EXAM #2: COMMUNITY-ACQUIRED PNEUMONIA

Question 1

If a patient presents with a likely pneumonia, what do you need to consider, and what do you need to ask about when taking a history?

Answer 1

1) Local epidemiology
2) Ask about travel hx.
3) Hobbies (caving)
4) International outbreaks
5) Recent hospitalization

Question 2

What three groups of patients have a greater prevalence of pneumonia?

Answer 2

• Elderly
• Male
• African Americans

Question 3

Generally, what presdisposes one to pneumonia?

Answer 3

Anything that impairs the normal defenses of the respiratory tract, especially:

1) Impaired cough reflex
2) Damage to mucociliary escalator
3) Mucus plugging

Question 4

What type of organism is most likely to cause pneumonia in patients with aspiration pneumonia?

Answer 4

Anaerobic organsims

*These are anaerobic bacteria from the oropharynx and may cause lung abscess and empyema

Question 5

What is the most commonly identified pathogen to cause CAP and secondary pneumonia?

Answer 5

Streptococcus penumoniae

Question 6

What is the most common virus to lead to pnuemonia?

Answer 6

Influenza virus

*Note that the virus impairs the mucociliary escalator and sets up a nidus for infection

Question 7

In patients with a history of recent influenza, what pathogen do you need to consdier as a superimposed infection?

Answer 7

Staphylococcus aureus

*Note that this is technically the 2nd most common cause of superimposed pneumonia

Question 8

What is the most common cause of pneumonia in patients with CF?

Answer 8

Pseudomonas aeruginosa

Question 9

What bacterial pathogen commonly causes pneumonia superimposed on COPD?

Answer 9

Haemophilus influenza

Question 10

What organism causes atypical pneumonia among college students and military recruits?

Answer 10

Mycoplasma pneumoniae

Question 11

How is Legionella transmitted?

Answer 11

Inhalation of aerosols from contaminated water sources

Question 12

What are the symptoms that are associated with pneumonia?

Answer 12

1) Productive cough (yellow-green sputum)
2) Fever
3) Dyspnea
4) Pleuritic chest pain*

*Note that pleuritic chest pain is mediated by bradykinin and PGE2

Question 13

What are the physical signs of pneumonia?

Answer 13

1) Fever
2) Tachypnea
3) Tachycardia
4) Crackles

Question 14

What lab sign on CBC is associated with pneumonia?

Answer 14

Leukocytosis with a left shift

Question 15

What is the gold standard for diagnosing a pneumonia?

Answer 15

CXR with infiltrate

Question 16

What is an air-fluid level with density below and transparency above associated with?

Answer 16

Lung abscess caused by an anaerobic organism i.e. seen more commonly in aspiration pneumonia

Question 17

What is the current recommendation for the treatment of most cases of CAP?

Answer 17

1) Outpatient treatment

2) Empiric abx

Question 18

What are the situations in which identification of the specific organism is critical?

Answer 18

1) Legionella pneumophila
2) Influenza A/B virus
3) MRSA
4) Agents of bioterrorism

Question 19

When is sputum stain and culture recommended in cases of CAP?

Answer 19

1) ICU admit
2) Failure of abx therapy
3) Cavitary changes on CXR
4) Immunocompromised
5) Alcoholism

Question 20

When is sputum testing useful?

Answer 20

1) Severe COPD
2) Evidence of pleural effusion
3) Cases of epidemic pneumonia
4) Likelihood of drug resistance (epidemiologically)

Question 21

What types of pneumonia have a urinary test?

Answer 21

1) Legionella pneumophila

2) Streptococcus pneumoniae

Question 22

In a previously healthy patient with no comorbidities, what is the recommended treatment for CAP?

Answer 22

Oral macrolide OR doxycycline

1) Azithromycin
2) Clindamycin
3) Erythromycin

Question 23

In patient with comorbidities and CAP, what is the recommended treatment?

Answer 23

1) Oral quinolone OR

2) Macrolide + Beta-lactam

Question 24

What are the treatment recommendations for non-ICU inpatient therapy for CAP?

Answer 24

1) Respiratory quinolone

2) Anti-pseudomonal beta lactam PLUS a macrolide

Question 25

What are the treatment recommendations for ICU patients with CAP?

Answer 25

1) Antipseudomonal Beta-Lactam PLUS asithromycin, OR

2) Antipseudomonal Beta-Lactam PLUS respiratory quinolone

Question 26

What is added as an up-and-coming treatment for severe penumonia in the ICU?

Answer 26

Systemic corticosteroid

Question 27

What are the three classic patterns of pneumonia on CXR?

Answer 27

1) Lobar= involves the entire lobe of the lung
2) Bronchopneumonia= consolidation around the bronchioles
3) Interstitial/atypical= involves the connective tissue between the alveolar walls*

*Note that this is more likely to be VIRAL vs. bacterial

Question 28

What are the most common causes of lobar pneumonia?

Answer 28

1) Streptococcus pneumoniae

2) Klebsiella pneumoniae

Question 29

What patient populations are most likely to have CAP associated with Klebsiella pneumoniae?

Answer 29

• Alcoholic
• DM
• Elderly nursing home patient

Question 30

How is the sputum from Klebsiella induced pneumonia described?

Answer 30

Currant jelly

Question 31

List the organisms that are associated with bronchopneumia.

Answer 31

1) Staphylococcus aureus
2) Haemophilus influenza
3) Pseudomonas aeruginosa
4) Moraxella catarrhalis
5) Legionella pneumophila

Question 32

List the organisms that are associated with atypical pneumonia.

Answer 32

1) Mycoplasma pneumoniae
2) Chlamydia pneumoniae
3) RSV
4) CMV
5) Influenza virus
6) Coxiella burnetii

Question 33

What are the two most common atypical pneumonias in young adults?

Answer 33

1) Mycoplasma pneumoniae
- College kids
- Military recruits
2) Chlamydia pneumoniae

Question 34

What is the most common cause of atypical pneumonia in infants?

Answer 34

RSV

Question 35

What organism is associated with pneumonia in post-transplant immunosuppressive therapy?

Answer 35

CMV

Question 36

What organism causes Q fever?

Answer 36

Coxiella burnetii

Question 37

Who are the typical patients that get Q fever? Why?

Answer 37

1) Farmers
2) Veterinarians

*Coxiella burnetii spores are deposited in cattle ticks or cattle placenta