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26 Cards in this Set

  • Front
  • Back
Community-acquired Pneumonia (CAP) is characterized by:
lung field consolidation
Most common bacterial causes of CAP
S. Pneumoniae,
M. Pneumoniae
C. Pneumoniae,
H. Influenza
Legionella sp.
Risk factors for CAP
smoking, chronic pulmonary ds., elderly, nursing home, ETOH, altered mental status, hypotension, BUN > 30mg/dL, exposure to bats, birds, bad soil etc., drug abuse, travel to southwest, Flu, poor dental hygiene,
S/S CAP
malaise, fever, fatigue, shaking chills, pleuritic chest pain, cough, rhonchi or rales in affected field(s), evidence of lung consolidation
Physical findings of lung consolidation
- increased fremitus
- egophony
- dullness to percussion
Diagnostic studies for CAP
- elevated WBC (may be low in elderly or immunocompromised)
- infiltrates on CXR

- GS and culture not routine
- routine electrolytes & LFTs of no value
most common cause of fatal CAP
S. pneumoniae
Risk factors for DRSP in CAP
- abx w/in 3 months
- age => 65
- exposure to daycare
- ETOH
- comorbidities
- immunosuppresive therapy or illness
CURB-65
scale used to assess need for hospital admit for CAP
- Confusion
- Uremia
- Respiratory rate
- Blood pressure low

- Age >= 65
Tx CAP
previously healthy, no comorbid, no recent abx w/in 3 months
Macrolide: azithromycin, clarithromycin, or erythromycin

weak evidence= Doxycycline
Tx CAP
presence of comorbidities or antibiotic w/in past 3 months (suspect DRSP)
Respiratory fluoroquinolone: moxifloxacin, levofloxacin, gemifloxacin
(NOT cipro)

Beta lactam with Macrolide:
azythromycin or clarithromycin
PLUS
HD amoxicilline (3-4g/d) or HD amosicillin-clavulanate (4 g/d)
Likely causative organisms in CAP include:
A. S. pneumoniae & select resp viruses
B. H. influenzae and S. aureus
C. M. catarrhalis & atypical pathogens
D. K. pneumoniae & Legionella species
S. pneumoniae and select respiratory viruses
38 y/o woman w/no chronic helath, undergone tubal ligation, no recent antimicrobials, presents w/ "Acold I can't shake" X 3 weeks.
- HA, malaise, dry cough
-SaO2 = 97%, BP 114/70, T 98*, HR 88, RR 20
- bilateral coarse late inspiratory crackles
-CXR= bilateral interstitial infiltrates
- tx option= Doxycycline?. Moxifloxacin?, Amoxicillin?, or TMP-SMX?
Doxycycline

moxi= no DRSP risk
amox = won't cover atypical if used alone
TMP-SMX = not alone
55 y/o male w/no chronic health probs, no recent antimicrobials. Has 24' hx of pleuritic chest pain, fever, chills, and rusty sputum production.
PE = dullness to percussion @ base w/tubular breath sounds and crackles. BP 118/72, T 100.4, HR 98, RR 24, SaO2 96%. CXR= RLL infiltrate.
which antibiotic to use?
azythromycin?, levofloxacin?, TMP-SMX?, or Cefprosil?
azithromycin
70 y/o male w/50 pack-year smoking, COPD, HTN, w/24 hx of increased dyspnea & productive cough. BP 130/78, T99.8, HR 98, RR 32. Evidence of consolidation on physical exam. preferred antimicrobial treatment? Doxycycline?, Levofloxacin?, Amox w/clavulanate?, or Cefdinir?
Levofloxacin
only one that covers all 3 risks (DRSP risk, H. influenza risk, and atypical pathogens risk)
which is more indicative of CAP in older adult?
elevated temp or elevated RR?
elevated RR

older adults don't get the same febrile response cuz have decreased immune system
what are the physical exam findings that suggest consolidation?
dullness to percusion (dense tissue when percussed sounds dull. dense=dull)

increased tactile fremitus (increases w/increased tissue density)

bronchial or tubular breath sounds

late inspiratory crackles
Components of WBC differential?
know what organism each works against and NL % of each differential

pneumonic = Nobody Likes My Educational Background
Neutrophils - bacteria- 60% (50-70)
Lymphocytes - virus - 30%
Monocytes - Debris - 6%
Eosinophils - allergens, parasites- 3%
Basophils -unknown- 1%
Which type of WBC will often rise after recovering from a serious illness?
Monocyte

cleaning up damaged tissue, this is a good sign
3 W's, cause for eosinophelia?
Worms
wheezes
weird diseases (addisons)
What are the 3 components of WBC "Left Shift"?
Leukocytosis: elevation TWBC => 10,000/mm3
Neutrophilia: increase neutrophils >70% TWBC; determined by ANC
Bandemia: bands = young neutrophils; determined by ABC
What is NL ANC?
How do you determine ANC?
NL ANC= 7000- 10,000/mm3

ANC = % neutrophils X TWBC
What is normal absolute Band count (ABC)?
How do you determine ABC?
NL = 400/mm3

ABC = % bands X TWBC

bands = young neutrophil
What is the NL total WBC (TWBC) (leukocytes)?
NL = 6000 - 10,000 in adults
What will you see on a WBC differential that is consistent with a viral infection?
Increased Lymphocytes
What is consolidation?
Alveoli fill with fluid or blood cells:
pneumonia
pulmonary edema
pulmonary hemorrhage