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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
Risk factors for pneumococcal pneumonia (Harrison pp 805)
``` Dementia Seizure disorder Heart Failure Cerebrovascular disease Alcoholism Tobacco smoking COPD HIV infection ```
26
Risk factor for Legionella (Harrison pp 805)
``` Diabetes Hematologic malignancy Cancer Severe renal disease HIV Smoking Male Gender Recent hotel stay or ship cruise ```
27
Sputum culture (Harrison pp 806)
> 25 neutrophils, < 10 squamous epithelial cells per low power fields Only ≤ 50% is positive
28
Blood culture (Harrison pp 806)
5-14% gets positive
29
High risk patient with CAP that should have blood culture done (Harrison pp 806)
``` CANS Complement deficiencies Chronic Liver Disease Asplenia Neutropenia sec to pneumonia Severe CAP ```
30
(+) PCR is associated with the following: (Harrison pp 806)
Sadist, Masochist leads to Death Septic Shock Mechanical Death
31
How high should IgM rise to be considered diagnostics? (Harrison pp 806)
4X
32
Identification of worsening disease or treatment failure (Harrison pp 806)
CRP
33
Need for antibacterial therapy (Harrison pp 806)
PCT
34
Prognostic model used to identify patient at low risk of dying (Harrison pp 806)
Pneumonia Index Severity (PSI) Class 1 and 2: Dec rates of admission Class 3: admission
35
Severity of illness scoring with CAP (Harrison pp 806)
CURB 65 Criteria ``` Confusion Urea > 7mmol/L Respiratory rate ≥ 30 breaths/min Blood pressure ≤ SBP 90 and ≤ DBP 60 Age ≥ 65 years old ```
36
Risk factors for early deterioration of CAP (Harrison pp 807)
``` Multilobar infiltrates Severe hypoxemia (<90%) Severe acidosis (<7.30) Mental confusion Severe tachypnea (>30 breaths/min) Hypoalbuminemia Neutropenia Thrombocytopenia Hyponatremia Hypoglycemia ```
37
Risk factors for penicillin-resistant pneumococcal infection (Harrison pp 807)
``` Recent antimicrobial therapy Age < 2 years or > 65 years Attendance at day care center Recent hospitalization HIV infection ```
38
Drug of choice for enterobacteriae species (CAP) (Harrison pp 807)
Fluoroquinolones or Carbapenems
39
CAP-MRSA superantigens (Harrison pp 807)
Enterotoxin B Enterotoxin C Panton-Valentine leukocidin
40
Antibiotics of choice for Outpatient CAP that is healthy and no antibiotics use for 3 months (Harrison pp 808)
Macrolides (Azithromycin 500mg OD, Clarithromycin 500mg BID) | Doxcycycline 100mg BID
41
Antibiotics of choice for Outpatient CAP that is comorbidities and recent antibiotics use (Harrison pp 808)
``` Respiratory fluoroquinolones (Moxifloxacin 400mg OD, gemifloxacin 320mg OD, and levofloxacin 750 mg OD) Beta lactam (Amoxicillin 1g TID or Amox-Clav 2g BID) ```
42
Antibiotics of choice for Inpatient NON-ICU (Harrison pp 808)
``` Respiratory fluoroquinolones (Moxifloxacin 400mg OD or Levoxfloxacin 750mg OD) Beta lactam (Ceftriaxone 2g IV OD, ampicillin 2g IV q6) + macrolide (Clarithromycin or azithromycin) ```
43
Antibiotics of choice for Inpatient ICU (Harrison pp 808)
Beta-lactam + azithromycin or fluoroquinolones
44
Antibiotics of choice for pseudomonas (Harrison pp 808)
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
Antibiotics of choice for CAP-MRSA (Harrison pp 808)
Linezolid 600mg q12 | Vancomycin 15mg/kg q12
46
Complications of CAP (Harrison pp 808)
Metastatic infection Lung abscess Aspiration pneumonia
47
Main preventive measure in CAP (Harrison pp 809)
Vaccination
48
Major risk factor for MDR pathogens (Harrison pp 809)
Recent hospitalization
49
What is the greatest difference of VAP and HCAP/HAP studies? (Harrison pp 809)
Expectorated sputum for a diagnosis of VAP
50
What are MDR pathogens causes of ventilator-associated pneumonia? (Harrison pp 809)
``` Pseudomonas aerigunosa MRSA Acinetobactor spp. Antibiotic-resistant Enterobacteriaceae (Enterobacter spp, ESBL +, Klebsiella pneumoniae) Legionella pneumophila Burkholderia cepacia Aspergillus spp. ```
51
Three factors critical in the pathogenesis of VAP (Harrison pp 810)
colonization--> aspiration --> compromising the normal flora
52
Most obvious risk factor for VAP (Harrison pp 810)
Endotracheal tube
53
What is the major complication of VAP? (Harrison pp 812)
Prolongation of mechanical ventilator
54
What is the major risk factor for primary lung abscess? (Harrison pp 813)
Aspiration
55
Patient that are risk for aspiration are the following: (Harrison pp 813)
``` Altered mental status Alcoholism Drug overdose Seizures Bulbar dysfunction Prior cerebrovascular or cardiovascular or neuromuscular disease ```
56
Infection of Fusobacterium necrophorum (pharynx)--> neck and carotid sheath and cause septic thrombophlebitis (Harrison pp 814)
Lemierre's syndrome
57
What is the treatment of choice for primary lung abscesses? (Harrison pp 815)
Clindamycin 600mg/IV 3x/day --> 300mg PO 4x/day IV administered B-lactam/B-lactamase for 3-4 weeks for weeks
58
Definition of lung abscess (Harrison pp 813)
Necrosis and cavitation | > 2cm in diameter
59
What size of abscess is considered less likely to respond to antibiotic therapy? (Harrison pp 815)
> 6-8 cm in diameter
60
What are the poor prognostic factors associated with lung abscess? (Harrison pp 815)
``` 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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