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Pneumonia Flashcards

1
Q

Clinical conditions with MRSA (Harrison pp 803)

A
  1. Hospiitalization ≥ 48 hours
  2. Hospitalization ≥2 days in prior 3 months
  3. Nursing homes
  4. Chronic dialysis
  5. Home infusion therapy
  6. Home wound care
  7. Family members with MDR
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2
Q

Clinical conditions with pseudomonas aeruginosa and MDR enterobacteriacea (Harrison pp 803)

A
  1. Hospitalization ≥ 48 hours
  2. Hospitalization ≥2 hours in preceding 3 months
  3. Nursing homes
  4. Antibiotics therapy in preceding 3 months
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3
Q

Proliferation of microbial pathogens at alveolar level and the host response to pathogen (Harrison pp 804)

A

Pneumonia

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4
Q

Most common etiology of pneumonia (Harrison pp 804)

A

aspiration from the oropharynx

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5
Q

Mechanical factors involved in pnuemonia (Harrison pp 804)

A

Gag reflex and cough mechanism

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6
Q

Initiate the inflammatory response (Harrison pp 804)

A

Macrophage

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7
Q

Inflammatory mediators for fever (Harrison pp 804)

A

Interlukin 1 and TNF

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8
Q

Stimulate release of neutrophils that increases purulent secretions (Harrison pp 804)

A

Interlukin 8 and granulocyte colony-stimulating

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9
Q

Pathologic phases of pneumonia (Harrison pp 804)

A

Edema
Red hepatization phase
Gray hepatization phase
Resolution

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10
Q

Most common in nosocomial pneumonia pattern (Harrison pp 804)

A

Bronchopneumonia pattern

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11
Q

Alveolar pattern (Harrison pp 804)

A

Pneumocystis pneumonia

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12
Q

Most common etiologic agent with CAP (Harrison pp 804)

A

Streptococcus pneumoniae

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13
Q

Atypical bacteria (Harrison pp 804)

A

L egionella species
C hlamydia pneumoniae
M ycoplasma pneumoniae

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14
Q

Common etiology for CAP Outpatient (Harrison pp 804)

A 
Streptococcus pneumoniae
Chlamydia pneumoniae
Mycoplasma pneumoniae
Haemophillus influenzae
Respiratory viruses
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15
Q

Common etiology for CAP Non-ICU (Harrison pp 804)

A 
Streptoccus pneumoniae
Mycoplasma pnuemoniae
Chlamydia pneumoniae
Haemophilus influenzae
Respiratory viruses
Legionella spp.
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16
Q

Common etiology for CAP-ICU (Harrison pp 804)

A 
Streptoccus pneumoniae
Staphyloccos aureus
Legionella sp
Gram negative 
Haemophilus influenzae
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17
Q

Staphylococcus pneumoniae common etiology for CAP Non-ICU (Harrison pp 805)

A

Necrotizing pneumonia

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18
Q

Alcoholism (Harrison pp 805)

A 
S treptoccus pneumoniae
O ral anaerobes
K lebsiella pneumoniae
A cinetobacter spp
M ycobacterium tuberculosis
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19
Q

COPD/Smoking (Harrison pp 805)

A 
Haemophilus influenza
Pseudomonas aeruginosa
Legionella spp
Moraxella catarrhalis
Chlamydia penumonias
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20
Q

Dementia, stroke, decrease level of consciousness (Harrison pp 805)

A

GO
Gram negative
Oral anaerobes

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21
Q

Lung abscess (Harrison pp 805)

A 
CAP-MRSA
Oral anaerobes
Endemic fungi 
Mycoplasma tuberculosis
Atypical mycobacterium
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22
Q

Exposure to birds (Harrison pp 805)

A

Chlamydia psitacci

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23
Q

Exposure to rabbits (Harrison pp 805)

A

Francisella tularensii

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24
Q

Exposure to sheep, goats, parturients cats (Harrison pp 805)

A

Coxiella burnetii

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25
Q

Risk factors for pneumococcal pneumonia (Harrison pp 805)

A 
Dementia 
Seizure disorder 
Heart Failure 
Cerebrovascular disease
Alcoholism 
Tobacco smoking
COPD
HIV infection
26
Q

Risk factor for Legionella (Harrison pp 805)

A 
Diabetes
Hematologic malignancy
Cancer
Severe renal disease
HIV
Smoking
Male Gender
Recent hotel stay or ship cruise
27
Q

Sputum culture (Harrison pp 806)

A

> 25 neutrophils, < 10 squamous epithelial cells per low power fields
Only ≤ 50% is positive

28
Q

Blood culture (Harrison pp 806)

A

5-14% gets positive

29
Q

High risk patient with CAP that should have blood culture done (Harrison pp 806)

A 
CANS
Complement deficiencies
Chronic Liver Disease
Asplenia
Neutropenia sec to pneumonia
Severe CAP
30
Q

(+) PCR is associated with the following: (Harrison pp 806)

A

Sadist, Masochist leads to Death
Septic Shock
Mechanical
Death

31
Q

How high should IgM rise to be considered diagnostics? (Harrison pp 806)

32
Q

Identification of worsening disease or treatment failure (Harrison pp 806)

33
Q

Need for antibacterial therapy (Harrison pp 806)

34
Q

Prognostic model used to identify patient at low risk of dying (Harrison pp 806)

A

Pneumonia Index Severity (PSI)
Class 1 and 2: Dec rates of admission
Class 3: admission

35
Q

Severity of illness scoring with CAP (Harrison pp 806)

A

CURB 65 Criteria

Confusion 
Urea > 7mmol/L
Respiratory rate ≥ 30 breaths/min
Blood pressure ≤ SBP 90 and ≤ DBP 60
Age ≥ 65 years old
36
Q

Risk factors for early deterioration of CAP (Harrison pp 807)

A 
Multilobar infiltrates
Severe hypoxemia (<90%)
Severe acidosis (<7.30) 
Mental confusion 
Severe tachypnea (>30 breaths/min)
Hypoalbuminemia
Neutropenia
Thrombocytopenia 
Hyponatremia 
Hypoglycemia
37
Q

Risk factors for penicillin-resistant pneumococcal infection (Harrison pp 807)

A 
Recent antimicrobial therapy
Age < 2 years or > 65 years 
Attendance at day care center
Recent hospitalization 
HIV infection
38
Q

Drug of choice for enterobacteriae species (CAP) (Harrison pp 807)

A

Fluoroquinolones or Carbapenems

39
Q

CAP-MRSA superantigens (Harrison pp 807)

A

Enterotoxin B
Enterotoxin C
Panton-Valentine leukocidin

40
Q

Antibiotics of choice for Outpatient CAP that is healthy and no antibiotics use for 3 months (Harrison pp 808)

A

Macrolides (Azithromycin 500mg OD, Clarithromycin 500mg BID)

Doxcycycline 100mg BID

41
Q

Antibiotics of choice for Outpatient CAP that is comorbidities and recent antibiotics use (Harrison pp 808)

A 
Respiratory fluoroquinolones (Moxifloxacin 400mg OD, gemifloxacin 320mg OD, and levofloxacin 750 mg OD)
Beta lactam (Amoxicillin 1g TID or Amox-Clav 2g BID)
42
Q

Antibiotics of choice for Inpatient NON-ICU (Harrison pp 808)

A 
Respiratory fluoroquinolones (Moxifloxacin 400mg OD or Levoxfloxacin 750mg OD)
Beta lactam (Ceftriaxone 2g IV OD, ampicillin 2g IV q6) + macrolide (Clarithromycin or azithromycin)
43
Q

Antibiotics of choice for Inpatient ICU (Harrison pp 808)

A

Beta-lactam + azithromycin or fluoroquinolones

44
Q

Antibiotics of choice for pseudomonas (Harrison pp 808)

A

Antipseudomonal Beta lactam ( pipercillin tazobactam 4.5 g q6, cefepime 2g q12, imipenem 500mg q6)
Beta-lactam plus aminoglycosides (amikacin 15mg/kg qd) plus azithromycin

45
Q

Antibiotics of choice for CAP-MRSA (Harrison pp 808)

A

Linezolid 600mg q12

Vancomycin 15mg/kg q12

46
Q

Complications of CAP (Harrison pp 808)

A

Metastatic infection
Lung abscess
Aspiration pneumonia

47
Q

Main preventive measure in CAP (Harrison pp 809)

A

Vaccination

48
Q

Major risk factor for MDR pathogens (Harrison pp 809)

A

Recent hospitalization

49
Q

What is the greatest difference of VAP and HCAP/HAP studies? (Harrison pp 809)

A

Expectorated sputum for a diagnosis of VAP

50
Q

What are MDR pathogens causes of ventilator-associated pneumonia? (Harrison pp 809)

A 
Pseudomonas aerigunosa
MRSA
Acinetobactor spp. 
Antibiotic-resistant 
Enterobacteriaceae (Enterobacter spp, ESBL +, Klebsiella pneumoniae)
Legionella pneumophila
Burkholderia cepacia
Aspergillus spp.
51
Q

Three factors critical in the pathogenesis of VAP (Harrison pp 810)

A

colonization–> aspiration –> compromising the normal flora

52
Q

Most obvious risk factor for VAP (Harrison pp 810)

A

Endotracheal tube

53
Q

What is the major complication of VAP? (Harrison pp 812)

A

Prolongation of mechanical ventilator

54
Q

What is the major risk factor for primary lung abscess? (Harrison pp 813)

A

Aspiration

55
Q

Patient that are risk for aspiration are the following: (Harrison pp 813)

A 
Altered mental status
Alcoholism 
Drug overdose
Seizures
Bulbar dysfunction
Prior cerebrovascular or cardiovascular or neuromuscular disease
56
Q

Infection of Fusobacterium necrophorum (pharynx)–> neck and carotid sheath and cause septic thrombophlebitis (Harrison pp 814)

A

Lemierre’s syndrome

57
Q

What is the treatment of choice for primary lung abscesses? (Harrison pp 815)

A

Clindamycin 600mg/IV 3x/day –> 300mg PO 4x/day
IV administered B-lactam/B-lactamase
for 3-4 weeks for weeks

58
Q

Definition of lung abscess (Harrison pp 813)

A

Necrosis and cavitation

> 2cm in diameter

59
Q

What size of abscess is considered less likely to respond to antibiotic therapy? (Harrison pp 815)

A

> 6-8 cm in diameter

60
Q

What are the poor prognostic factors associated with lung abscess? (Harrison pp 815)

A 
age > 60 year old
presence of aerobic bacteria
sepsis at presentation
symptom duration of > 8 weeks 
abscess size > 6 cm

Pulmonology (9 decks)

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