IM Essentials: Ch. 57 - Community-Acquired Pneumonia

Question 1

Normally, the lower respiratory tract is ____________.

Answer 1

sterile; pneumonia results from defects in the processes that keep it sterile

Question 2

What percent of cases of CAP are due to Streptococcus pneumoniae?

Answer 2

40%

Question 3

Which is the elderly pneumonia vaccine and which is the pediatric vaccine?

Answer 3

23 = adult

Question 4

True or false: you give both vaccines every five years.

Answer 4

False

Give the 13-valent one only once, then the 23-valent one every five years.

Question 5

What are the CURB-65 criteria?

Answer 5

Confusion
bUn > 30
RR > 30 
BP < 90 
65 or older

• Meeting 2: admit
• Meeting 3 or more: admit to ICU

Question 6

In whom should you suspect Legionella?

Answer 6

• Older than 50
• Smoker
• Immunocompromised
• Extra-pulmonary symptoms: renal failure, diarrhea, headache

Question 7

Review the treatments for community-acquired pneumonia in the hospital and in the outpatient setting.

Answer 7

•Outpatient:
- No risk factors: macrolide or doxycycline
- Cardiopulmonary comorbidity: beta-lactam and macrolide or doxycycline
•Inpatient:
- Beta-lactam and macrolide or doxycycline; or just a fluoroquinolone

Question 8

How long will radiographic findings continue to be positive in those with CAP?

Answer 8

Up to six weeks after clinical resolution

Question 9

Empiric treatment for suspected Pseudomonas should begin with ______________.

Answer 9

piperacillin-tazobactam and amikacin