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26 Cards in this Set
- Front
- Back
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What is the most common bacterial pathogen for community acquired pneumonia (CAP)?
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Streptococcus pneumoniae
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What are the two most common bacterial pathogens for nosocomial acquired pneumonia?
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1. Gram negative rods
2. Staph aureus |
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List the symptoms associated with classic CAP (3)
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-fever
-pleuritic pain -productive cough |
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List the symptoms associated with atypical pneumonia (4)
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-sore throat
-headache -non productive cough -dyspnea |
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What are the common agents that cause atypical pneumonia? (5)
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-Mycoplasma pneumoniae (most common)
-Chlamydia pneumoniae -Chlamydia psittaci -Coxiella burnetti (Q fever) -Legionella spp |
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what are the (4) mc atypical viral pneumonias?
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parainfluenza
adenoviruses influenza A and B RSV |
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Most common pneumonia in following populations:
a. alcoholics b. immigrants c. nursing home residents d. HIV patients e. organ transplant pts f. renal failure pts g. pts with chronic lung dz h. smokers |
a. alcoholics- Klebsiella pneumonia
b. immigrants- TB c. nursing home- nosocomial, pseudomonas, aspiration d. HIV patients- typical agents (strep), PCP, TB e. organ transplant pts- Legionella f. renal failure pts- Legionella g. pts with chronic lung dz- Legionella h. smokers- Legionella |
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What are the appropriate steps in management of pts with suspected pneumonia? (6)
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-CXR (PA and lateral)
-Labs- CBC with diff, CMP -O2 Sat -Two pretreatment blood Cxs -Gram stain and culture of sputum -Antibiotic therapy |
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If you suspect Legionella, what additional test should get?
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urinary antigen assay
(NB: antigen persists in urine for several weeks even after txt has started) |
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What special stain would you do to identify fungi (as well as pneumocystis carinii)?
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Silver stain
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What is the first line outpatien therapy for pneumonia in pts <60 yo? (2 drugs possible)
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Macrolides
or doxycycline (alternatives: fluoroquinolones) |
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What is the first line therapy for typical CAP? (3 possible drugs)
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- 2/3G cephalosporin
- amoxacillin/clavulanic acid (Augmentin) - Fluoroquinolones |
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What is the first line therapy for pts hospitalized with pneumonia? (2)
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fluoroquinolone
OR 3G cephalosporin + macrolide |
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What is the most common site of aspiration pneumonia?
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-right lung (due to angle of right main stem bronchus from the trachea)
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Which lobes of the lungs would be the most common sites for lung abscesses?
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dependent zones:
-posterior segments of upper lung lobes -superior segments of lower lung lobes |
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treatment of lung abscess caused by anaerobes? (2 drugs)
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clindamycin
metronidazole |
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Treatment of lung abscesses caused by gram positive cocci? (4 drug options)
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-Ampicillin
-Ampicillin/sulbactam -Augmentin -Vancomycin (for staph aureus) |
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Treatment of lung abscesses caused by gram negative organisms
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-Fluoroquinolone
-Ceftazidime |
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Briefly describe primary TB
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- bacilli inhaled/deposited then ingested by alveolar macrophages
- organisms multiply and disseminate via lymphatics - usually asymptomatic - granulomas form and wall off mycobacteria |
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Briefly describe secondary TB
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- host immunocomprimised
- apical/posterior segments (O2 rich areas) - clinically symptomatic - can be spread via hematogenous or lymphatic route (miliary TB) |
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Briefly describe extrapulmonary TB
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-common in pts with HIV
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What are the two radiographic findings seen in primary TB?
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-Ghon's complex
-Ranke's complex |
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What is the first line therapy for active TB?
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Rifampin
Isoniazid Pyrazinamide Ethambutol or Streptomycin |
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What drug do you use as prophy for latent (primary) TB
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Isoniazid for 9 months
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if vital signs are normal, the probability of pneumonia in outpatients is __.
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< 1%
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what is a pulse-temperature dissociation (nl pulse, high fever) suggestive of?
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atypical community-acquired pneumonia
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