CAP

Question 1

Microorganisms gain access to the lower respiratory tract in several ways. The most common is

Answer 1

Aspiration

Question 2

inflammatory mediators that results in fever

Answer 2

interleukin 1 and tumor necrosis factor

Question 3

stimulate the release of neutrophils and their attraction to the lung, producing both peripheral leukocytosis and increased purulent secretions

Answer 3

interleukin 8 and granulocyte colony-stimulating factor

Question 4

What phase represents the presence of a proteinaceous exudate—and often of bacteria—in the alveoli

Answer 4

Initial phase-edema

Question 5

presence of erythrocytes in the cellular intra-alveolar exudate. neutrophil influx is more important with regard to host defense.

Answer 5

Second stage red hepatization

Question 6

no new erythrocytes are extravasating, and those already present have been lysed and degraded. The neutrophil is the predominant cell, fibrin deposition is abundant, and bacteria have disappeared

Answer 6

Third stage gray hepatization

Question 7

This phase corresponds with successful containment of the infection and improvement in gas exchange

Answer 7

Gray hepatization

Question 8

macrophage reappears as the dominant cell type in the alveolar space, and the debris of neutrophils, bacteria, and fibrin has been cleared, as has the inflammatory response

Answer 8

Resolution

Question 9

most common pattern in nosocomial pneumonias

Answer 9

Bronchopneumonia pattern

Question 10

Most common pattern bacterial CAP

Answer 10

Lobar pneumonia

Question 11

Major risk factor for anaerobic pneumonia

Answer 11

combination of an unprotected airway (e.g., in patients with alcohol or drug overdose or a seizure disorder) and significant gingivitis

Question 12

Possible etiology

Risk factor: Travel to Ohio or St. Lawrence river valley

Answer 12

Histoplasma capsulatum

Question 13

infect patients who have recently been hospitalized and/or received antibiotic therapy or who have comorbidities such as alcoholism, heart failure, or renal failure

Answer 13

Enterobacteriaceae

Question 14

Tend to infect patients with severe structural lung disease, such as bronchiectasis, cystic fibrosis, or severe COPD

Answer 14

P aeruginosa

Question 15

Risk factors for this infection include diabetes, hematologic malignancy, cancer, severe renal disease, HIV infection, smoking, male gender, and a recent hotel stay or ship cruise.

Answer 15

Legionella

Question 16

sensitivity and specificity of the findings on physical examination

Answer 16

58% 67%

Question 17

To be adequate for culture, a sputum sample must have

Answer 17

> 25 neutrophils and <10 squamous epithelial cells per low-power field

Question 18

Percentage of cultures of blood from patients hospitalized with CAP are positive

Answer 18

5-14%

Question 19

sensitivity and specificity of the Legionella urine antigen test are as high as

Answer 19

70, 99%

Question 20

The pneumococcal urine antigen test is also quite sensitive and specific

Answer 20

70, >90%

Question 21

The standard for diagnosis of respiratory viral infection

Answer 21

PCR of nasopharyngeal swabs

Question 22

may be of use in the identification of worsening disease or treatment failure

Answer 22

C reactive protein

Question 23

may play a role in distinguishing bacterial from viral infection, determining the need for antibacterial therapy, or deciding when to discontinue treatment

Answer 23

Procalcitonin

Question 24

prognostic model used to identify patients at low risk of dying

Answer 24

Pneumonia Severity Index PSI

Question 25

severity-of-illness score

Answer 25

CURB 65 criteria

Question 26

CURB-65 criteria include five variables

Answer 26

confusion (C)
urea >7 mmol/L  (U)
respiratory rate ≥30/min (R)
blood pressure, systolic ≤90 mmHg or diastolic ≤60 mmHg (B)
age ≥65 years

Question 27

Pneumococcal resistance to β-lactam drugs is due solely to

Answer 27

low-affinity penicillin-binding proteins

Question 28

Resistance to Macrolide that results in high level resistance

Answer 28

arget-site modification caused by ribosomal methylation in 23S rRNA encoded by the ermB gene

Question 29

Resistance to macrolide that results in low level resistance

Answer 29

efflux mechanism encoded by the mef gene (M phenotype)

Question 30

Gene responsible for flouroquinolone resistance

Answer 30

topoisomerases II and IV from mutations in the gyrA and parC genes, respectively

Question 31

Mycoplasma resistance to macrolides is on the rise as a result of binding-site mutation in

Answer 31

domain V of 23S rRNA

Question 32

Methicillin resistance in S. aureus is determined by a gene which encodes for resistance to all β-lactam drugs.

Answer 32

mecA gene

Question 33

typical hospital-acquired strain usually has what type of staphylococcal chromosomal cassette mec (SCCmec)

Answer 33

Tyep II or III

Question 34

CA-MRSA usually has what type of staphylococcal chromosomal cassette mec (SCCmec)

Answer 34

Type IV

Question 35

membrane-tropic toxin that can create cytolytic pores in polymorphonuclear neutrophils, monocytes, and macrophages

Answer 35

Panton-Valentine leukocidin