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Clinical Medicine II > pulm infectious disease > Flashcards

pulm infectious disease Flashcards

1
Q

What are the two major criteria for admitting to ICU with CAP?

A

septic shock w/ need for vasopressor support and respiratory failure w/ need for mechanical ventilation

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2
Q

What are the minor criteria for admission to ICU?

A
  • RR 30
  • hypoxemia
  • hypothermia
  • hypotension requiring aggressive fluid resuscitation
  • confusion/disorientation
  • multi-lobar pulmonary opacities
  • leukopenia
  • thrombocytopenia
  • uremia
  • metabolic acidosis
  • elevated lactate level
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3
Q

What in general criteria is required for admission to ICU?

A

one major criteria or 3+ minor criteria should be in ICU and consider other patient factors

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4
Q

What score should you look at considering admission with pneumonia?

A

CRB-65 score

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5
Q

What CRB-65 score means urgent admission?

A

3-4

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6
Q

What are the CRB-65 criteria?

A

Confusion
RR >30
BP <90 SBP <60 DBP
Age>65 years

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7
Q

What are these symptoms indicative of:
>5 day duration cough w/ URI symptoms, purulent or nonpurulent, mild dyspnea, chest wall/substernal pain and can be caused by various viruses?

A

acute bronchitis

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8
Q

With acute bronchitis, what may you see on a PE?

A

rhonchi or wheezing but does not require specific testing

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9
Q

What is concerning with acute bronchitis?

A

high fever or systemic symptoms, consolidation in the lungs, rales, egophony, pleural inflammation

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10
Q

How do you treat acute bronchitis?

A

supportive treatment and recommend throat lozenges, hot tea, smoking cessation, humidifier, gen OTC meds

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11
Q

Review: pertussis

A

rapid, consecutive coughs followed by high pitch inspiration
treat with azithromycin, bactrim, clarithromycin

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12
Q

What do these symptoms indicate: fever or hypothermia, cough, dyspnea, sweats/chills, discomfort, pleuritic chest pain, tachypnea, tachycardia, hypoxia, inspiratory crackles, bronchial breath sounds, dullness to percussion?

A

pneumonia (CAP)

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13
Q

What are risks for pneumonia?

A

advanced age, alcoholism, tobacco use, comorbidities, immunosuppression

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14
Q

What’s the MC CAP bacteria?

A

strep pneumo (rusty)

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15
Q

What’s the MC gradual CAP bacteria?

A

mycoplasma pneumo

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16
Q

What color is H flu CAP?

A

green

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17
Q

What should you think in CF patients?

A

staph aureus in infancy, pseudomonas in older children

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18
Q

When should you admit a CAP patient?

A

CRB-65 – Confusion, RR >30, BP<90 or <60, >65y 3 or 4

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19
Q

When should you consider hospitalization in infants?

A

<6m, bacterial, concern for pathogen w/ virulence, concerns about caregiver, comorbidities

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20
Q

How do you classify pneumonia?

A

1) where you got the infection
2) type of pathogen
3) clinical presentation
4) extent of involvement and CXR findings

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21
Q

What indicates typical pneumonia on a CXR?

A

lobar consolidation

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22
Q

What causes patchy pneumonia on a CXR?

A

atypical, viral, or legionella

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23
Q

What causes interstitial pneumonia on a CXR?

A

viral, PCP, legionella

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24
Q

What bacteria causes cavitary pneumonia on a CXR?

A

anaerobes, klebsiella, s. aureus, TB, fungi

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25
Q

What causes large effusion pneumonia on a CXR?

A

s aureus, anaerobes, klebsiella

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26
Q

What’s preferred for diagnosis?

A

CXR

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27
Q

In a hospitalized patient, what’s required for diagnosis of CAP?

A

pulmonary opacity

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28
Q

What indicates bacterial pneumonia?

A

lobar infiltrates/consolidation or round pneumonia w/ pleural effusion

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29
Q

What indicates viral pneumonia?

A

diffuse, streaky infiltrates in bronchi + hyperinflation

30
Q

What indicates atypical pneumonia?

A

increased interstitial markings or bronchopneumonia

31
Q

How do you treat CAP outpatient who have not taken abx within 3 months and not in area of high resistance?

A

macrolide, doxycycline, amoxicillin

32
Q

How do you treat CAP outpatient in high risk for drug resistance patients outpatient?

A

macrolide + beta lactam or a respiratory fluoroquinolone

33
Q

How do you treat CAP inpatient?

A

macrolide + beta-lactam or respiratory fluoroquinolone

34
Q

How do you treat CAP inpatient in the ICU?

A

antipneumo beta-lactam ( cefotaxime, ceftriaxone, ceftaroline or amp-sulb )+ azithro or respiratory fluoroquinolone

35
Q

What are some other specific situation CAP treatments?

A

PCN allergy = fluoroquinolone + aztreonam
pseudomonas = piperacillin+tazobactam, cefepime, imipenem, meropenem + fluoroquinolone or azithromycin

MRSA + linezolid or vancomycin

36
Q

What is the timeline for nosocomial pneumonia?

A

> 48 hrs

fever, leukocytosis, purulent sputum, worsening respiratory status (2+) and new symptoms and progressive opacity on chest xray

37
Q

What bacteria is seen in VAP?

A

stenotrophomonas maltophilia, acetinobacter

38
Q

What bacteria is seen in HAP?

A

staph aureus, strep, pseudomonas, klebsiella, e coli, enterobacter, anaerobic

39
Q

How do you diagnose nosocomial pneumonia?

A

blood cultures, CBC, CMP, ABG for severity

thoracentesis w/ pleural fluid analysis

LRI culture to direct therapy

CXR often nonspecific

40
Q

How is treatment based upon in nosocomial pneumonia?

A

empiric with
- risk of MRSA, MDR, psuedomonas, other g- bacilli
- drug resistance
- local antibiograms
- mortality risk
~ 7 days

41
Q

What type of pneumonia is considered walking pneumonia and can worsen asthma symptoms, produce wheezing, have a gradual onset, and a variety of other sick symptoms like headache, malaise, fever, sore throat with a cough that follows w/ pleuritic CP or SOB?

A

mycoplasma pneumonia

42
Q

When does mycoplasma pneumoniae peak?

A

summer and late fall

43
Q

How do you diagnose mycoplasma pneumonia?

A

rales and wheezing later on, mild hepatic transaminitis may occur

CXR: reticulonodular opacities or patchy consolidations

Diagnosis cannot be made without testing

44
Q

How do you treat mycoplasma pneumonia?

A

self-limiting so usually doesn’t require treatment but if you want some,

macrolide (azithro), doxycycline, levofloxacin

45
Q

How do you treat serious mycoplasma pneumonia?

A

respiratory fluroquinolone or beta-lactam + macrolide

46
Q

What does nausea, vomiting, and diarrhea indicate in a pneumonia patient?

A

legionella bacteria, common in people who smoke, chronic lung disease, immunocompromised, from contaminated water

47
Q

How can you diagnose legionella pneumonia?

A

sputum PCR, culture, dieterle silver staining, urinary antigen testing

48
Q

How do you treat legionella pneumonia?

A

azithromycin, clarithromycin, or fluoroquinolone (levofloxacin)

49
Q

What does insidious onset of necrotizing pneumonia, lung abscess or empyema with fever, weight loss, malaise, cough w/ expectoration of foul-smelling purulent sputum indicate?

A

anaerobic pneumonia

50
Q

What does aspiration pneumonia cause?

A

anaerobic pneumonia

51
Q

What do multiple areas of cavitation within areas of consolidation indicate?

A

necrotizing pneumonia

52
Q

What does a thick-walled solitary cavity surrounded by consolidation and air fluid level present indicate?

A

lung abscess

53
Q

What does a purulent pleural fluid and pleural loculations indicate?

54
Q

How do you treat anaerobic pneumonia?

A

beta-lactam/lactamase inhibitor combo:
piperacillin-tazobactam or amoxicillin-clav OR carbapenem

continue until CXR improve

empyema –> tube thoracostomy or open pleural drainage

55
Q

What is characterized by low grade fever and wheezing, cough, tachypnea, difficulty feeding, cyanosis (bronchiolitis), and grunting, crackles, prolonged expiration, retractions, apnea, lethargy, palpable liver/spleen?

A

acute bronchiolitis/respiratory syncytial virus

56
Q

When does acute bronchiolitis/respiratory syncytial virus peak?

A

winter

major risk: prematurity

57
Q

What’s the leading cause of hospitilization in children?

A

bronchiolitis and pneumonia

58
Q

When can you make an RSV/acute bronchiolitis diagnosis in infant/child?

A

1-3d of URI followed by cough + tachypnea +/- chest retractions + wheeze +/- crackles on auscultation

RT-PCR w/ nasal swab

59
Q

How do you treat RSV/acute bronchiolitis?

A

time! respiratory isolation, tube feeding or IV nutrition

support

high risk = aerosolized ribavirin

60
Q

What’s RSV/ acute bronchiolitis associated with?

A

airway reactivity later in life and otitis media

61
Q

What is respiratory syncytial virus prophylaxis?

A

RSV antibody immunization recommended for all infants who are younger than 8 months, born during or entering RSV season IF birth parent did not recieve or IF birth is within 14 days of vaccine administration

also for children between 8-19m entering RSV season if chronic lung disease, immunocomp, CF, American Indian and Alaska Native

62
Q

Review

A

influenza, TB, COVID

63
Q

Where does aspergillus fumigatus often go?

A

lungs, sinuses, brain

64
Q

How do you diagnose aspergillosis?

A

tissue or culture but should consider in patients with risk

CT chest -> nodules, wedge shaped infarcts, halo sign

65
Q

What’s prophylaxis for aspergillosis?

A

posaconazole or voriconazole

66
Q

What’s treatment for aspergillosis?

A

IV voriconazole

67
Q

When should you hospitalize an infant for RSV?

A

Hospitalize if <95% O2, <3m, RR>70, toxic appearance

68
Q

What should you recommend for adult vaccinations?

A

all adults 75+
adults 60-74 if increased risk of severe

best in late summer or early fall

69
Q

Is RSV an annual vaccine?

70
Q

Review: RSV vaccine

A

infant <8m who are born during or entering first season if mom did not recieve it, unknown, or born within 14 days of vaccine
OR
8-19m if chronic lung disease w/ support, severe immunocomp, CF w. severeness, or low weight, or american Indian or alaska native children

71
Q

Should >8m or older children that are healthy get another dose?

A

no they are fine

72
Q

Which RSV maternal vaccine is the only one approved for pregnancy?

A

Pfizer’s Abrysvo during 32-36 weeks, generally September - January
just first pregnancy!

Clinical Medicine II (26 decks)

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