Card Set Information
Pulmonary PA Pneumonia
, severe with
SX: N/V/D, anorexia, elevated LFT's, hyponatremia.
, elderly, ETOH, DM, <6yo
2nd MC CAP pneumonia
Immunocompromised (HIV, sp transplant, neutropenic). Cystic Fibrosis, Bronchiectasis
S. pneumo, H. influenzae, Klebsiella, S. aureus
CXR = lobar pneumonia
Diffuse patchy infiltrates
productive cough, Dry. Extrapulmonary sx: myalgias, malasise, sore throat, HA, N/V/D
sudden OS fever,
cough w/ purulent sputum, pluritic chest pain,
CXR = lobar
PE = bronchial lung sounds, dullness on percussion, inc fremitus
H. influenzae, Legionella, Klebsiella, Psudomoas
Strep & Staph
MC Viral in infants and young children
RSV & parainfluenza
MC Viral in adults
MC Viral infection in AIDs patients
MC Viral infection in transplant patients
Sever Viral infection in adults
PCP, HIstoplasma capsulatum, Coccidiodies
Fungal / Parasites
Usually associated with O2 desaturation with ambulation.
P jiroveci (PCP)
Psudomonas (MC), klebsiella, S. aureus, GNR, enterobacter, Serratia, CMV, HSV
aspiration of acidic gastric contents
1. aspiration of inhaled oropharyngeal microbes.
If chronically ill: GNR and S. aureus
out ptns: typical orlal flora (2.)
pneumonia (staph, strep,
Lobar, Lower lung field
Upper lung field
S. aureus, kleb, anaerobes
What tests do you send for Chlamydia
IgM, IgG titers
What test do you send for Mycoplasma for Dx?
serum cold agglutinins
What do you send for Legionella?
Send urine Antigen w/ or w/o PCR
What organisms have myalgia, malaise, NVD clinical manifestations.
Atypical org (legionella mainly) but could also be mycoplasma or chlamydia.
non productive cough
Macrolides (zpack aka azithromycin or clarithromycin)
not used because it could result in resistance.
Fluoroquinolones (levaquin, Tequin, Avelox, Factive)
What do you give for an Inpatient pneumonia?
Macrolide and a beta lactam or FQuin
Maxipime, Primaxin, Merrem, Zosyn
Antipsudomonal beta lactams
What can you give to an ICU patient with Beta lactam allergy?
FQ +- Aztreonam OR Clindamycin + Aztreonam
What can you give to a HAP patient with Beta lactam allergy?
FQ +- Clindamycin (Aminoglycoside, Aztreonam)
HAP suspect legonella
add Macrolide (zpack)
HAP suspect with PCP
+ Bactrim to the Anti psudomonial Beta lactam
pneumococcal vaccine for kids
pneumococcal vaccine given to adults
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
How long can TV remain viable in the air.
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.
What immune response helps prevent active TB and how?
Cell mediated type IV, which contain the TB within granulomas.
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.
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
How long does it take to become PPD + after exposure.
A. 2 days
C. 2 weeks
D. 1 month
E. 2 years
B. 2-4 weeks
(this multiple choice question has been scrambled)
Reactive TB is usually localized in which lobe of the lung?
upper or Apex because there is a better supply of O2
Which of the following can result from a TB infection.
a. Pott's dz
E Pott's aka Vertebral, Scrofula aka lymph nodes, and TB meningitis. it can actually spread to anywhere int the body.
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.
SE: GI, Thrombocytopenia, Orange secretions.
What is CI in this TB drug?
NNRTI's the drug is RIF aka Rifampin
Hepatitis, GI, Hyperuricemia, arthritis.
Is this drug ok to give?
durring the first trimester
PZA - pyrazinamide.
yes to all but caution with gout and liver dz
GI, Optic neuritis, Peripheral neuropathy.
EMB or ETH aka Ethambutol
STM - Streptomycin