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Cavitary Lesions, severe with ETOHics, GNR
Klebsiella pneumonia
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GI SX: N/V/D, anorexia, elevated LFT's, hyponatremia.
Legionella pneumonia
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Aspiration pneumonia
Anaerobes
-
Increased incidence: COPD, elderly, ETOH, DM, <6yo
Heamophilus influenzae
-
2nd MC CAP pneumonia
H. influenzae
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Immunocompromised (HIV, sp transplant, neutropenic). Cystic Fibrosis, Bronchiectasis
Psudomonas aeruginosa
-
S. pneumo, H. influenzae, Klebsiella, S. aureus
Typical pneumonia
-
Mycoplasma, Chlamydia, Legionella, Virus
Atypical pneumonia
-
CXR = lobar pneumonia
Typical pneumonia
-
Diffuse patchy infiltrates
Atypical pneumonia
-
Low fever, Non-productive cough, Dry. Extrapulmonary sx: myalgias, malasise, sore throat, HA, N/V/D
Atypical pneumonia
-
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
-
H. influenzae, Legionella, Klebsiella, Psudomoas
GNR
-
-
MC Viral in infants and young children
RSV & parainfluenza
-
MC Viral in adults
Infuenza (-e)
-
MC Viral infection in AIDs patients
CMV
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MC Viral infection in transplant patients
CMV
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Sever Viral infection in adults
Varicella Zoster
-
PCP, HIstoplasma capsulatum, Coccidiodies
Fungal / Parasites
-
Usually associated with O2 desaturation with ambulation.
PCP
-
-
-
Psudomonas (MC), klebsiella, S. aureus, GNR, enterobacter, Serratia, CMV, HSV
HAP
-
aspiration of acidic gastric contents
pneumonitis
-
1. aspiration of inhaled oropharyngeal microbes.
If chronically ill: GNR and S. aureus
out ptns: typical orlal flora (2.)
pneumonia (staph, strep, anaerobes)
-
Lobar, Lower lung field
Legionella
-
-
Abcess formation
S. aureus, kleb, anaerobes
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What tests do you send for Chlamydia
IgM, IgG titers
-
What test do you send for Mycoplasma for Dx?
serum cold agglutinins
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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
Atypical
-
-
Outpatient
Macrolides (zpack aka azithromycin or clarithromycin)
-
not used because it could result in resistance.
Fluoroquinolones (levaquin, Tequin, Avelox, Factive)
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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
-
PCV13
pneumococcal vaccine for kids
-
PPV23
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.
hours.
-
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.
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What immune response helps prevent active TB and how?
Cell mediated type IV, which contain the TB within granulomas.
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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.
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What can happen to a Granuloma containing TB.
E. All
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How long does it take to become PPD + after exposure.
D. 2-4 weeks
-
Reactive TB is usually localized in which lobe of the lung?
upper
middle
lower
all
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
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.
-
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
Gout
liver dz
PZA - pyrazinamide.
yes to all but caution with gout and liver dz
-
GI, Optic neuritis, Peripheral neuropathy.
EMB or ETH aka Ethambutol
-
Ototoxicity, nephrotoxicity
STM - Streptomycin
G- only
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