Pneumonnia

Question 1

what should you do if you have a high clinical suspicion but CXR is negative?

Answer 1

get serial xrays, the disease may blossom

Question 2

what do you do if the CXR shows what looks like pneumonia but the clinical picture doesn’t fit?

Answer 2

think of something else

Question 3

what are classic presentation of legionella pneumonia?

Answer 3

GI sxs

hyponatremia

Question 4

what is drug of choice for legionnella?

Answer 4

azithromycin

Question 5

what are drugs that get good atypical coverage?

Answer 5

macrolides
doxycyline
fluorquinolones

Question 6

what is proper dosing of levaquin for pneumonia?

Answer 6

750mg IV

Question 7

what do you do with pleural fluid with a pneumonia?

Answer 7

tap it if there is enough (antibiotics won’t be enough)

Question 8

what do you do with pts with pneumonia in flu season?

Answer 8

flu swab and if you still think they have it do a PCR

Question 9

what are DOC in outpatient previously healthy pt with pneumonia?

Answer 9

macrolide

tetracycline

Question 10

what are DOC in outpatient with comorbid dz with pneumonia?

Answer 10

levaquin, moxiflox, 
combo therapy (aug + azithromycin)

Question 11

what are DOC in inpatient non ICU pneumonia?

Answer 11

levaquin, moxiflox,
ceftaroline OR
combo (rocephin PLUS azithro)

Question 12

what are DOC in inpatient, ICU pneumonia?

Answer 12

zosyn 4.5 PLUS cipro PLUS vanc

Question 13

what type of pneumonia hits hard and very abrupt?

Answer 13

strep pneumonia

Question 14

what is the criteria for sepsis?

Answer 14

10% bands on WBC count

Question 15

how can you evaluate for a pleural effusion?

Answer 15

US or CT without contrast

Question 16

how long might a pneumonia take to get better radiographically?

Answer 16

2-4 weeks

Question 17

always, always follow pneumonia until it does what?

Answer 17

clears up radiographically

Question 18

what is the definition of an MDR pathogen?

Answer 18

bug with resistance to 2 or more of the abx typically used to treat it (esp important in regards to Gram negative bacilli)

Question 19

what is the leading cause of death of nosocomial infections?

Answer 19

hospital acquired pneumonia

Question 20

what are common HAP bugs?

Answer 20

klebsiella
e. coli
pseudomonas
acinetobacter
enterobacter

MRSA

Question 21

what are clinical signs of HAP?

Answer 21

fever
purulent sputum
decline in oxygenation
leukocytosis
new infiltrate on CXR

Question 22

what is zosyn?

Answer 22

pipercillin and BL inhibitor

Question 23

people die because of what?

Answer 23

they don’t get abx quickly enough or the right kind

Question 24

what should you do when you go to a new job/hospital?

Answer 24

learn your bugs so you can tailor abx choices based on where you are

Question 25

what is the trough that you want for vanc?

Answer 25

15-20

Question 26

what are good/bads with linezolid for MRSA?

Answer 26

expensive, easier to dose, GI issues

Question 27

what are good/bad with vancomycin for MRSA?

Answer 27

nephrotoxic, harder to dose, cheaper

Question 28

what is the timing goal for abx therapy?

Answer 28

direct approach at 72hrs

Question 29

what time frame determines a chronic lung absess?

Answer 29

> 1month

Question 30

what is a common cause of a lung abscess?

Answer 30

aspiration

Question 31

what defines a primary abscess?

Answer 31

healthy host

Question 32

what defines a secondary abscess?

Answer 32

immunocompromised

Question 33

what are most bugs that cause lung abscess?

Answer 33

anaerobes from the mouth

Question 34

what is Lemierre's syndrome?

Answer 34

thrombophlebitis of the IJ can cause lung abscess fusobacterium

Question 35

what are classic sxs of lung abscess?

Answer 35

cough, fever, wt loss, purulent sputum, bad taste in mouth, poor dentition

Question 36

what bug is a/w DM and lung abscess?

Answer 36

klebsiella

Question 37

nocardia

Answer 37

bactrim

Question 38

actinomyces

Answer 38

penicillin

Question 39

think about these bugs in PING and lung abscess?

Answer 39

mycobacterium nocardia aspergillus rhodococcus

Question 40

where is TB usually located in the lungs?

Answer 40

upper lobes with associated parenchymal involvement

Question 41

what type of carcinoma of the lung cavitates?

Answer 41

squamous cell

Question 42

what causes multifocal lesions, recurrent sinusitis, renal failure, and hematuria?

Answer 42

wegner's granulomatous

Question 43

txment of lung abscess with no MDR risks

Answer 43

unasyn and clinda

Question 44

txment of lung abscess with no MDR risks and PCN allergy

Answer 44

fluorquinolones

Question 45

once off IV abx continue treatment with

Answer 45

augmentin | PCN fluor + clinda

Question 46

how long do you treat with abx?

Answer 46

6-8 weeks with serial images to ensure resolution

Question 47

what is the last, last choice with lung abscess?

Answer 47

no abx choices and can not tolerate surgery