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27 Cards in this Set
- Front
- Back
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What is the most common lethal nosocomial infection?
Leading cause of death from an infectious dz? |
HAP
CAP |
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What is the most common route of infection that leads to pneumonia?
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microaspiration of pathogens colonizing the oropharynx
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What often causes pneumonias in alcoholics?
Smokers, COPD? Often has a younger host? Most common cause of CAP? Seen after influenza infections, nosocomial, is also a hematogen? Sick host, associated with bronchiectasis, nosocomial? |
Klebsiella pneumoniae (-)
H. influ (-) Mycoplasma pneumonia Strep Pneumo (+) Staph aureus (+) P. Aeruginosa (-) |
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Are the clinical sx of pneumonia onset highly predictive of specific pathogens?
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No.
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Classify the following Sx list as either a typical or atypical presentation of pneumonia:
Rapid onset Ill appearing High fever, rigors, chest pain, purulent sputum Consolidation, rales on exam Leukocytosis Airspace filling/lobar infiltrate on CXR What was this meant to describe? |
Typical
Meant to describe: S. pneumo, S. aureus, GN bacilli |
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Does the following Sx list describe a typical or an atypical presentation of pneumonia:
Indolent onset Less ill appearing Low-grade fever, malaise, headache, dry cough Rales without consolidation Mild/no leukocytosis; negative cultures Patchy/interstitial infiltrates What types of organism(s) is this *meant* to describe? |
Atypical
Mycoplasma or Chlamydia |
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What usefulness does CXR have in Dx'ing pneumonia?
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may dist. b/t pneumonia and other issues (TB, CHF, etc)
Assesses severity Identifies complications |
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What kind of pneumonia causes an interstitial infiltrate, and is often seen in HIV+ pts?
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PCP
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Are blood cultures specific for pneumonia dx? Sensitive?
Are gram stains/cultures useful, generally speaking? How do you test for TB microbiologically? Fungus? Legionella? |
Specific, but not sensitive.
Meh: high false neg and pos rates. AFB smear/culture KOH/culture urinary antigen immunoassay |
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When *are* gram stains/cultures useful?
When is it recommended that they be use? |
Large # of bact/ w/ a single morphology observed
- many PMNs - few/no swuamous epithelial cells --> lower airway specimin - sample obtained before antiB - detection of a non-colonizer (mycobacteria, endemic fungi, Legionella, PCP) Use in hospitalized pts; but pay attn to caveats. |
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On CXR of suspected pneumonia, etc., what should we think when we see an upper lobe, cavitary infiltrate?
How about when the sx have an indolent course x weeks/months --> non-resolving on txt? What should be closely investigated, in either case? |
TB
Fungal or TB Potential exposures. |
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If an atypical presentation pneumonia is seen in an outdoorsman, what might you think of?
How about in someone from the desert southwest? |
Blastomycosis
Coccidioidomycosis |
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Would you expect to see cavitations with fungal pneumonias (e.g. coccidioidomycosis)?
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Yes b/c they can cause necrotic granulomatous inflammation as well.
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Age >60yr
comorbidities (cancer, organ failures, etc) altered mental status RR>30 SBP<90 T>40 or <35 HR>125 WBC>30k or <4k hypoxemia acidosis multilobar involvement on CXR fulminant progression ... what do these findings evidence in a pneumonia pt? |
severity.
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Are inital tx's usually based on a certain pathogen dx re: pneumonia?
How many tx categories are there? |
no.
Initial treatment choices are nearly always empiric. 4 |
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If there is structural lung dz present (e.g. bronchiectasis, CF, etc.), or if there has been recent broad spec. antiB use, malnutrition or chronic steroid use... what pathogen might you put high up on the Diff Dx?
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P. aeruginosa
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What are the 4 tx groups for pneumonia?
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*Outpatient
1: no underlying dz or modifying fx 2: underlying comorbidities or modifying factors (CHF, COPD, alcoholism, etc...) *Inpatient 3. Inpatients *not* needing ICU care a. no comorbidities b. comorbidities 4. severe dz requiring ICU care a. low psuedomonas risk b. @ risk for psuedomonas |
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What bugs would we think for Pneumonia Tx group 1? Tx?
Group two? 3? |
S. pneunomia, H. influ, Mycoplasma, chlamydia, viri
- adv. macrolide (azithromycin, clarithromycin) - fquin with good respiratory coverage: levofloxacin, moxifloxacin Same, but w/ Aerobic GN bacilli and DRSP - antipneumococcal fquin - 2nd/3rd ceph + macrolide w/Legionella - IV 3rd cepth + macrolide - IV antiP fquin |
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What bugs would we think for Pneumonia Tx group 4? Tx?
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S. pneumoniae
Aerobic GN bacilli DRSP Legionella S. aureus Pseudomonas H. influ - IV 3rd ceph + macrolide - IV antipneumococcal fquin - consider Vancomycin (MRSA and PRSP) - if @ risk for psuedomonas: + anti-pseudomonal B-lactam w/ ciprofloxacin. |
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How long can fever persist when pt is being given appropiate tx?
Patchy CXR? |
~3 days
Weeks |
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What is the dx of HAP based on?
What might it be difficult to distinguish from? |
Fever, leukocytosis
new, worsening infiltrates new/increased respiratory secretions Not based solely on a new culture result CHF, PE, Pulm hemorr, ARDS |
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Which is more likely to be polymicrobial, CAP or HAP?
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HAP
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Below whichCD4+ # should we really worry about PCP in an HIV+ pt?
Is prophylactic tx in compliant pts effective? |
<200
Yes: trimethoprim/sulfa, dapsone, inhaled pentamidine |
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What is the most likely dx in the sx HIV+ pt w/ an abnormal CXR?
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Bacterial pneumonia.
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What are the features of the clinical presentation of PCP?
How do we make the dx? Tx? |
dyspnea, dry cough, fever.... insidious onset
Diffuse infiltrates typical Hypoxemia prominent feature. Visualization: DFA/Silver stain in BAL. Trimeth/sulfa IV pentamidine Coriticosteroids if pO2<70mmHg or A-a grad > 35mmHg |
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Is there a particular CD4# that puts HIV pts @ risk for TB?
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No, susceptible @ any number; however, more typical at higher CD4 counts.
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Cryptococcus neoformans is a common cause of what in HIV pts?
When it does cause pulmonary dz, is it any specific pattern? |
meningitis, usually w/o pneumonia
Meh, Local or diffuse pulmonary dz; disseminates |
