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568 - Exam 2 McPhee

CMN 568 - Exam 2 covering McPhee readings

QuestionAnswer
For previously healthy pt who has not taken abx within the past 3 mo, what will you RX for outpatient management of CAP? a. A macrolide (Clarithromycin 500 mg PO BID; or azithromycin, 500 mg PO 1st dose followed by 250 mg PO QD X 4 d, or 500 mg PO QD X 3d) OR b. doxycycline, 100 mg PO BID
In the patient with suspected CAP, it is essential that you order what diagnostic test? CXR
Patient presents with an acute or subactue onset of fever, cough with or without sputum production, and dyspnea. You suspect what? Upon exam, you expect to find? 1. CAP 2. Tachypnea, tachycardia and arterial O2 desat, insp crackles and bronchial breath sounds
Common viral causes of CAP Influenza virus, RSV, adenovirus and parainfluenza virus
Most common bacterial pathogen identified in CAP? Other common causes? 1.S pneumoniae 2. M pneumoniae; C pneumoniae; Viruses
What are the essentials of diagnosis for CAP? 1. Fever or hypothermia, tachypnea, cough with or without sputum, dyspnea, chest discomfort, sweats or rigors (or both) 2. Bronchial breath sounds or insp crackles 3. CXR shows parenchymal opacity 4. Outside of hosp or within 48 hrs of admit
Risk factors for the development of CAP Advanced age; tobacco use; comorbid medication conditions, esp asthma or COPD; and immunosuppresion
Pt with CAP is at risk for drug resistance, What is the appropriate outpt management? a. resp fluoroquinolone b. macrolide plus a B-lactam
You have decided to RX respiratory fluoroquinolone for CAP, what are appropriate medications/dosages? moxifloxacin, 400 mg PO QD gemifloxacin, 320 mg PO QD levofloxacin 750 mg PO QD
You have decided to RX a macrolide in combination with a B-lactam to treat CAP, what medications/dosages does this include? Macrolide: (Clarithromycin 500 mg PO BID; or azithromycin, 500 mg PO 1st dose followed by 250 mg PO QD X 4 d, or 500 mg PO QD X 3d) B-lactam: amoxicillin, 1g PO TID; augmentin 2g PO BID; cefpodoxime, 200 mg PO BID; cefuroxime, 500 mg PO BID
What puts a patient at risk for drug resistance in CAP? 1. Abx therapy in past 90 days 2. Age > 65 years 3. Comorbid illness 4. Exposure to a child in daycare
What is the appropriate duration of treatment in CAP? Most experts recommend a minimum of 5 days of therapy and to continue abx until the patient is afebrile for 48 to 72 hours
The most common etiologies of CAP in patients who require hospitalization (not ICU) S pneumoniae, M pneumoniae, C pneumoniae, H influenza, Legionella species, and viruses
Most common etiologies of CAP in patients who require ICU stay S pneumoniae, Legionella species, H influenza, Enterobacteriaceae species, S aureus, and Pseudomonas species
What are indications for the pneumococcal vaccine? Age >/= 65 years Any chronic illness that increases risk of CAP
Who should receive a revaccination of the pneumococcal vaccine? Immunocompromised pts should receive 2nd dose 6 years after the first; Immunocompetent persons 65 or older that received the first dose prior to age 65 should get a 2nd dose 6 years after the 1st
Name two clinical prediction tools available to guide hospital admission decisions R/T CAP. Pneumonia severity index (PSI) CURB - 65
3 factors that distinguish nosocomial pneumonia from CAP 1. Different infectious causes 2. Higher incidence of drug resistance 3. Patient's underlying health status puts them at risk for more severe infections
What is the most important step in the pathogenesis of nosocomial pneumonia? Colonization of the pharynx and possibly the stomach with bacteria
Organisms prevalent in nosocomial pneumonias Streptococcus Pneumoniae Staph aureus MRSA Gram-neg rods, non-ESBL ESBL-producing gram neg rods (Klebsiella pneumonia, E. coli and Enterobacter species Psuedomonas aeruginosa Acinetobacter species
What are the signs and symptoms of nosoc
3 factors that distinguish nosocomial pneumonia from CAP 1. Different infectious causes 2. Higher incidence of drug resistance 3. Patient's underlying health status puts them at risk for more severe infections
What is the most important step in the pathogenesis of nosocomial pneumonia? Colonization of the pharynx and possibly the stomach with bacteria
Organisms prevalent in nosocomial pneumonias Streptococcus Pneumoniae Staph aureus MRSA Gram-neg rods, non-ESBL ESBL-producing gram neg rods (Klebsiella pneumonia, E. coli and Enterobacter species Psuedomonas aeruginosa Acinetobacter species
What are the signs and symptoms of nosocomial pneumonias? At least 2 of the following: fever, leukocytosis, purulent sputum AND New or progressive parenchymal opacity on CXR
Differential diagnosis of new lower resp tract ssx Nosocomial pneumonias CHF Atelectasis Aspiration ARDS Pulmonary thromboembolism Pulmonary hemorrhage Drug reactions
Diagnostic evaluation for suspected nosocomial pneumonia Blood cultures from two different sites
Essentials of diagnosis for anaerobic pneumonia and lung abscess Hx of or predisposition to aspiration Indolent symptoms (fever, wt loss, malaise) Poor dentition Foul-smelling purulent sputum (Most pts) Infiltrate in dependent lung zone
Most aspiration patients with necrotizing pneumonia, lung abcess, and empyema are found to be infected with... Multiple species of anaerobic bacteria including: Prevotella melaninogenica, Peptostreptococcus, Fusobacterium nucleatum, and Bacteroides species
Identify acceptable methods of collecting representative material for culture with suspected anaerobic pneumonia Transthoracic aspiration Thoracentesis Bronchoscopy with a protected brush
Different types of anaerobic pleuropulmonary infections are distinguished on the basis of... X-ray appearance
Describe the appearance of lung abcess on CXR Thick-walled solitary cavity surrounded by consolidation
How does necrotizing pneumonia look on CXR? Multiple areas of cavitation within an area of consolidation
Viewing the CXR of a patient with an empyema, you expect to see.. Presence of purulent pleural fluid, possibly in combination with findings suggestive of lung abcess or necrotizing pneumonia
Drugs of Choice for Anaerobic pneumonia and lung abcess Clindamycin, 600 mg IV Q8H until improvement, then 300 mg PO Q6H or Augmentin, 875 mg PO Q12H
Patient with defect in humoral immunity is predisposed to? Bacterial infections
Defects in cellular immunity lead to infections with... Viruses, fungi, mycobacteria, and protozoa
Neutropenia & impaired granulocyte formation predispose to infections from S aureus, Aspergillus, gram neg bacilli, and Candida.
Fulminant pneumonia is often caused by Bacterial infection
Insidious pneumonia is likely caused by Viral, fungal, protozoal, or mycobacterial infection
What are the essentials of diagnosis of pulmonary venous thromboembolism? -Predisposition to venous thrombosis -At least one: dyspnea, chest pain, hemoptysis, syncope -Tachypnea & widened alveolar-arterial PO2 difference -Elevated D-Dimer, characteristic defects on CT arteriogram, VQ scan, or pulmonary angiogram
What is Virchow's Triad? Why is it significant? -Venous stasis, injury to the vessel wall, & hypercoagulability -Risk factors for PE
Profound hypoxia with a normal CXR in the absence of preexisting lung disease leads one to suspect what condition? Highly suspicious for PE
What is Westermark sign? Sign that represents a focus of oligemia (vasoconstriction)distal to a PE
What is Hampton hump? Wedge-shaped opacity that represents intraparenchymal hemorrhage; in combination with Westermark sign, indicates PE
Created by: julieford88