Anita Douglas Community Acquired Pneumonia Shadow
Health (All Tabs) | GRADED A+
What general categories can increase the likelihood of CAP? - ANSWER
decreased mucociliary transport
decreased host immune response
decreased cough reflex (aspiration risk)
List factors that decrease mucociliary transport. - ANSWER smoking
COPD
CF
viral infection
elderly
List factors that decrease host immune response. - ANSWER ethanol abuse viral
infection
elderly hypoxemia
DM, AIDS, cancer pulmonary edema
malnutrition bacterial endotoxin
immunosuppressants
List factors that increase G- colonization. - ANSWER malnutrition
chronic ilness
elderly/nursing home resident
surgery or prolonged hospitalization
smoking
antacids, H2 blockers, PPIs
List factors that decrease cough reflex and thereby increase aspiration risk. -
ANSWER ethanol intoxication
stroke
general anesthesia
drugs that impair mental status
Explain the classic presentation of pneumococcal pneumonia. - ANSWER follows
respiratory viral illness
abrupt onset of severe chill
high fever
chest pain
productive cough
T/F: the classic presentation of CAP is seen in all age groups. - ANSWER False
young or middle aged
[elderly have mental status changes instead]
List lab test findings for CAP. - ANSWER increased WBC w/ left shift (15-40,000)
, CXR inflitrates
decreased PO2 on ABG
blood cultures of pneumonia causing bacteria
+- sputum culture and gram stain
Why is a sputum culture not always helpful in diagnosis of CAP? - ANSWER often
contaminated by natural flora of the mouth
List some bacteria that commonly cause CAP. - ANSWER strep pneumo
(pneumococcal pneumonia) - G+ diplococci
staph - G+ cocci in clusters
h. flu - small G- coccobacilli
klebsiella - short plump G- bacilli
mycoplasma - unremarkable
anaerobic - foul smelling, polymicrobial
How would mycoplasma CAP present? - ANSWER "walking pneumonia"
low grade fever, non-productive cough
Anaerobic pneumonia is often secondary to ________. - ANSWER Anaerobic
pneumonia is often secondary to *peridontal disease*.
How are patients evaluated for seriousness of pneumonia? - ANSWER CURB-65
scale
Confusion
Uremia (BUN>20)
Respiratory rate (>=30)
low Blood pressure (SBP<90 or DBP=<60)
65 y/o or greater
Using the CURB-65 scale, determine where a patient should be treated. - ANSWER
1 point for each letter/number
0-1: outpatient
2: inpatient, general ward
>=3: inpatient, ICU
How should a CAP be treated if outpatient and previously healthy, no ABx in past
3mos? - ANSWER *macrolide*
doxycyline
How should a CAP patient be treated if outpatient with comorbidities or ABx in past
3mos? - ANSWER respiratory FQ
B-lactam + macrolide
How should a CAP patient be treated if inpatient but non-ICU? - ANSWER
respiratory FQ
B-lactam + macrolide
How should a CAP patient be treated if inpatient ICU? - ANSWER B-lactam
(ceftriaxone, cefotaxime, or unasyn) *plus* either azithromycin or respiratory FQ
Health (All Tabs) | GRADED A+
What general categories can increase the likelihood of CAP? - ANSWER
decreased mucociliary transport
decreased host immune response
decreased cough reflex (aspiration risk)
List factors that decrease mucociliary transport. - ANSWER smoking
COPD
CF
viral infection
elderly
List factors that decrease host immune response. - ANSWER ethanol abuse viral
infection
elderly hypoxemia
DM, AIDS, cancer pulmonary edema
malnutrition bacterial endotoxin
immunosuppressants
List factors that increase G- colonization. - ANSWER malnutrition
chronic ilness
elderly/nursing home resident
surgery or prolonged hospitalization
smoking
antacids, H2 blockers, PPIs
List factors that decrease cough reflex and thereby increase aspiration risk. -
ANSWER ethanol intoxication
stroke
general anesthesia
drugs that impair mental status
Explain the classic presentation of pneumococcal pneumonia. - ANSWER follows
respiratory viral illness
abrupt onset of severe chill
high fever
chest pain
productive cough
T/F: the classic presentation of CAP is seen in all age groups. - ANSWER False
young or middle aged
[elderly have mental status changes instead]
List lab test findings for CAP. - ANSWER increased WBC w/ left shift (15-40,000)
, CXR inflitrates
decreased PO2 on ABG
blood cultures of pneumonia causing bacteria
+- sputum culture and gram stain
Why is a sputum culture not always helpful in diagnosis of CAP? - ANSWER often
contaminated by natural flora of the mouth
List some bacteria that commonly cause CAP. - ANSWER strep pneumo
(pneumococcal pneumonia) - G+ diplococci
staph - G+ cocci in clusters
h. flu - small G- coccobacilli
klebsiella - short plump G- bacilli
mycoplasma - unremarkable
anaerobic - foul smelling, polymicrobial
How would mycoplasma CAP present? - ANSWER "walking pneumonia"
low grade fever, non-productive cough
Anaerobic pneumonia is often secondary to ________. - ANSWER Anaerobic
pneumonia is often secondary to *peridontal disease*.
How are patients evaluated for seriousness of pneumonia? - ANSWER CURB-65
scale
Confusion
Uremia (BUN>20)
Respiratory rate (>=30)
low Blood pressure (SBP<90 or DBP=<60)
65 y/o or greater
Using the CURB-65 scale, determine where a patient should be treated. - ANSWER
1 point for each letter/number
0-1: outpatient
2: inpatient, general ward
>=3: inpatient, ICU
How should a CAP be treated if outpatient and previously healthy, no ABx in past
3mos? - ANSWER *macrolide*
doxycyline
How should a CAP patient be treated if outpatient with comorbidities or ABx in past
3mos? - ANSWER respiratory FQ
B-lactam + macrolide
How should a CAP patient be treated if inpatient but non-ICU? - ANSWER
respiratory FQ
B-lactam + macrolide
How should a CAP patient be treated if inpatient ICU? - ANSWER B-lactam
(ceftriaxone, cefotaxime, or unasyn) *plus* either azithromycin or respiratory FQ
