LRTI Flashcards


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1

Bronchitis

Inflammation of the LARGE airways that does not extend to the alveoli

2

Bronchiolitis

Inflammation of the small airways due to infections

3

Acute bronchitis is most often caused by bacteria?

False- mostly caused by viruses

4

Acute bronchitis is mostly self-limiting?

True

5

What is the most common symptom of bronchitis?

COUGH- lasting for 3 or more weeks

Gagging/vomiting in children

6

Antibiotic used is discouraged in bronchitis?

True

7

Chronic bronchitis:

Chronic cough with sputum lasting 3 months for 2 years

8

What is treated with antibiotics in chronic bronchitis?

Acute exacerbations of chronic bronchitis

9

Acute exacerbations of chronic bronchitis:

Severe incessant coughing with productive purulent sputum

10

Etiology of chronic bronchitis:

S. pneumoniae

H. influenza

M. Catarrhalis

11

Triad of chronic bronchitis:

1. increased sputum purulence

2. increased sputum volume

3. Increased dyspnea

12

When to treat chronic bronchitis:

1. Pt has all three symptoms

2. Pt has 2 symptoms with one being purulence

3. Mechanical ventilation

13

Preferred treatment of chronic bronchitis:

DAAZ x 5-7 days

Doxycycline 100 mg BID

Amoxicillin 500-875 TID

Augmentin 875 mg BID

Z-pak- 5 days

14

Alternatives treatment chronic bronchitis:

Cefuroxime

Cefdinir

Clarithromycin

Levofloxacin

Moxifloxacin

Bactrim

15

Pneumonia:

Presence of new lung infiltrate AND clinical evidence that the filtrate is infectious (fever, purulent sputum, leukocytosis, decreased oxygenation)

16

HAP:

Pneumonia >48 hours after admission

17

VAP

Pneumonia >48 hours after endotracheal intubation

18

Most common entrance of pneumonia?

Microaspiration

19

Three aspects of a quality sample:

1. <10 epithelial cells

2. WBC >25

3. One type of organism

20

CURB-65 score: 1 point for each

30-day mortality rate:

Confusion

Uremia (BUN >20 mg/dL)

Respiratory rate (>30 bpm)

BP (SBP <90, DBP <60)

65 years and older

21

Which CURB scores can be treated outpatient?

0 and 1

22

Which CURB score can be treated in a medicine ward?

2

23

Which CURB score can be treated ICU?

3 and up

24

Etiology of pneumonia:

Strept pneumoniae

Atypicals- Mycoplasma: walking pneumonia

Legionella- Pontiac fever

25

Outpatient treatment for patients with no comorbidities for MRSA or pseudomonas or had IV antibiotics in the last 90 days?

DAZ

Doxycycline 100 mg BID

Amoxicilline 1000 mg TID

Z-pak

26

Outpatient treatment for patients with heart, liver, lung, renal disease, diabetes, alcoholism, asplenia

Augmentin

Cephalosporin + Z-pak

Cephalosporin + Doxycyline

Fluroquinolone mono therapy (Levo/Moxi)

27

What two fluroquinolones can be used in pneumonia?

Levofloxacin

Moxifloxacin

28

Inpatient non-severe treatment of pneumonia?

1. Beta- lactam + Azithromycin

OR

2. Fluroquinolone mono therapy

29

Which beta-lactams are used in pneumonia?

Ceftriaxone 1-2 grams IV daily

Zosyn

Cefepime

Carbapenems

30

Treatment of severe inpatient pneumonia?

DI-THERAPY

1. Beta-lactam + Azithromycin

2. Beta-lactam + fluoroquinolone

31

A nasal MRSA PCR should be used to de-escalate treatment?

True

32

Pneumonia with psuedomonas, MRSA CAP should be treated how long?

7 days

33

What is the major criteria for pneumonia severity?

Need one

1. Septic shock

2. Mechanical ventilation

34

What is the minor criteria for pneumonia severity?

1. RR >30

2. Multilobar infiltrates

3. Confusion

4. BUN >20

5. WBC <4000 cells

6. Thrombocytopenia

7. Hypothermia

8. Hypotension requiring fluid resuscitation

9. PaO2/FIO2 ration <250

35

What is the duration of treatment of HAP/VAP?

7 days

One week

36

If a patient has had IV antibiotic use in the last 90 days how many agents should be started?

3 AGENTS

1. Antipseudomonal beta-lactam

2. Antipseudomonal amino glycoside or fluoroquinolone

3. Anti-MRSA agent

37

Antipseudomonal beta-lactams:

Cefepime

Zosyn

Imipenem

Meropenem

Aztreonam

38

Antipseudomonal aminoglycoside or fluoroquinolone

Ciprofloxacin

Levofloxacin

Gentamicin

Tobramycin

39

Anti-MRSA agent:

Vancomycin

Linezolid

Ceftaroline

40

MRSA risk in HAP:

IV ABX use in the last 90 days

>20% isolates of MRSA

Ventilator support

Septic shock

41

Pseudomonal risk in HAP:

IV ABX use in the last 90 days

Mechanical ventilation

COPD

CF

Bronchiectasis

>10% resistant to mono therapy

42

Treatment modality of HAP/VAP:

1. Antipseudomonal BL

2. MRSA coverage if needed

3. Additional pseudomonas coverage

43

MRSA risk in VAP:

IV ABX used in the last 90 days

>5 days hospitalization B4 VAP

ARDS B4 VAP

RRT B4 VAP

10-20% staph. aureus isolated MRSA

MRSA prevalence unknown

44

Pseudomonal risk in VAP:

Risk for resistance

Units where >10% gram negatives isolated

CF, COPD, bronchiectasis

45

Which Hib vaccine is a 2 dose series?

PedvaxHib