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26 Cards in this Set
- Front
- Back
Community-acquired Pneumonia (CAP) is characterized by:
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lung field consolidation
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Most common bacterial causes of CAP
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S. Pneumoniae,
M. Pneumoniae C. Pneumoniae, H. Influenza Legionella sp. |
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Risk factors for CAP
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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,
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S/S CAP
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malaise, fever, fatigue, shaking chills, pleuritic chest pain, cough, rhonchi or rales in affected field(s), evidence of lung consolidation
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Physical findings of lung consolidation
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- increased fremitus
- egophony - dullness to percussion |
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Diagnostic studies for CAP
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- elevated WBC (may be low in elderly or immunocompromised)
- infiltrates on CXR - GS and culture not routine - routine electrolytes & LFTs of no value |
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most common cause of fatal CAP
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S. pneumoniae
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Risk factors for DRSP in CAP
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- abx w/in 3 months
- age => 65 - exposure to daycare - ETOH - comorbidities - immunosuppresive therapy or illness |
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CURB-65
scale used to assess need for hospital admit for CAP |
- Confusion
- Uremia - Respiratory rate - Blood pressure low - Age >= 65 |
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Tx CAP
previously healthy, no comorbid, no recent abx w/in 3 months |
Macrolide: azithromycin, clarithromycin, or erythromycin
weak evidence= Doxycycline |
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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) |
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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
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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 |
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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
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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?
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Levofloxacin
only one that covers all 3 risks (DRSP risk, H. influenza risk, and atypical pathogens risk) |
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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 |
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what are the physical exam findings that suggest consolidation?
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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 |
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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% |
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Which type of WBC will often rise after recovering from a serious illness?
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Monocyte
cleaning up damaged tissue, this is a good sign |
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3 W's, cause for eosinophelia?
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Worms
wheezes weird diseases (addisons) |
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What are the 3 components of WBC "Left Shift"?
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Leukocytosis: elevation TWBC => 10,000/mm3
Neutrophilia: increase neutrophils >70% TWBC; determined by ANC Bandemia: bands = young neutrophils; determined by ABC |
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What is NL ANC?
How do you determine ANC? |
NL ANC= 7000- 10,000/mm3
ANC = % neutrophils X TWBC |
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What is normal absolute Band count (ABC)?
How do you determine ABC? |
NL = 400/mm3
ABC = % bands X TWBC bands = young neutrophil |
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What is the NL total WBC (TWBC) (leukocytes)?
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NL = 6000 - 10,000 in adults
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What will you see on a WBC differential that is consistent with a viral infection?
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Increased Lymphocytes
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What is consolidation?
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Alveoli fill with fluid or blood cells:
pneumonia pulmonary edema pulmonary hemorrhage |