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Clin Med II > pneumonia and acute bronchitis > Flashcards

pneumonia and acute bronchitis Flashcards

1
Q

pneumonia

A
  • infection of pulmonary parenchyma
  • starts in alveoli and spreads up
  • due to microaspiration, defect in host organ system, or organism virulence
  • main cause= bacteria
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2
Q

supportive care for pneumonia

A
  • rest
  • IV/ PO fluids
  • oxygen
  • cough meds
  • antipyretics, analgesics
  • incentive spirometer
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3
Q

prevention of pneumonia

A
  • smoking cessation
  • pneumococcal vaccines for at risk pts
  • flu vaccine
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4
Q

community acquired pneumonia (CAP)

A
  • pneumonia outside of health care setting

- 2nd most common cause of hospitalizations and most common cause of infectious related death

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5
Q

CAP risk factors

A
  • age
  • chronic comorbidities
  • viral respiratory infections
  • impaired airway protection
  • etoh
  • smoking
  • crowded living conditions
  • low income settings
  • toxins
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6
Q

typical bacteria associated with CAP

A
  • strep pneumonia*- most common cause
  • haemophilus influenza
  • moraxella catarrhalis
  • s aureus
  • group a strep
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7
Q

atypical bacteria associated with CAP

A
  • mycoplasma pneumonia*
  • leigonella species
  • chlamydia pneumonia
  • chlamydia psittraci
  • coxiella burnetiid
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8
Q

other bacteria associated with CAP

A
  • klebsiella pneuonia
  • histoplasma capsulatum
  • francisella tularenis
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9
Q

what is assoc with rust colored sputum

A
  • s pneumonia
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10
Q

what typical bacteria is associated with COPD and smokers

A
  • haemophilus influenza
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11
Q

what is the main cause of walking pneumonia

A
  • mycoplasma pneumoniae
  • common in young or college aged
  • assoc with bullous myringitis- blisters on TM
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12
Q

what is legionella associated with

A
  • water
  • contaminated water
  • air conditioners
  • hot tubs
  • cruise
  • travel
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13
Q

clinical presentation of CAP

A
  • fever/chills
  • cough
  • pleuritic pain
  • hemoptysis
  • HA, myalgias
  • nausea
  • in kids poor feeding or restlessness
  • altered mental status
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14
Q

PE findings for CAP

A
  • fever
  • tachypnea
  • hypoxemia
  • tachycardia
  • hypotension
  • rales/crackles
  • decreased breath sounds
  • asymmetric breath sounds
  • expiratory wheezing
  • egophony, whispered pectoriloquy, increased tactile fremitus
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15
Q

CXR findings for CAP

A
  • need PA and lateral views, get portable if unable to get 2 views
  • lobar consolidations- more well defined
  • interstitial infiltrates- less defined, hazy
  • bronchopneumonia
  • cavitations- must get CT without contrast
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16
Q

labs for pneumonia

A
  • CBC with diff*
  • BMP*
  • flu swab
  • lactic acid, CRP, ESR, pro-calcitonin
  • urine antigens- s pneumoniae and legionella
  • sputum gram stain and cultures
  • blood culture X 2
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17
Q

CURB-65

A
  • assesses severity of pneumonia
  • confusion (new onset)
  • urea > 7 (BUN > 19)
  • RR > 30
  • BP <90/60
  • 65 years or older
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18
Q

usually admit to ICU if pt has 3+ of following:

A
  • altered mental status
  • hypotension
  • temp < 96.8
  • RR >30
  • PaO2/ FiO2 ratio <250
  • BUN > 20
  • leukocyte count < 100,000
  • multi-lobar infiltrates
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19
Q

first line OP tx for CAP

A
  • azythromycin or doxycycline

- for atypical coverage

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20
Q

second line OP tx for CAP or if pt is sicker

A
  • first line azythromycin or doxicycline tx PLUS
  • amoxicillin
  • augmentin
  • cefpodoxime
  • cefuroxime
  • gives typical + atypical coverage
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21
Q

alternative OP tx for CAP wtih PCN allergy

A
  • respiratory fluoroqinolones
  • levofloxacin
  • moxifloxacin
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22
Q

when should you see improvement of CAP sx?

A
  • after 72 hours
  • before stopping abx sx should start to improve and be afebrile for 48 hours
  • sx may persist for 5-7 days after abx
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23
Q

how soon should you start IP abx treatment for CAP

A
  • within four hours
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24
Q

how soon should you start ICU abx treatment for CAP

A
  • within one hour
25
Q

IP/ICU CAP tx considerations

A
  • determine if pseudomonas risk, MRSA risk, or both
  • if not at risk then start IV tx then transition to PO
  • if not at risk give beta lactam + macrolide/tetracycline or respiratory quinolone
26
Q

IP CAP tx for MRSA risk

A
  • combo beta lactam or quinolone plus VANCO
27
Q

IP CAP tx for pseudo risk

A
  • cipro or levo PLUS

- zosyn, cefepime, ceftazidime, meropenom, imipenem

28
Q

risk factors for MRSA

A
  • GP cocci in clusters
  • MRSA colonization
  • abx (esp quinolones) in last 3 mo
  • necrotizing or cavitary pneumonia
  • empyema
  • presence of MRSA colonizing risks
29
Q

MRSA colonizing risks

A
  • end stage renal disease
  • MSM
  • crowded conditions/ incarceration
  • IVDU
  • contact sports
30
Q

pseudomonas risk factors

A
  • structural lung abnormalities
  • frequent COPD exacerbations requiring frequent steroid or abx use
  • GN bacilli on sputum
31
Q

hospital acquired pneumonia (HAP)

A
  • pneumonia > 48 hours after hospital admission
  • common hospital infection
  • highest risk if ventilated
  • increased mortality assoc with ventilation and septic shock
32
Q

most common bacteria assoc with HAP

A
  • pseudomonas
  • MRSA
  • high risk for pseduo or MRSA if IV abx within last 90 days
  • can also be polymicrobial
33
Q

MDR

A
  • nonsusceptibility to at least 1 agent in 3 dif abx classes
34
Q

XDR

A
  • nonsusceptibility to at least 1 agent in all but 2 abx classes
35
Q

pandrug resistant

A
  • nonsusceptibility to all abx that can be used for tx
36
Q

risk for MDR pseudomonas in HAP

A
  • structural lung disease

- sputum with GN bacilli

37
Q

risk for MRSA in HAP

A
  • tx in unit with > 20% of s aureus being MRSA

- tx in a unit where MRSA prevalence isn ot known

38
Q

diagnosis of HAP

A
  • new onset fever
  • purulent sputum
  • leukocytosis
  • decline in oxygenation
39
Q

ventilator acquired pneumonia

A
  • pneumonia > 48 hours after endotracheal intubation
40
Q

risk factors for MDR in VAP

A
  • IV abx within last 90 days

- > 5 days of hospitalizations prior to occurrence of VAP

41
Q

aspiration pneumonia

A
  • d/t abnormal fluid entry, exogenous substances, or endogenous secretions into lower airways
  • compromise in host defenses
  • inoculum is deleterious to lower airways
42
Q

cause of aspiration pneumonia

A
  • oral anaerobes
  • strep
  • can be mixed aerobes and anaerobes
43
Q

predisposing conditions assoc with aspiration pneumonia

A
  • altered consciousness
  • dysphagia
  • neurologic disorders
  • mechanical disruption of usual defense barriers
44
Q

most common predisposing conditions assoc with aspiration pneumonia

A
  • drug abuse
  • alcoholism
  • anesthesia
  • dysphagia - can be d/t neoplasm, diverticula, fistula, xerostomia, achalasia
45
Q

diagnosis of aspiration pneumonia

A
  • presence of predisposing condition
  • no rigors
  • putrid odor of sputum
  • periodontal disease
  • CXR- right lower lobe pneumonia
  • CT- pulmonar necrosis wiht lung abscess/ empyema
46
Q

treatment for aspiration pneumonia

A
  • first line IV- unasyn
  • first line PO- augmentin
  • alternatives- metronidazole + amoxicillin/pen G; clindamycin
47
Q

risk factors for opportunistic infections

A
  • neutropenia*
  • chronic steroid use
  • biologics
  • t cell suppression and lymphocyte depletion
  • autoimmune and inflammatory conditions
  • HIV
  • transplant pts
48
Q

PCP pneumonia

A
  • aka pneumocysis jirovecci
  • most common opportunistic infection in HIV/AIDs with a low CD4 count
  • prolonged steroids and deficits in cell mediated immunity are other common causes
49
Q

diagnosis of PCP pneumonia

A
  • CD4 count < 200
  • ABGs
  • I-3- beta-d glucone levels (fungal infections)
  • sputum culture
  • CXR- diffuse bilateral infiltrates
  • CT- ground glass appearance
50
Q

treatment of PCP pneumonia

A
  • mild- bactrim
  • mod- bactrim + PO steroids
  • severe- bactrim + IV steroids
51
Q

prevention of PCP pneumonia

A
  • bactrim SS daily or DS 3X week

- bactrim DS daily if CD4 < 100

52
Q

acute bronchitis

A
  • lower respiratory tract infection
  • large bronchi involvement
  • lasts 5 days
  • usually self limited 1-3 weeks
53
Q

most common cause of acute bronchitis

A
  • viral
54
Q

clinical manifestations of acute bronchitis

A
  • persistent cough 1-3 weeks
  • +/- sputum
  • low grade fever
  • wheezing, mild dyspnea
  • ronchi that clear with cough
  • first few days may be indistinguishable from URI
  • chest pain usually d/t cough
55
Q

dx of acute bronchitis

A
  • clinical dx
  • suspect if pt has cough for 5 days and no sx of pneumonia or COPD
  • CXR and sputum usually not needed
  • procalcitonin is emerging blood marker for bacterial infections
56
Q

indications for CXR in possible acute bronchitis

A
  • tachycardia, tachypnea
  • high grade fever
  • hypoxia
  • dementia, mental status change in elderly
  • rales, egophony, tactile fremitus
57
Q

management of acute bronchitis

A
  • pt edu
  • antitussives
  • bronchodilators for pts who are wheezing or comorbidities
  • steroids dont have much use
58
Q

OTC cough meds

A
  • dextromethorphan- cough suppressant
  • nyquil, mucinex, robitussin
  • dissociative hallucinogen in high doses
59
Q

RX cough meds

A
  • robitussin AC- guanifenesin + codeine

- tessalon pearles- local anesthetic

Clin Med II (16 decks)

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