Community Acquired Pneumonia, D Kinder, DSA

Question 1

Dx of CAP

Answer 1

evidence infection: fever chills leuocytes
signs or Sx
new or changed infiltrate on CXR

Question 2

DDX for abnormal CXR

Answer 2

CHF, viral infection, aspiration pneumonitis, pulmonary infarction, acute exacerbation of pulmonary fibrosis, acute exacerbation bronchiectasis, acute eosinophlic pneumonia, HS pneumonitis, pulmonary vasculitis, cocaine induced lung injury

Question 3

Ddx for CAP Sx but normal CXR

Answer 3

acute exacerbation COPD, influenza, acute bronchitis, pertussis, asthma with viral syndrome

Question 4

typical microbes causing pneumonia

Answer 4

S pnuemoniae, H influenzae, M catarrhalis

Question 5

atypical pneumonia microbes

Answer 5

Legionella
Mycoplasma
C pneumoniae and viruses

Question 6

Sx atypical pneumonia

Answer 6

dry cough, diffuse patchy infiltrate on CXR

Question 7

Tx for actypical bacteria causing pneumonia

Answer 7

macrolides, doxy and FQ

Question 8

first line Tx HAP

Answer 8

resp FQ

or 2nd/3rd cephalosporin and macrolide

Question 9

exception to starting antibiotics ASAP for pneumonia

Answer 9

shock

Question 10

microbes causing HAP or VAP

Answer 10

MRSA and multi drug R gram - bacteria

pseudomonas

Question 11

Helath care assoc pneumonia criteria

Answer 11

• hospitalization for >2 days during previous 90 days
• Residence in nursing home
• home infusion therapy
• hemodialysis during previous 30 days
• home wound care
• family member with multidrug R pathogen
• immunosuppressive disease or therapy

Question 12

Pneumonia specific criteria for health care associated pneumonia

Answer 12

• hospitalizaiton >2 days during previous 90 days
• antibiotics previous 90 days
• non-ambulatory
• tube feedings
• immnocompromised
• gastric acid suppressive agent

Question 13

MRSA criteria

Answer 13

cavitary infiltrate
rapid pleural effusion
gross hemoptysis
concurrent influenza
neutropenia
erythematous rash
skin pustules
young previously healthy patient
severe pneumonia during summer

Question 14

Testing for HAP and VAP

Answer 14

blood culture, resp tract culture, influenza testing, urinary pneumococcal Ag, urinary legionella Ag, pleurl fluit culture

Question 15

viruses that cause pneumonia

Answer 15

RSV, influenza and para influenza

Question 16

When should you perform thoracentesis

Answer 16

> 10mm pleural fluid or loculated fluid

Question 17

CURB 65

Answer 17

to assess if hospitalization needed
Confusion
BUN >20
RR >30
BP S65
>3 total need to hospitalize

Question 18

what is PSI

Answer 18

pneumonia severity index used to assess mortality risk

Question 19

What are criteria for ICU admission from pneumonia

Answer 19

confusion, BUN, tachypnea, multilobular infiltrates, hypoxemia, thrombocytopenia, hypotension, hypothermia, leukopenia, lactic acidosis, low pH, low albumin, hyponatermia, leukocytosis, tachycardia, >65

Question 20

special populations at risk for pneumonia

Answer 20

smoking or COPD
alcholism :drug R s pneumonia, anaerobes and TB
bird exposure: psittacosis
bird droppings: histoplasmosis
Bats: histoplasmosis
rabbits:tularemia
farm animals: q fever
bioterrosism: B anthracis, tularemia, yersinia pestis

Question 21

Central US exposure (ohio rivers)

Answer 21

histoplasmosis

Question 22

southwest US (arizona

Answer 22

coccidiomycosis

Question 23

northern central US

Answer 23

blastomycosis