CAP

Question 1

What is the MOST COMMON cause of CAP?

Answer 1

S. pneumoniae

Question 2

Patient presents with dypnea, cough with sputum, tachypnea, tachycardia, and a fever. What are you concerned about?

Answer 2

CAP

Question 3

What do you expect to hear on PE?

Answer 3

focal crackles, bronchial breath sounds, increased tactile fremitus, vocal resonance

Question 4

What diagnostics should you order?

Answer 4

CXR (PA and lateral view)
CBC
pulse O2
ABG if they are inpatient
Culture and GS esp if unsure of pathogen
**Urine antigen testing for pneumoccal and legionella

Question 5

What do you expect to see on the CXR?

Answer 5

a consolidation.

Question 6

How do you decide if you should admit a patient or not?

Answer 6

PSI and CURB-65 are useful tools to see if patient can be admitted. If patient is normally healthy and fairly young with no pre-disposing factors, you will most likely treat outpatient.

Question 7

How do you decide if they should go to the ICU or Gen ward?

Answer 7

Use the 1 major or 3 minor rule.
major=mechanical ventilation or pressors
minors: increased heart rate, increased breathing rate, hypothermia, hypotension, multilobar filtrates (etc)

Question 8

If outpatient, how do you tx?

Answer 8

macrolide

Question 9

if inpatient, how do you treat?

Answer 9

gen ward:macrolide + beta-lactam and RFQ, if ICU then marcrolide + beta-lactam and RFQ + beta-lactam

Question 10

What is the general discharge criteria?

Answer 10

no more than 1 of the following in a 24 hour period:

>100bpm, fever, 24 resp/min, >90mmHg systolic

Question 11

What are GN risks?

Answer 11

elderly, smokers, COPD or heart disease

Question 12

What are DRSP risks?

Answer 12

immunocomrompised, alcoholic, older than 65, beta-lactam therapy within last three months, child in daycare