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2012-12-11 00:39:28
Pulmonary PA Pneumonia

Pulmonary Medicine
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  1. Cavitary Lesions, severe with ETOHics, GNR
    Klebsiella pneumonia
  2. GI SX: N/V/D, anorexia, elevated LFT's, hyponatremia.
    Legionella pneumonia
  3. Aspiration pneumonia
  4. Increased incidence: COPD, elderly, ETOH, DM, <6yo
    Heamophilus influenzae
  5. 2nd MC CAP pneumonia
    H. influenzae 
  6. Immunocompromised (HIV, sp transplant, neutropenic). Cystic Fibrosis, Bronchiectasis
    Psudomonas aeruginosa
  7. S. pneumo, H. influenzae, Klebsiella, S. aureus
    Typical pneumonia
  8. Mycoplasma, Chlamydia, Legionella, Virus
    Atypical pneumonia
  9. CXR = lobar pneumonia
    Typical pneumonia
  10. Diffuse patchy infiltrates
    Atypical pneumonia
  11. Low fever, Non-productive cough, Dry. Extrapulmonary sx: myalgias, malasise, sore throat, HA, N/V/D
    Atypical pneumonia
  12. sudden OS fever, Productive cough w/ purulent sputum, pluritic chest pain, Rigors, tachycardia, tachypnea.

    CXR = lobar

    PE = bronchial lung sounds, dullness on percussion, inc fremitus
    Typical pneumonia
  13. H. influenzae, Legionella, Klebsiella, Psudomoas
  14. Strep & Staph
  15. MC Viral in infants and young children
    RSV & parainfluenza
  16. MC Viral in adults
    Infuenza (-e)
  17. MC Viral infection in AIDs patients
  18. MC Viral infection in transplant patients
  19. Sever Viral infection in adults
    Varicella Zoster
  20. PCP, HIstoplasma capsulatum, Coccidiodies
    Fungal / Parasites
  21. Usually associated with O2 desaturation with ambulation. 
  22. MC OI
    P jiroveci (PCP)
  23. MC CAP
    S. pneumoniae
  24. Psudomonas (MC), klebsiella, S. aureus, GNR, enterobacter, Serratia, CMV, HSV
  25. aspiration of acidic gastric contents
  26. 1. aspiration of inhaled oropharyngeal microbes.
         If chronically ill: GNR and S. aureus 
         out ptns: typical orlal flora (2.)
    pneumonia (staph, strep, anaerobes)
  27. Lobar, Lower lung field 
  28. Upper lung field
    • S. pneumo
    • Klebsiella
  29. Abcess formation
    S. aureus, kleb, anaerobes
  30. What tests do you send for Chlamydia
    IgM, IgG titers
  31. What test do you send for Mycoplasma for Dx?
    serum cold agglutinins 
  32. What do you send for Legionella?
    Send urine Antigen w/ or w/o PCR
  33. What organisms have myalgia, malaise, NVD clinical manifestations.
    Atypical org (legionella mainly) but could also be mycoplasma or chlamydia.
  34. non productive cough
  35. hyponatremia
  36. Outpatient
    Macrolides (zpack aka azithromycin or clarithromycin)
  37. not used because it could result in resistance.
    Fluoroquinolones (levaquin, Tequin, Avelox, Factive)
  38. What do you give for an Inpatient pneumonia?
    Macrolide and a beta lactam or FQuin
  39. Maxipime, Primaxin, Merrem, Zosyn
    Antipsudomonal beta lactams
  40. What can you give to an ICU patient with Beta lactam allergy?
    FQ +- Aztreonam OR Clindamycin + Aztreonam
  41. What can you give to a HAP patient with Beta lactam allergy?
    FQ +- Clindamycin (Aminoglycoside, Aztreonam)
  42. HAP suspect legonella
    add Macrolide (zpack) 
  43. HAP suspect with PCP
    + Bactrim to the Anti psudomonial Beta lactam 
  44. PCV13
    pneumococcal vaccine for kids
  45. PPV23
    pneumococcal vaccine given to adults
  46. T or F Chronic kidney dz, DM, and ETOHics all have an increased risk of active TB infection once exposed?
    True. also includes HIV+ and IVDA
  47. How long can TV remain viable in the air.
  48. What happends to TB when it escapes the granulomas and is not kept in check? Why would this happen?
    They form Cavitary lesions that can erode into the larger airways. Immune suppression by one or more of the 6 RF's.
  49. What immune response helps prevent active TB and how?
    Cell mediated type IV, which contain the TB within granulomas. 
  50. When granulomas form they undergo central caseous necrosis. Does this remove the TB from the body?
    NO, it could also remain dormant and cause secondary TB reactivation if the host's immune system is suppressed. 5-10% chance.
  51. What can happen to a Granuloma containing TB.
    A. it heals
    B. remains dormant
    C. is calcified
    D. forms a Ghon complex
    E. All of the above
    E. All
  52. How long does it take to become PPD + after exposure.
    A. 2 days
    B. C&D
    C. 2 weeks
    D. 1 month
    E. 2 years
    B. 2-4 weeks
    (this multiple choice question has been scrambled)
  53. Reactive TB is usually localized in which lobe of the lung?
    upper or Apex because there is a better supply of O2
  54. Which of the following can result from a TB infection.
    a. Pott's dz 
    b. meningitis
    c. scrofula
    d. none
    e. A,B,C
    E Pott's aka Vertebral, Scrofula aka lymph nodes, and TB meningitis. it can actually spread to anywhere int the body. 
  55. side effects incude: Hepatitis, peripheral neuropathy, GI, acidosis, lupus like syndrome.

    What helps with peripheral neuropathy?
    INH - Isoniazid

    PE can be prevented by B6 aka pyridoxine.
  56. SE: GI, Thrombocytopenia, Orange secretions. 

    What is CI in this TB drug?
    NNRTI's  the drug is RIF aka Rifampin
  57. Hepatitis, GI, Hyperuricemia, arthritis.

    Is this drug ok to give?
    durring the first trimester
    liver dz
    PZA - pyrazinamide.

    yes to all but caution with gout and liver dz
  58. GI, Optic neuritis, Peripheral neuropathy.
    EMB or ETH aka Ethambutol
  59. Ototoxicity, nephrotoxicity
    STM - Streptomycin

    G- only