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15 Cards in this Set

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27. What does the paediatric pt older than ~5 yrs old with pneumonia typically have (aetiology)?
a. Mycoplasma!
b. However, most of the viral and bacterial aetiologies previously listed are possible, except GBS and listeria.
28. What are abx in the >5yo age group directed towards for pneumonia?
a. Mycoplasma and typical bacteria (pneumococcus)
b. Tx options:
1. Macrolides (Azithromycin) or
2. Cephalosporins (ceftriaxone or cefuroxime
29. 2 possible aetiologies in pneumonia in the intubated ICU pt w/central lines?
a. Pseudomonas aeruginosa or fungal species (candida)
30. 2 possible aetiologies in pneumonia in the pt w/chronic lung disease (cystic fibrosis)?
a. Pseudomonas and Aspergillus
31. When should varicella pneumonia be considered?
a. In pts w/typical skin findings and pneumonia.
32. When to consider CMV pneumonia?
a. When CMV retinitis is present.
33. When to consider Legionella pneumophila pneumonia?
a. If the pt has been exposed to stagnant water.
34. When to consider Aspergillus pneumonia?
a. If pt has refractory asthma or a classic “fungal ball” on chest radiograph.
35. Pneumonia to consider with travel to Southwestern US?
a. Coccidioides immitis?
36. Pneumonia to consider with exposure to sheep or cattle?
a. Coxiella burnetii.
37. Pneumonia to consider with Spelunking of working on a farm east of the Rocky Mountains?
a. Histoplasma capsulatum.
38. Presentation of TB?
a. Range from traditional cough, bloody sputum, fever, and weight loss to subtle or nonspecific symptoms.
39. Positive ppd definition?
a. Indurated diameter in the context of the pt’s exposure history, radiographic findings, and immune status.
b. i.e a 5-mm induration may be considered a “positive” PPD at 48-72 hours in a pt w/confirmed exposure, abnormal CXR, or immunodeficiency.
c. The same measurement in an otherwise healthy child w/o exposure would not be considered positive.
40. Possible sources for acid-fast bacilli for stain and culture?
a. First-morning sputum samples
b. Gastric aspirates
c. Bronchial washes
d. Biopsy obtain via bronchoscopy
e. Empyema fluid analysis or pleural biopsy if surgical intervention is required.
41. Standard Tb rx while awaiting culture and sensitivities in children?
1. INH
2. Rifampin
3. Pyrazinamide
b. For possible drug-resistant organisms, ethambutol can be added temporarily as long as visual acuity can be followed!
c. Typical abx course consists of initial phase of approx. 2 months duration on 3 or 4 meds, followed by a continuation phase of 4-7 months on INH and rifampin.