CAP/HAP

Question 1

What is the CURB-65 score?

Answer 1

clinical prediction rule for predicting mortality in community-acquired pneumonia

Question 2

What is involved in the CURB-65 score?

Answer 2

C- confusion
U- urea >7mmol/L
R- RR >30/min
B- BP systolic: <90mmHg, diastolic <60mmHg

Age >65 years

Question 3

According to the CURB score what is the severity and recommended tx for a score of 0

Answer 3

severity: low
tx: outpt

Question 4

According to the CURB score what is the severity and recommended tx for a score of 1

Answer 4

Severity: low
Tx: outpt

Question 5

According to the CURB score what is the severity and recommended tx for a score of 2

Answer 5

Severity: moderate
Tx: Hospital

Question 6

According to the CURB score what is the severity and recommended tx for a score of 3-5

Answer 6

Severity: high
Tx: hosptial (ITU admission)

Question 7

What is the most common bacterial cause for PNA?

Answer 7

Streptococcal Pneumoniae

Question 8

What are other common causes for CAP?

Answer 8

H. influenzae

M. catarrhalis

Question 9

What are causes of atypical PNA?

Answer 9

Mycoplasma pneumoniae
Chlamydophila pneumoniae
Legionella
RSV

Question 10

What are examples of HAP agents?

Answer 10

Pseudomonas aeruginosa
Staph aureus
Klebsiella pnuemonia
E. coli

Question 11

What are some s/s of PNA

Answer 11

Fever
Productive cough
SOB

Question 12

What Dx tests may you order in the w/u of PNA?

Answer 12

O2 sat
CBC: increased WBC
CXR: Infiltrations
sputum cx

Question 13

Typical PNA has a ___ onset while atyplical PNA has a ____ onset

Answer 13

Abrupt

insidious

Question 14

What are the two vaccine options for PNA prevention?

Who should get these vaccines?

Answer 14

Polyvalent 23
+65 y.o.
2+ and high risk

Prevnar 13
children 0-5 y.o.
65+ or high risk

Question 15

What are important hx questions to ask a pt with possible PNA

Answer 15

Productive cough
Sick contacts
Recent hospitalizations
Co-morbid illnesses.

Question 16

What are PE signs you are looking for to dx PNA?

Answer 16

Fever
lymphadenopathy 
Tachypnea
Tachycardia
adventitious breath sounds 
consolidation

Question 17

How is egophony performed?

Answer 17

have pt say the letter “E”, while you’re listening through the stethoscope to a suspected area of involvement.
If you are listening for an “E”, and it comes through like “A”, then egophony is present.

Question 18

How is bronchophony performed

Answer 18

Have the pt verbalize “99”.

if bronchophony is present, the sound is very distinct, very clear and very loud.

Question 19

How is Whisper Pectoriloquy performed?

Answer 19

Same as bronchophony, but now the patient whispers “99”.

in areas of the lung that are filled with fluid it comes through very distinctly. it is a more sensitive indicator than bronchophony

Question 20

What is the tx for CAP in an otherwise healthy pt?

Answer 20

Macrolide (clarithromycin, azithromycin)

Doxycycline (not 1st line)

Question 21

What is the tx for in-pt CAP or for out-pt tx in a pt with comorbidities

Answer 21

Respiratory Fluoroquinolone (levofloxacin) or B-lactam (Amoxicillin) + Macrolide

Question 22

How do you tx a pen allergic pt with PNA?

Answer 22

Respiratory Fluoroquinolone or Aminoglycoside (Gentamicin, Tobramycin)

Question 23

How do you tx HAP?

Answer 23

levofloxacin + vancomycin OR Linezolid + penicillin if MSSA suspected

Question 24

How long should a pt admitted to the hosptial for PNA be given IV abx.

When can you d/c a pt with PNA?

Answer 24

take of IV abx when vitals stabilize

D/c once pt has been hemodynamically stable and afebrile 48-72 hrs