Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
34 Cards in this Set
- Front
- Back
|
3 routes of entry for pneumonia
|
aspiration/microaspiration
hematogenous aerosolized droplets |
|
|
RF for aerobic gram- (klebsiella)
|
alcoholism, nursing home, cardiopulmonary dz
|
|
|
RF for anaerobes
|
loss of consciousness, swallowing dysfunction, poor dental hygiene, airway obstruction
|
|
|
RF for H flu
|
COPD, smokers
|
|
|
RF for S. aureus
|
nursing home, post-influenza, IV drug users, bronchiectasis
|
|
|
RF for P. aeruginosa
|
structural lung disease (bronchiectasis, CF), recent broad spectrum antibiotics, malnutrition, chronic steroids
|
|
|
RF for DR Strep pneumo
|
Age >65; B-lactam tx within 3 mo; exposure to child in daycare, underlying medical co-morbidities
|
|
|
Potential with sputum gram's stain and culture
|
high false+ and false- rates
|
|
|
Culture can be useful in which pts?
|
hospitalized
|
|
|
Gram's stain can be useful when...(3)
|
large # of bacteria with a single morphology
many PMNs and few/no squamous epithelial obtained before antibiotics |
|
|
When is sputum cultures often not useful?
|
prior antibiotics
misinterpret colonizers as the pathogen dry cough poor specimen |
|
|
Upper lobe cavitary infiltrate, think what pathogen?
|
TB
|
|
|
Pt has indolent course, non-resolving on tx and is an outdoorsman, what bug causing his/her pneumonia?
|
blastomycosis
|
|
|
Pt has indolent course, non-resolving on tx and went to desert in the southwest, what bug causing his/her pneumonia?
|
coccidioidomycosis
|
|
|
demographics to consider for severity
|
age >60 yrs, comorbidities (cancer, organ failures, immunosuppressed)
|
|
|
Clinical findings for severity
|
altered mental status, severe vital sign abnormalities (RR>30, SBP <90, T>40 or <35, HR >125)
|
|
|
Clinical findings for lab data for severity
|
WBC >30k or <4k, hypoxemia, acidosis
|
|
|
What are 4 general tx groups for pneumonia?
|
Group 1: no underlying dz or modifying factors
Group 2: undelrying co-morbidities (COPD, CHF, alcoholism) Group 3: Inpatients not needing ICU (no comorbidities or underlying) Group 4: severe pneumonia requiring ICU care (low risk for pseudomonas and risk for pseudomonas) |
|
|
Tx for healthy outpts
|
macrolide or doxycycline
|
|
|
Tx for outpatient at risk for DRSP
|
respiratory fluoroquinolone
OR Beta-lactam + macrolide |
|
|
Tx for inpatient, non-ICU
|
respiratory fluoroquinolone
OR Beta-lactam + macrolide |
|
|
Tx for inpatient, ICU
|
Beta-lactam + fluoroquinolone
OR Beta-lactam + azithromycin |
|
|
General clinical response for CAP
|
24-48 hrs
-fever up to 3 days -fatigue, dyspnea, cough last 7-14 days -CXR takes weeks to clear (document resolution after 8-12w) |
|
|
Pts who don't respond or deteriorate
|
consider wrong dx, wrong antibiotic, host failure
consider further dx procedures look for complications (infectious or acute MI) |
|
|
RF for HAP
|
underlying dz, IV/urinary catheters, endotracheal tube, severity of comorbid illness, contaminated respiratory devices, poor staff hand washing
|
|
|
Common pathogens in HAP
|
gram- bacilli (P. aeruginosa, Enterobacter, E. coli, Klebsiella, Acinetobacter), MRSA, anaerobes
more likely to be polymicrobial |
|
|
3 immune deficits for immunocompromised hosts
|
neutropenia (bacteria, aspergillus, candida)
splenectomy (encapsulated organisms) T-cell number (fungi, mycobacteria, viruses, bacteria) |
|
|
when is PCP higher on risk for AIDS pts?
|
<200 T cell ct
|
|
|
What are AIDS pts at higher risk for regardless of CD4 ct?
|
bacterial pneumonia, esp S. pneumo and H. flu
|
|
|
3 prophylactic tx for PCP
|
sulfa/trimeth, dapsone, inhaled pentamidine
|
|
|
What is the prominent feature of PCP?
|
hypoxemia with diffuse infiltrates, insidious onset
|
|
|
Dx of PCP
|
visualize DFA or silver stain (induced sputum)
|
|
|
Tx for PCP in AIDS
|
sulfa/trimeth, corticosteroids (A-a >35), IV pentamidine
|
|
|
What type of pneumonia does cryptococcus present as?
|
local or diffue, disseminate
|
