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