Pneumonnia Flashcards
what should you do if you have a high clinical suspicion but CXR is negative?
get serial xrays, the disease may blossom
what do you do if the CXR shows what looks like pneumonia but the clinical picture doesn’t fit?
think of something else
what are classic presentation of legionella pneumonia?
GI sxs
hyponatremia
what is drug of choice for legionnella?
azithromycin
what are drugs that get good atypical coverage?
macrolides
doxycyline
fluorquinolones
what is proper dosing of levaquin for pneumonia?
750mg IV
what do you do with pleural fluid with a pneumonia?
tap it if there is enough (antibiotics won’t be enough)
what do you do with pts with pneumonia in flu season?
flu swab and if you still think they have it do a PCR
what are DOC in outpatient previously healthy pt with pneumonia?
macrolide
tetracycline
what are DOC in outpatient with comorbid dz with pneumonia?
levaquin, moxiflox, combo therapy (aug + azithromycin)
what are DOC in inpatient non ICU pneumonia?
levaquin, moxiflox,
ceftaroline OR
combo (rocephin PLUS azithro)
what are DOC in inpatient, ICU pneumonia?
zosyn 4.5 PLUS cipro PLUS vanc
what type of pneumonia hits hard and very abrupt?
strep pneumonia
what is the criteria for sepsis?
10% bands on WBC count
how can you evaluate for a pleural effusion?
US or CT without contrast
how long might a pneumonia take to get better radiographically?
2-4 weeks
always, always follow pneumonia until it does what?
clears up radiographically
what is the definition of an MDR pathogen?
bug with resistance to 2 or more of the abx typically used to treat it (esp important in regards to Gram negative bacilli)
what is the leading cause of death of nosocomial infections?
hospital acquired pneumonia
what are common HAP bugs?
klebsiella e. coli pseudomonas acinetobacter enterobacter
MRSA
what are clinical signs of HAP?
fever purulent sputum decline in oxygenation leukocytosis new infiltrate on CXR
what is zosyn?
pipercillin and BL inhibitor
people die because of what?
they don’t get abx quickly enough or the right kind
what should you do when you go to a new job/hospital?
learn your bugs so you can tailor abx choices based on where you are
what is the trough that you want for vanc?
15-20
what are good/bads with linezolid for MRSA?
expensive, easier to dose, GI issues
what are good/bad with vancomycin for MRSA?
nephrotoxic, harder to dose, cheaper
what is the timing goal for abx therapy?
direct approach at 72hrs
what time frame determines a chronic lung absess?
> 1month
what is a common cause of a lung abscess?
aspiration
what defines a primary abscess?
healthy host
what defines a secondary abscess?
immunocompromised
what are most bugs that cause lung abscess?
anaerobes from the mouth
what is Lemierre’s syndrome?
thrombophlebitis of the IJ
can cause lung abscess
fusobacterium
what are classic sxs of lung abscess?
cough, fever, wt loss, purulent sputum, bad taste in mouth, poor dentition
what bug is a/w DM and lung abscess?
klebsiella
nocardia
bactrim
actinomyces
penicillin
think about these bugs in PING and lung abscess?
mycobacterium
nocardia
aspergillus
rhodococcus
where is TB usually located in the lungs?
upper lobes with associated parenchymal involvement
what type of carcinoma of the lung cavitates?
squamous cell
what causes multifocal lesions, recurrent sinusitis, renal failure, and hematuria?
wegner’s granulomatous
txment of lung abscess with no MDR risks
unasyn and clinda
txment of lung abscess with no MDR risks and PCN allergy
fluorquinolones
once off IV abx continue treatment with
augmentin
PCN fluor + clinda
how long do you treat with abx?
6-8 weeks with serial images to ensure resolution
what is the last, last choice with lung abscess?
no abx choices and can not tolerate surgery
