Pulm Flashcards
COPD CAP association
H. influenzae
Recent viral infection CAP association
S. aureus
Poor dentition/Aspiration CAP association
Anaerobes
Young healthy patient CAP association
Mycoplasma pneumoniae
Hoarseness CAP association
Chlamydophila pneumoniae
Diarrhea CAP association
Legionella
Birds CAP association
Chlamydia psittaci
Animals birthing, veterinarians, farmers CAP association
Coxiella burnetii
Hemoptysis from necrotizing disease, currant jelly sputum
Klebsiella pneumoniae
Foul-smelling sputum like rotten eggs
Anaerobes
Dry cough, rarely severe, bullous myringitis
Mycoplasma pneumoniae
Abdominal pain, diarrhea or headache and confusion
Legionella
Aids with <200 CD4 cells
Pneumoncystis
Infections associated with dry non-productive cough
Mycoplasma, viruses, Coxiella, pneumocystis, chlamydia
Involve interstitial space more than air space
Mycoplasma pneumoniae diagnostic tests
PCR
Cold agglutins
Serology
Eaton’s agar culture
Chlamydophila pneumonia diagnostic test
Rising Ab titers
Legionella diagnostic test
Urine antigen, culture on charcoal-yeast agar
Chlamydia psittaci diagnostic test
Rising Ab titers
Coxiella burnetii diagnostic test
Rising Ab titers
PJP diagnostic test
brochoalvelolar lavage with silver stain
Outpatient tx of CAP in healthy patient with no abx in last 3 months
Azithromycin/clarithromycin
Doxycycline
Outpatient tx of CAP in patient with comorbidities or abx in the last 3 months
Levofloxacin/moxifloxacin
Inpatient tx of CAP
levoflaxacin/moxiflaxacin
ceftriaxone and azithromycin
When to hospitalize CAP?
C-confusion U-uremia R-respiratory distress B-BP low 65- Age >65
2+ = hospitalization
Hospital acquired pneumonia definition
- Pneumonia developing more than 48 hours after hospitalization
- 90 days after hospital admission
Hospital acquired pneumonia etiology
E.coli or psuedomonas
HAP treatment
cefepime/ceftazidine
Piperacillin/tazobactam
Carbapenem
Treatment of ventilator associated pneumonia
- Antipseudomonal beta lactam:
celphalosporin/zosyn/carbapenem - Second antipseudomonal agent:
gentamicin(or other amino glycoside)/flouroquinolone - MRSA agent: Vancomycin or linezolid
When to add steroids to bacterium in PCP?
pO2 35
Alternative treatment for mild PCP with mild hypoxia
Atovoquone
Alternative treatment for PCP with bactrim toxicity
- Clindamycin and primaquine
- Pentamidine
When to prophylax for PCP
CD4>200
Alternatives to bactrim for PCP prophylaxis
Atovaquone or dapsone
When/what to use for prophylaxis for atypical mycobacterium?
CD4 >50
Azithromycin
Risk factors for TB
Immigrant in last 5 years Prisoners HIV positive Healthcare workers Close contact with person with TB Steroid use Hematologic malignancy Alcoholic DM
Diagnosing TB
Best initial test: CXR
Sputum stain and culture for acid x3
Most accurate test: pleural biopsy
Active TB treatment
2 months: Rifampin, INH, pyrazinamide, ethambutol
4 additional months: rifampin and INH
Treatment continues for 9 months if: Osteomyelitis Miliary TB Meningitis Pregnancy or other contraindication for pyrasinamide
Rifampin toxicity
Red color to body secretions
No need to stop therapy
Isoniazid toxicity
Peripherla neuropathy
Use pyridoxine to prevent
Pyrazinamide toxicity
Hyperuricemia
No need to treat unless symptomatic
Ethambutol toxicity
Optic neuritis/color vision
Management: decrease dose in renal failure
Induration >5mm positive
HIV Glucocorticoid user Close contact with TB Abnormal calcifications on CXR Organ transplant recipient
Induration >10mm positive
Immigrant in last 5 years Prisoner Healthcare worker Close contact with TB Hematologic malignancy Alcoholic DM
Treatment of Pulmonary hypertension
Prostacyclin analogues (PA vasodilators): epoprostenol, treprostinil, iloprost, beraprost
Endothelin antagonists: bosetan
PDE inhibitor: sildenafil
