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41 Cards in this Set

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(3) Typical Sx of Pneumonia
Fever;

Cough w/ sputum;

Pleurtic Chest pain
(4) Physical Exam findings w/ Pneumonia
Dullness to Percussion;
Rales (Crackles);
Egophany;
Tactile Fremitus in consolidated segment
Bug Dx:
27-yo patient has pneumonia, bullous myringitis and a chest film that looks worse then expected
Mycoplasma Pneumonia
If a patient comes to the ER w/ consolidation and pleural effusion on CXR, what is the most important test to determine admission / Tx?
Thoracentesis
Bug Dx:
patient w/ HIV who has a CD-4 count of 52 does not take antiretroviral meds or TMP-SMX, is hypoxic on room air, and has a diffuse bilateral infiltrate on chest film
PCP
(Pneumocystis Carinii Pneumonia)
Bug Dx:
Elderly man presents w/ pneumonia, GI Sx, bradycardia, and hypoN
Legionella
Pneumonia Bug Dx:

Currant Jelly sputum
Klebsiella
Pneumonia Bug Dx:

Rusty sputum
Pneumococcus
Pneumonia Bug Dx:

patient develops a post-influenza pneumonia
Pneumococcus
Pneumonia Bug Dx:

Buldging fissure on CXR
Klebsiella
Pneumonia Bug Dx:

No bacteria on sputum gram stain culture
(2)
Legionella


Mycoplasma
Pneumonia Bug Dx:

signs of pneumonia and Serum LDH is high
PCP
MC Community Acquired, typical pneumonia
(2)
S. pneumoniae


H. Influenzae
MC Community Acquired, atypical pneumonia
(3)*
Community Lung Mess:

Chlamydia pneumoniae;

Legionella;

Mycoplasma
Community Lung Mess
MC Hospital Acquired pneumonia
(3)
Pseudomonas aeruginosa;

S. aureus;

Enteric organisms (E. coli)
What is the MCC of pneumonia (bugs) in the HIV patients as the CD-4 count decreases to the following numbers
(in order of occurrence)*:
1. < 500
2. < 200
3. < 200
4. < 200
5. < 50
6. < 50
The Pneumonia HIV Causes Are Count-based:
1. TB (500)
2. PCP (200)
3. Histoplasma (200)
4. Cryptococcus (200)
5. Avium (mycoplasma) (50)
6. CMV (50)
The Pneumonia HIV Causes Are Count-based
MCC of pneumonia in the immunocompromised host w/ Neutropenia
(4)*
Pseudomonas;

Enterobacteriaceae;

S. Aureus;

Aspergillus
PESA
MCC of pneumonia in the immunocompromised host w/ sickle cell or a splenectomy
Encapsulated organisms
MCC of pneumonia in the immunocompromised host w/ chronic Steroid use
(2)
TB;

Nocardia
MCC of pneumonia in Alcoholics
(4)
S. pneumoniae;

H. Influenzae;

Klebsiella;

TB
Pneumonia Bug Dx:

Small gram negative rod w/ a halo on gram stain
H. Influenzae
CXR pneumonia findings:

Upper lobe
(2)
TB;

Klebsiella
CXR pneumonia findings:

small cavities w/o air-fluid levels
TB

(Mycobacterium)
CXR pneumonia findings:

Large cavities w/ air-fluid levels that do not culture
(2)
Coccidioidomycosis;

Nocardia
CXR pneumonia findings:

Diffuse Bilateral Infiltrates
(2)
PCP;

Mycoplasma
Definition:
Idiopathic Eosinophilic Pneumonia
Loeffler's pneumonia
Pneumonia bugs causing "Relative Bradycardia"
(slower then expected HR for Temp, but above 60bpm)
(3)
Legionella;

Salmonella;

Chlamydia Psittaci
What drug prevents respiratory failure and improves survival in PCP pneumonia patients?

Criteria for when it is given?
(2)
Steroids

give:
A-a gradient > 35
PaO2 < 75
Drug of choice for:

Any Community Acquired Pneumonia w/ no risk factors
Macrolide

(Erythromycin, Azithromycin)
Drug of choice for:

Any Community Acquired Pneumonia w/ risk factors
(CHF, DM, etc)
(2)
1. Macrolide + 2nd generation Cephalosporin

2. FQ (Extended-spectum)
Drug of choice for:

Any Hospital Acquired Pneumonia
(2)
1. Cefixime

2. Piperacillin-tazobactam

[both for Pseudomonas coverage]
Drug of choice for:

Any Immunocompromised patient w/ Pneumonia
TMP-SMX

[for PCP coverage]
Dx:
Productive cough, night sweats, hemoptysis, anorexia, weight loss, chest pain, fever, chills
TB
(3) Dx tests for TB
Positive PPD;

Granuloma in upper lobes of lung;

Acid-fast bacilli on sputum
How is latent TB treated?
INH daily for 9 months

(or Rifampin for 4 if in contact w/ INH-resistant TB)
How is Active TB treated?
RIPE for 2 months:
Rifampin; INH, Pyrazinamide; Ethambutol

followed w/ 4 months of:
INH and Rifampin
How is tx of TB different w/ pregnant pt?
No pyrazamide

(other med ok)
Toxicity of INH
(2)*
INH: Infects Neuro and Hepatic:

Neruopathy;
Seizures;

Hepatitis
Dx:
patient brought by ambulance in status epilepticus. Patient says only medical history is TB

How is it treated?
INH toxicity


Tx: Pyridoxine
Toxicity of Rifampin
(2)
Induces P450

Gives Red-orange secretions
(tears, urine, sweat, etc)
Toxicity of Ethambutol
Optic neuritis and impaired color vision