, cefuroxime

follow up 1 week

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9
Q

CAP - hospitalized - organisms and tx

A

S. pneumo
M. pneumo

fluoroquinolones ( levofloxacin, moxifloxacin)
consider macrolide + ceftriaxone

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10
Q

CAP hospitalized ICU bed organisms and tx

A

s. pneumo
staph
legionella

fluoroquinolones ( levofloxacin, moxifloxacin) + beta lactam -(ampicillin,ceftriaxone)

consider: fluoroquinolones (levofloxacin, moxifloxacin) + clindai

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11
Q

HCAP - organisms and tx

A

s. pneumo
h. flu
potentially drug resistant

OUTPATIENT: fluoroquinolones ( levofloxacin, moxifloxacin)

consider: macrolide + augmentin

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12
Q

HAP - organisms

A

s. pneumo
h. flu
staph
pseudomonas

ADMISSION:
EARLY/LOW RISK - fluoroquinolones ( levofloxacin, moxifloxacin)

consider ceftriaxone or Unasyn

LATE/HIGH RISK - cefepime pr pipercillin-tazobactam, levofloxacin + vancomycin (MRSA coverage)

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13
Q

VAP - organisms and tx

A

s. pneumo
h. flue
staph
pseudomonas
acinetobacter
stenotrophomonas maltophilia

< tx is same as high risk/late HAP>

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14
Q

Aspiration pneumonia and tx

A

anaerobes - fusobacterium, bacteroides

clindamycin - best for mixed flora in the mouth

consider: augmentin and Imipenem - carbapentum

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15
Q

Neonate - just born (pediatric pneumonia) - organism and tx

A

Group B strep
listeria

2/3 women have it (try and treat mom before baby comes out)

amoxicillin or ceftriaxone

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16
Q

1-3 month (pediatric pneumonia) - organisms and tx

A

Chlamydia
s. pneumo

amoxicillin or ceftriaxone

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17
Q

3m-5y (pediatric pneumonia) - organisms and tx

A

s. pneumo
mycoplasma (atypical starts to creep up)

amoxicillin or ceftriaxone
but macrolide for mycoplasma

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18
Q

5-18 years (pediatric pneumonia) - organisms and tx

A

mycoplasma
s.pneumo

macrolides

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19
Q

CAP Typical H & P

A

fever
cough
dyspnea
chest pain pleuritic

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20
Q

CAP Atypical H & P

A

GRADUAL and insidious onset
low fever
slowly worsening cough
diarrhea

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21
Q

CAP Typical - Physical

A

tachypnea
crackles
dull percussion
increased TF

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22
Q

CAP Atypical - Physical

A

pharyngeal injection
cervical adenopahty
normal lung finding at first - remember slow onset
non toxic appearance

23
Q

s. pneumo suptum color & CXR?

A

rust color & lobar infiltrate, patchy

24
Q

when do we usually get staph? staph on CXR?

A

just after a viral illness

multi lobar infiltrates

25
Q

Kiebsiella pneumoniae sputum color and symptoms?

A

brown currant jelly & and symptoms seen in alcoholics or nursing home patients

26
Q

pseudomonas

A

recently hospitalized , debilitated or immunocompromised and usually forms abscess

27
Q

H. flu causes symptoms in______ & ____.

A

elderly and COPD

28
Q

Legionella symptoms

A

diarrhea, vomiting and nausea

29
Q

M. pneumo symptoms and CXR?

A

upper and lower respiratory tract symptoms & and CXR shows interstitial infiltrates - RETICULONODULAR PATTERN

30
Q

Bacterial Pneumonia Diagnostic studies?

A

CXR
Sputum Gram stain - help direct tx.
Blood cultures

maybe: ABG

31
Q

Typical CXR?

A

consolidation , one lobe, concentrated

32
Q

Atypical CXR?

A

diffuse , cloudy

33
Q

CURB 65 ( admit them or not)

A 
confusion
BUN > 19
Resp. rate > 30
BP < 90/60
> or equal to 65
34
Q

Viral pneumonia pathogens and tx

A 
influenza A and B
RSV
adenovirus
parainfluenza virus
rhinovirus

tx: mostly supportive but…. :

influenza - Zanamivir or Oseltamivir (Amantadine / Rimantadine)

CMV - Ganciclovir
RSV - Ribavirin

35
Q

Viral pneumonia H & P?

A

sudden onset fever
arthralgia
sore throat
rhinorrhea

36
Q

Viral pneumonia diagnostic studies?

A

Rapid antigen detection kits

CXR

37
Q

Viral pneumonia CXR findings?

A

diffuse infiltrates

similar to atypical cloudy

38
Q

Fungal pneumonia pathogens

A

Coccidioidomycosis
Cryptococcosis (pigeon shit)
Histoplasmosis (bird shit, CD$ <50)
Pneumocystosis jiroveci (CD4<200) - classic of AIDS and bactrum - TMP-SMX - for prophylactic treatment

immunicompromise and workers or farmers

39
Q

Fungal pneumonia risk factor geographic locations?

A

Histoplasmosis - Mississippi, ohio

Coccidiomycosis - SW US and NW mexico

40
Q

Is fungal pneumonia cough productive or not?

A

usually nonproductive

41
Q

Fungal specific test for Coccidiomycosis?

A

IgG and IgM

42
Q

Fungal specific test for cryptococcosis?

A

india ink

43
Q

Fungal specific test for histoplasmosis?

A

urine antigen

44
Q

fungal pneumonia CXR finding?

A

Patchy infiltrate
military - little dots
consolidation or cavitation

CT or MRI for hemorrhagic lesions

45
Q

when do you use fiberoptic bronchoscopy?

A

obtain bronchial lavage specimens from staining and culture techniques

46
Q

histoplasmosis prognosis?

A

80 % mortality if untreated but 25% if treated

47
Q

Fungal pneumonia complications?

A

hematogenous dissemination - especially in immunocompromised

48
Q

Fungal pneumonia tx?

A

pneumocystis - TMP-SMX for empiric and preventative (CD4 <200)

alternatives: Dapsone, Pentamidine, Atovaquone

49
Q

Tx for uncomplicated fungal pneumonia ?

A

oral antifungals: fluconazole, itraconazole) for months

50
Q

Tx for complicated fungal pneumonia ? ( disseminating or meningeal)

A

IV antifungals : Amphotericin B

51
Q

HIV related pneumonia pathogens?

A

pneumocystosis jiroveci

52
Q

HIV related pneumonia Hx?

A

exertion dyspnea
nonproductive cough
pleuritic chest pain
anorexia and weight loss

findings are disproportionate to image results - lungs may sound normal but the Pulse OX is low

53
Q

HIV related pneumonia tx?

A

treat underlying type of pneumonia

treat HIV with highly active antiretroviral therapy ( HAART)

Clinical Medicine Lecture - Professor Kramer (28 decks)

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