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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
IP/ICU CAP tx considerations
- 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
IP CAP tx for MRSA risk
- combo beta lactam or quinolone plus VANCO
27
IP CAP tx for pseudo risk
- cipro or levo PLUS | - zosyn, cefepime, ceftazidime, meropenom, imipenem
28
risk factors for MRSA
- GP cocci in clusters - MRSA colonization - abx (esp quinolones) in last 3 mo - necrotizing or cavitary pneumonia - empyema - presence of MRSA colonizing risks
29
MRSA colonizing risks
- end stage renal disease - MSM - crowded conditions/ incarceration - IVDU - contact sports
30
pseudomonas risk factors
- structural lung abnormalities - frequent COPD exacerbations requiring frequent steroid or abx use - GN bacilli on sputum
31
hospital acquired pneumonia (HAP)
- pneumonia > 48 hours after hospital admission - common hospital infection - highest risk if ventilated - increased mortality assoc with ventilation and septic shock
32
most common bacteria assoc with HAP
- pseudomonas - MRSA - high risk for pseduo or MRSA if IV abx within last 90 days - can also be polymicrobial
33
MDR
- nonsusceptibility to at least 1 agent in 3 dif abx classes
34
XDR
- nonsusceptibility to at least 1 agent in all but 2 abx classes
35
pandrug resistant
- nonsusceptibility to all abx that can be used for tx
36
risk for MDR pseudomonas in HAP
- structural lung disease | - sputum with GN bacilli
37
risk for MRSA in HAP
- tx in unit with > 20% of s aureus being MRSA | - tx in a unit where MRSA prevalence isn ot known
38
diagnosis of HAP
- new onset fever - purulent sputum - leukocytosis - decline in oxygenation
39
ventilator acquired pneumonia
- pneumonia > 48 hours after endotracheal intubation
40
risk factors for MDR in VAP
- IV abx within last 90 days | - > 5 days of hospitalizations prior to occurrence of VAP
41
aspiration pneumonia
- d/t abnormal fluid entry, exogenous substances, or endogenous secretions into lower airways - compromise in host defenses - inoculum is deleterious to lower airways
42
cause of aspiration pneumonia
- oral anaerobes - strep - can be mixed aerobes and anaerobes
43
predisposing conditions assoc with aspiration pneumonia
- altered consciousness - dysphagia - neurologic disorders - mechanical disruption of usual defense barriers
44
most common predisposing conditions assoc with aspiration pneumonia
- drug abuse - alcoholism - anesthesia - dysphagia - can be d/t neoplasm, diverticula, fistula, xerostomia, achalasia
45
diagnosis of aspiration pneumonia
- 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
treatment for aspiration pneumonia
- first line IV- unasyn - first line PO- augmentin - alternatives- metronidazole + amoxicillin/pen G; clindamycin
47
risk factors for opportunistic infections
- neutropenia* - chronic steroid use - biologics - t cell suppression and lymphocyte depletion - autoimmune and inflammatory conditions - HIV - transplant pts
48
PCP pneumonia
- 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
diagnosis of PCP pneumonia
- CD4 count < 200 - ABGs - I-3- beta-d glucone levels (fungal infections) - sputum culture - CXR- diffuse bilateral infiltrates - CT- ground glass appearance
50
treatment of PCP pneumonia
- mild- bactrim - mod- bactrim + PO steroids - severe- bactrim + IV steroids
51
prevention of PCP pneumonia
- bactrim SS daily or DS 3X week | - bactrim DS daily if CD4 < 100
52
acute bronchitis
- lower respiratory tract infection - large bronchi involvement - lasts 5 days - usually self limited 1-3 weeks
53
most common cause of acute bronchitis
- viral
54
clinical manifestations of acute bronchitis
- 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
dx of acute bronchitis
- 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
indications for CXR in possible acute bronchitis
- tachycardia, tachypnea - high grade fever - hypoxia - dementia, mental status change in elderly - rales, egophony, tactile fremitus
57
management of acute bronchitis
- pt edu - antitussives - bronchodilators for pts who are wheezing or comorbidities - steroids dont have much use
58
OTC cough meds
- dextromethorphan- cough suppressant - nyquil, mucinex, robitussin - dissociative hallucinogen in high doses
59
RX cough meds
- robitussin AC- guanifenesin + codeine | - tessalon pearles- local anesthetic

Clin Med II (16 decks)

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