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Pulmo Infxs


Urine Ag test for: S pneumo or Legionella pneumophila PNA
PNA empiric tx resp FQs, macrolides, 2G or 3G cephs x5-21days = TxOC; kids HD amox or Aug
Nosocomial PNA tx Antipseudomonal PCNs + aminoglycosides or cephs ± vanc; Early onset: CTX or resp FQ (IV), Unasyn or ertapenem; Late onset (poss MDR): antipseudomonal ceph + antispeudo FQ; aminoglycoside + vanc
PNA Mgmt guides (acronyms) PORT, CURB-65 (consciousness impaired, urea>7, RR>30, SBP<90, >65yo
Nosocomial PNA bugs GN: E coli, PA, klebs, acinetobacter; SA, SP, H flu
Pos PPD tx INH 300mg daily for 6-12 months; monitor LFTs
Aspergillus tx itraconazole, voriconazole; resection
Flu incubation 1-4 days post-exposure
Flu presentation in kids croup, bronchiolitis, GI upset, conjunctivitis, OM; sore throat, nasal congestion, conjunctivitis, nonproductive cough
Flu: comps Pneumonia; Myositis; Myocarditis, pericarditis; Aseptic meningitis; Encephalitis; Reye syndrome; Guillain-Barre syndrome
Flu: dx Epidemiologic; Virus isolation or antigen detection; Serologic
Most common clinical manifestation of acute upper airway obstruction: croup
Croup presentation stridor, barking seal; worse at night; winter; 6 mos-3 yo; males; Parainfluenza; high RR, rales, rhonchi, retractions; steeple sx
Prolonged expiratory phase, hyper-resonance to percussion, & wheezing = bronchiolitis
Bronchiolitis presentation <2 yo (peak 6 mos); M>F; winter; if cardiopulmonary dz / immunodeficiency: more severe dz; concurrent URI; low fever
Bronchiolitis agent RSV or HMPV (also poss PIV, flu or adeno)
Premature infants w/bronchiolitis often have: apneic spells as presenting symptom
Bronchiolitis: X-ray may show: hyperinflation, atelectasis and infiltrates
Croup/bronchiolitis tx supportive; cool mist humidification; pulse ox, O2 if hypoxemia; poss bronchodilators
Pneumonia RFs CHD/ lung dz; CF; asthma; SCD; immunodeficiency syndromes
Pneumonia: viral causes more common in kids <5 yo; RSV, PIVs, Influenza, Adenovirus
Pneumonia: viral causes in neonates: consider CMV, Herpes, rubella
Pneumonia: bac causes if <1 month old GBS, SA, gram neg enteric bacilli; T. pallidum; Listeria
Pneumonia: bac causes for 1 month-5 yo SP (most common); H flu; GAS; SA (&MRSA); M. pneumo; C. pneumoniae
Pneumonia: bac causes for >5 yo M pneumo most common; SP, C pneumo; TB
Less common bac causes of pneumonia C trachomatis (afebrile pneumo in 2 wks-3 mos); pertussis, PCP
Pneumonia: dx CXR = segmental infiltrates, atelectasis, pleural effusions; poss empyema; blood cx pos in 10-30% of bac
Viral pneumonia s/s tachypnea, retractions, nasal flaring & use of accessory mx; diffuse rales, wheezing; CXR diffuse interstitial infiltrates & hyperinflation
M pneumo findings CXR interstitial or bronchopneumonic infiltrates, frequently in the middle or lower lobes; Fever, cough, HA, malaise; sore throat / OM
No. 1 cause of death from infectious disease in the US pneumonia
HAP = sx onset >___ hours after hospital admission 48
Most common cause of bacterial pneumonia (70%) Streptococcus pneumoniae
May have associated non-respiratory syndromes (CNS, immune hemolytic anemia) Mycoplasma pneumoniae
may cause necrotizing infiltrates or pneumatoceles Staphylococcal pneumonia; GN; aspiration pna
Inhalation of oropharyngeal or gastric contents (volume-dependent) aspiration pneumonia
RF for infection with drug resistant pneumococci recent beta lactam therapy (within 3 months); >65 yo
Risk factor that increases the risk for gram negative respiratory infection residence at nursing home
RF for pseudomonas aeruginosa PNA Corticosteroid therapy (> 10 mg/d of prednisone); Structural lung disease (bronchiectasis); Broad-spectrum antibiotics (>7 d in past month)
Apical/posterior infiltrates of upper lobes, F, C, dry cough TB
Pediatric with barking cough, stridor viral croup (laryngotracheobronchitis); Tx w/ racemic epi and glucocorticosteroids if stridor at rest.
Fever (80%), cough, rusty sputum. RR often >24. Crackles/rales, decreased breath sounds, dullness to percussion, +egophony, pectoriloquy. CXR infiltrates/ consolidation Pneumonia
Pt >35 yo with PNA. Rusty colored or yellow-green sputum. Acute onset, F/C. Bug = Strep pneumoniae
Pt <35 yo, college students. Fever, cough, +/- sputum, chills, muscle aches. PNA bug = Mycoplasma pneumonia
PNA w/ Smokers, COPD: bugs = H. influenza; M cat (COPD)
PNA w/ DM, immunocompromised, EtOH. Currant color sputum. Bug = Klebsiella
PNA w/ Water, late summer, construction site. Diarrhea, toxic looking; males, high fevers, multilobar dz Legionella
PNA from Nursing homes, chronic care facility. Purulent sputum. Bug = Staphylococcus aureus
PNA & HIV+, AIDS, Immunocompromised, sxs out of proportion to exam; diffuse interstitial/alveolar infiltrates. Bug = Pneumocystis jerovecii (tx of choice: TMP-SMX)
PNA & decreased mental status, poor dental hygiene, dentures, foul smelling sputum, bronchiectasis. Patchy infiltrates in dependant lung zones Aspiration PNA
Cystic fibrosis w/ PNA. Bug = Pseudomonas aeruginosa
PNA: lancet-shaped gram-positive diplococci Strep pneumo
PNA: patchy lower lung consolidations. Bug = Pseudo aeruginosa
Gram negative PNA organisms (2) seen in EtOH/COPD: Klebsiella, Legionella
Lancet shaped gram positive cocci in pairs = Streptococcus pneumoniae
TB infection is spread person to person via: respiratory droplets in air (cough)
Positive PPD Zone Size >= __ mm if no risk factors: 15
Positive PPD Zone Size >= __ mm if co-morbid RFs: DM, CKD, ca, IVDA, congregate setting, foreign born/immigrant <5yrs from endemic area (Asia, Africa, Latin America), Mycobacteriology lab tech, gastrectomy 10
Positive PPD Zone Size >= __ mm if HIV+, contact of TB+ person, organ transplant / immuno-suppression, fibrotic CXR, on 15 mg prednison/day, or TNF alpha inhibitor 5
Positive PPD Zone Size >10 if comorbid RFs = DM, CKD, ca, IVDA, congregate setting, foreign born/immigrant <5yrs from endemic area (Asia, Africa, Latin America), Mycobacteriology lab tech, gastrectomy
Positive PPD Zone Size >5 if: HIV+, contact of TB+ person, organ transplant / immunosuppression, fibrotic CXR, on 15 mg prednisone/day, or TNF alpha inhibitor
Substance used for control in PPD test: Candida albicans antigen
The inability to react to TB skin tests because of a weakened immune system = anergy
More specific test for LTBI & can help exclude BCG or Mycobacterium (non-TB) reactions = Interferon Gamma Release Assay
Macrophages: Activated phagocytic cells are common in: fungal, acid-fast & some atypical bacterial infections
Influenza has an incubation period of ___ days 1-4
Fever, myalgia, headache, malaise, nonproductive cough, sore throat, rhinitis are all symptoms of: influenza
Flu resolves in ___ days; cough/ malaise can persist for 2 weeks 3-7
Children with influenza may present with: otitis media, nausea, vomiting
Viral cultures are optimal from ______ specimens and require specific viral culture media nasopharyngeal
Only _______ are effective against both Influenza A and B ostelmavir and zanamivir
Who needs annual influenza vaccinations? LT aspirin tx. PG. Chronic medical conditions (pulmo, cardiac, metabolic, renal, neuro, immunodef, hemoglobinopathy). SNF residents. Age 6 mos-18 yrs or >50 yo
Who needs annual influenza vaccinations? Chronic medical conditions (pulmonary, cardiac, metabolic, renal, neurologic, immunodeficiency, hemoglobinopathy)
Cough, weight loss, fever, night sweats, hemoptysis, fatigue, decreased appetite, chest pain can be: reactivated TB
In bacterial pneumonia, blood cx is positive how often: in 10-30%
frank pus located in pleural space = empyema
Pulmonary defense mechanisms = mucociliary lining of lung, phagocytes (alveolar macrophages, neutrophils), surfactant, IgG, chemotactic agents (C5a, IL-8)
Serum antibody titer (IgG, IgM, Legionella) can be helpful to dx: Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella
Respiratory anthrax tx Cipro or doxy
Respiratory (pneumonic) plague tx streptomycin or doxy
Respiratory tularemia (F tularensis) tx streptomycin
Bronchitis vs pneumonia Bronchitis: prior URI; cough, low fever, clear lungs or ronchi, normal CXR. PNA: acute cough, fever, tachypnea, CP, WBCs, pulmonary infiltrate on CXR
‘Discovered’ in 1976; found in aquatic environments Legionella pneumophilia
50% of 20 yo have serologic evidence of past infxn; assoc w/ chronic inflammatory dz (atherosclerosis) Chlamydia pneumonia
pneumococcus colonizes ____% of healthy adults 5-10
Risk factor for enteric gram negative respiratory infection underlying cardiopulmonary disease
Influenza rate has doubled in past decade, possibly due to: aging population and/or change in predominating viral strains (H3N2)
Influenza sees resolution in ___ days, though cough and malaise can persist for over 2 weeks 3-7
lower respiratory tract is normally sterile if directly sampled
Acceptable sputum specimen has fewer than ___ squamous epithelial cells per low power field 10
vaccine against tuberculosis Bacille Calmette-Guérin (BCG)
Short-term cough, producing mucoid sputum, persistent cough after 5 days of URI, usually viral in etiology acute bronchitis
Lower respiratory tract starts below what anatomic structure? vocal chords
Tx of latent TB INH x9 months (or RIF x4 months; or RIF + PZA x2 months in resistant pts)
Tx of active TB Quad therapy x8 weeks (INH/vit B6, RIF, ethambutol, PZA), followed by INH/RIF x4 months
Tx of TB in immunocompromised pt HIV: Quad tx x1 year. Pt on chemo: 6-9 months
TB tx if converted neg to pos INH 6-12 months
TB tx of family members of index case INH x1 year as Ppx
Side effects of ethambutol optic neuritis, red/green color blindness
Side effects of rifampin liver dysfunction, rash, flu, turn orange
Side effects of INH hepatitis, peripheral neuropathy (give vit B6 with INH)
Side effects of pyrazinamide (PZA) increased uric acid, hepatitis
Created by: Abarnard
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