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CLMD: Respiratory > Pneumonia, Bronchiectasis, And Lung Abscess > Flashcards

Pneumonia, Bronchiectasis, And Lung Abscess Flashcards

1
Q

What are the categories of the pneumonia?

A
  • Community-acquired (CAP)
  • Health care-associated (HCAP)
    —hospital-acquired pneumonia (HAP)
    —ventilator-associated pneumonia (VAP)
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2
Q

What is health care-associated with current hospitalization for ___ hrs, or hospitalization for ____ hr in the prior ___ months, residence in a _____ home or extended-care facility, ________ therapy in the preceding 3 months

A
  • current hospitalization for 48 hrs
  • Hospitalization for 48 hr/2 days in the prior 3 months
  • nursing home
  • antibiotic therapy
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3
Q

Classic pneumonia presents as a lobar pattern and evolves through four phases. What are the four phases?

A
  1. Edema- proteinaceous exudates are present in the alveoli
  2. Red hepatization- erythrocytes and neutrophils are present in the intraalveolar exudate
  3. Gray hepatization- neutrophils and fibrin depostion are abundant
  4. Resolution- macrophages are the dominant cell type
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4
Q

What are the typical bacterial pathogens involved in CA-pneumonia( 5)

A 
Gram positives: 
—s. Pneumonia
—h. Influenza
—s. Aureus 
Gram negatives:
—klebsiella
—pseudomonas aeruginosa
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5
Q

What are the atypical organism involved in CA-pneumonia(4)?

A

Mycoplasma Pneumonia
Chlamydia pneumonia
Legionella
Respiratory viruses ( influenza viruses, adenoviruses, human metapneumonvirus, RSV)

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6
Q

How does the clinical manifestations of pneumonia present?

A

Fever, chills, sweats, cough (either nonproductive or productive of mucous, purple the, or blood-tinged sputum), pleuritic chest pain, and dyspnea
—N/V, diarrhea, fatigue, headache, myalgia, arthralgia

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7
Q

How do you diagnosis pneumonia?

A

CXR: differentiate CAP from other condition
Sputum samples: >25 WBCs and <10 squamous epithelial cells er high
blood cultures: positive in 5-14% of cases
—should be performed in high risk pts (chronic liver disease)
Urine antigen tests: s. Pneumonia and legionella
PCR: nasopharyngeal swab, respiratory infections
Serology: IgM antibody can assist in the diagnosis

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8
Q

What are the two criteria to identify whether to hospitalize pt with pneumonia?

A

Pneumonia Severity Index (PSI)

CURB-65

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9
Q

What are the criteria for pneumonia severity index (PSI)?

A

Points are given for 20 variables, including age, coexisting illness, and abnormal physical and laboratory findings
Puts are assigned to one of five classes of mortality risk

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10
Q

What are the criteria for CURB-65?

A 
Five variable are included:
Confusion
Urea > 7mmol/L
Respiratory rate > 30/min
BP, systolic <90 mmHg or diasystolic <60 
Age > 65 yo

Score of 0: treated at home
Score of 2: should be hospitalized
Score of >3 require management in the ICU

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11
Q

What is the empirical antibiotic treatment for an outpatient?

A
  1. Previously healthy and no antibiotics in past 3 months
    —macrolide: clarithromycin, azithromycin or doxycycline
  2. Comorbidities or antibiotics in past 3 month
    —fluoroquinoline, gemifloxacin, levofloxacin
    —beta-lactate or amoxicillin
    —or cefltriaxone, cefpodoxime, cefuroxime plus a macrolide
  3. In regions with a high rate of “high-level” pneumoncoccal macrolide resistance
    —use drugs from classic 2
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12
Q

What is the empiric antibiotic treatment in inpatients, non-ICU?

A
  1. Fluoroquinolone (moxifloxacin, or levofloxacin)

2. Beta-lactam (ceftriaxone, ampicillin, cefotaxime, ertapenem plus a macrolide

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13
Q

What is the empiric treatment for inpatient, ICU patient?

A

Beta-lactam (ceftriaxone, ampicillin-sulbactam or cefotaxime plus either azithromycin or a fluoroquinoline

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14
Q

What antibiotic should be added to patient with pseudomonas?

A

Antipseudomonal beta-lactam (piperacillin/tazobactam), cefepime, imipenem, meropenem plus either ciprofloxacin or levofloxacin
—plus aminoglycoside (amikacin or tobramycin plus azithromycin)
—plus antipneumoncoccal fluoroquinolone

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15
Q

What drugs should be when considering CA-MRSA?

A

Add linezolid or vancomycin

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16
Q

What are some of the complications of pneumonia?

A

Common in severe CAP-respiratory failure, shock and multi-organ failure, coagulopathy, and exacerbation of comorbid disease
—Lung abscess ( usually CA-MRSA or p. Aeruginosa); drainage
—pleural effusion

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17
Q

Highest hazard ratio in the _____ ______ days of mechanical ventilation for acquiring VAP?

A

The first 5 days

18
Q

What 3 factor are important for the pathogenesis of VAP?

A
  1. Colonization of the oropharynx
  2. Aspiration of these organisms to the LRT
  3. Compromise of normal ost defenses mechanisms
19
Q

How do we prevent VAP when the pathogenic mechanism is elimination of normal flora?

A

Avoidance of prolonged antibiotic course

20
Q

How do we prevent VAP when the pathogenic mechanism is large-volume oropharyngeal aspiration around time of intubation ?

A

Short course of prophylactic antibiotics for comatose pt

21
Q

How do we prevent VAP when the pathogenic mechanism is gastroesophageal reflux?

A

Postpyloric enteral feeding; avoidance of high gastric residuals, pro kinetic agents

22
Q

How do we prevent VAP when the pathogenic mechanism is bacterial overgrowth of stomach?

A

avoidance of prophylactic agents that raise gastric pH;selective decontamination of digestive tract with non-absorbable antibiotics

23
Q

How do we prevent VAP when the pathogenic mechanism is cross-infection from other colonized pts?

A

Hand washing, especially with alcohol-based hand rub; intensive infection control education; isolation; proper cleaning of reuse-able equipment

24
Q

How do we prevent VAP when the pathogenic mechanism is large-volume aspiration?

A

Endotracheal intubation; rapid-sequence intubation techniques; avoidance of sedation;decompresssion of small-bowel obstruction

25
Q

How do we prevent VAP when the pathogenic mechanism is endotracheal intubation?

A

Noninvasive ventilation

26
Q

How do we prevent VAP when the pathogenic mechanism is prolonged duration of ventilation?

A

Daily awakening from sedation, weaning protocols

27
Q

How do we prevent VAP when the pathogenic mechanism is abnormal swallowing function?

A

Early percutaneous tracheostomy

28
Q

How do we prevent VAP when the pathogenic mechanism is secretions pooled above endotracheal tube

A

Head of bed elevated; continues aspiration of subglottic secretions with specialized endotracheal tube; avoidance of reintubation; minimization of sedation and pt transport

29
Q

How do we prevent VAP when the pathogenic mechanism is lathered lower respiratory host defenses?

A

Tight glycemic control; lowering of hemoglobin transfusion threshold

30
Q

What pt population is at risk for developing CA-PNA?

A

Extremes of age
Risk factors: alcoholism, asthma, immunosuppression, institutionalizations, and age of >70 yo
Other: smoking, COPD, recent hospitalization or antibiotic therapy

31
Q

Describe primary tuberculosis?

A

Acquired through aerosolized transmission- suspended for hours
New TB infection or active diseases in naive person
-fever(low grade)
-CXR: Hilar lymphadenopathy=> can develop pleural effusions
—lobes involved middle and lower losers, healing= calcification

32
Q

Describe Primary Progressive Tuberculosis?

A

No healing by fibrosis after infective day with M. Tuberculosis

33
Q

What are the 3 patterns of Primary Progressive TB?

A

P atterns

  1. Primary caseous Pneumonia- Ghon complex expands to entire lobe or segment, a seating necrosis, consolidated appearance
  2. Tuberculosis Bronchopneumonia- 2nd to bronchopneumonia spread to entire lung parenchyma, patchy Fock
  3. Millay Tuberculosis- 2nd to hematogenous spread, multiple nodule, millet seed appearance, spread across entire affect organ (liver, kidneys, meninges, spleen).
34
Q

Describe Secondary Tuberculosis?

A

Reactivation TB
Most common (90-95%)
-fever, chills, cough, weight loss
CXR: apical and posterior segment involvement, pulmonary cavitation present

35
Q

What is another name for the PPD skin test and what is it?

A

Mantoux skin test

Intradermal injection
Read w/in 48-72 hrs
Made from Purified protein of M. Tuberculosis— will not cause infection, will illicit a reaction if previous exposure

36
Q

What is the BCG vaccination?

A

Bacilli Calmette-Guerin
Made from M. Boris
-given to ppl exposed to TB or those that live in a high prevalence area

-can cause False Positive on TST

37
Q

What Auramine-Rhodamine stain is use for ______?

A

Screening for AFB (most sensitive)

Utilizes Fluorescent microscopy

38
Q

What is the Ziegler-Nielsen stain used for __________?

A

Confirmatory AFB stain, more specific for TB

39
Q

NAAT-R testing detects resistance to which TB Drugs?

A

Rifampin and INH

40
Q

Describe Mycobacterium Tuberculosis?

A 
AFB- mycolic acid
Aerobic, slow, growing
Facultative intracellular (Macrophages)
Caseating granulomas
Virulence:
—cord factor (releases cachectin-wt loss, inhibits phagosome)
—sulfatides (inhibit phagosome-lysosomes fusion)
—siderophore Fe2+ acquisition
41
Q

What are the extrapulmonary manifestations of M. Tuberculosis?

A

Lymphadenitis- scrofula
Pleural effusions- adenosine delaminates and Interferon gamma
Military TB: widespread hematogenous shedding of TB
Meningitis
Tuberculosis spondylitis
Intestinal TB

42
Q

Describe Mycobacterium Kansasii?

A 
AFB, non-motile
Spread via environment
—old ppl w/ lung disease or smokers 
—m>>w
—Midwest and southwest

Rx: rifampin, isoniazid, ethambutal for at least 18 months

CLMD: Respiratory (4 decks)

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