Cases- Pneumonia (3)-Leah

Question 1

Virus that causes severe pneumonia and 30k annual US deaths?

Answer 1

Influenza

Question 2

“Hyporesonance at the base of the lung” is characteristic of?
What action should you take if this is heard in the presence of pneumonia?

Answer 2

Pleural effusion

–drain any effusion of 1cm or greater via thoracentesis

Question 3

Walking pneumonia:
Classic bug? (2)
Treatment needed? (2)

Answer 3

Mycoplasma; chlamydia
Organisms lack a CELL WALL = NO penicillins
Can use macrolides, doxycycline

Question 4

Respiratory infection most likely to lead to serious complications?

Answer 4

Pneumonia

Question 5

Flu assc bacterial pneumonias (2)

Answer 5

Strep aureus; Strep pneumo also.

Question 6

Before running cultures and CXR on a patient with suspected pneumonia you should always?

Answer 6

Stabilize the patient!
(This is kind of a no brainer but just in case….. If the patient has super low BP/O2 sat- fix those problems before trying to diagnose an underlying condition!!)

Question 7

Pneumonia assc with

-alcoholism, abscesses, aspiration

Answer 7

KlebsiellAAAA
(Anaerobe)
(As are for alcoholics, aspiration, abscesses, anaerobes)

Gram - rod; urease +; lactose fermenting, grows on MacKonKEES agar.
(KEES = klebsiella, E. coli, enterococcus, serratia)

Question 8

Standard treatment for community acquired pneumonia/strep pneumo (2)

Answer 8

Ceftriaxone

Azithromycin (macrolide)

Question 9

Biggest risk factor for resistant bacterial pneumonia

Answer 9

Hospital stay >48 hours

Question 10

Wheezing + prolonged expiration are characteristic of?

Answer 10

Obstructive disease!!!

Question 11

Cold + runny nose + sore throat are most suggestive of what type of illness?

Answer 11

Viral

Question 12

To what do obstructive diseases respond? (2)

Answer 12

Steroids and bronchodilators

Question 13

No wheezing in pneumonia indicates?

Answer 13

Significant, severe disease

Question 14

Most common pneumonia in immunosupressed patients?

Answer 14

COMMON THINGS ARE STILL COMMON!!!

Strep pneumo, etc.

Question 15

“Rust colored sputum” is a buzzword for?

Answer 15

Strep pneumo pneumonia

Question 16

What should you ask foreigners/ travelers about?

Answer 16

Vaccination

Question 17

People in “close quarters” should get the vaccine for:

Answer 17

Meningococcus

Question 18

“Crackles at the base of the lung” is a classic presentation for?

Answer 18

Chronic CHF

Question 19

“Constantly coughing until you vomit” should be a red flag for?

Answer 19

Pertussis

Question 20

What is a high WBC count? What is a SERIOUSLY high WBC count?

Answer 20

Anything 10+ is high; 20+ is indicative of severe illness

Question 21

What two things do neutrophils in sputum suggest?

Answer 21

• good sample

- bacterial infection

Question 22

In the absence of wheezing, you can usually rule out?

Answer 22

Asthma exacerbation

Question 23

Scattered patchy infiltrates on CXR and red bullpen on the tympanic membrane is suggestive of?

Answer 23

Atypical pneumonia; mycoplasma

Question 24

Antibiotic treatment of hospital acquired pneumonia should cover what bugs?

Answer 24

Common things +
Gram negatives like space bugs
Staph aureus
Legionella

Question 25

Legionella:
Bacterial class:
Characteristics of legionella pneumonia: (3)

Answer 25

Atypical
Super high fever; hyponatremia; possible liver dysfxn

RX QUESTION

Question 26

Test that should be run on every patient admitted to the hospital with pneumonia

Answer 26

Blood culture

Question 27

Low WBC at baseline are common in what population?

Answer 27

Black males

Question 28

Pregnant patients are inherently ________.

Answer 28

Immunocompromised

Question 29

Fungal infection seen in Arizona/ four corners?

Answer 29

Coccidiodes (sp?)
Rx question
In the question; they used amp B to treat which led to a DRUG INDUCED FEVER.

Note that it grows on sabourauds agar; has “spherule” shape.

Question 30

Low temp is always?

Answer 30

OMINOUS

Question 31

Two common AIDS assc infections

Answer 31

There are so many but meadows likes to mention:

Pneumocystis; TB

Question 32

“Military recruit” is a buzzword for?

Answer 32

Adenovirus

Question 33

Dry cough and patchy infiltrates seen on CXR is typical of?

Answer 33

Viral pneumonia