Infections of the Lower Respiratory Tract

Question 1

What is the most common route of infection for pneumonia?

Answer 1

Micro aspiration of oropharyngeal secretions

Question 2

What is the most common bacterial cause of CAP?

Answer 2

Steptococcus pneumoniae (Gram + cocci in pairs)
65%

Question 3

What is the second most common bacterial cause of CAP?

Answer 3

Haemophilus influenzae (Gram - bacilli/rods)

Question 4

What underlying pulmonary disease puts patients at an increased risk of getting pneumonia caused by h. influenza?

Answer 4

COPD! Cystic fibrosis!

Question 5

What bacteria are responsible for hospital acquired pneumonia?

Answer 5

Gram negative rods: Pseudamonas*, klebsiella, enterobacter, serratia, achinetobacter, s. aureus

Question 6

Pneumonia acquired OUTSIDE of the hospital setting and patient is not a resident of LTCF OR a patient who was ambulatory prior to admission who develops pneumonia within 48 hours of initial admission to hospital

Answer 6

Community acquired pneumonia

Question 7

Pneumonia occurring >48 hours after hospital admission. Often caused by pseudomonas and other organisms found in the hospital.

Answer 7

Hospital acquired pneumonia (nosocomial)

Question 8

Sudden onset of fever, productive cough with purulent sputum, pleuritic chest pain, rigors, tachycardia, tachypnea

Answer 8

Symptoms of pneumonia (typical)

Question 9

Bronchial breath sounds
Dullness to percussion
Increase in tactile remits, ego phony
Inspiratory rales and crackles

Answer 9

Signs of consolidation on PE of pneumonia

Question 10

Chlamydia, legionella, and viruses are all causes of which type of pneumonia?

Answer 10

atypical

Question 11

What should you expect to see on a CXR of a patient with pneumonia?

Answer 11

Lobar pneumonia

Question 12

If you look at an CXR of a patient who you suspect has pneumonia and you see diffuse, patchy infiltrates (reticulonodular or interstitial), what should you suspect?

Answer 12

Atypical pneumonia

Question 13

Low grade fever, dry, non productive cough, and extrapulmonary sxs like myalgias, malaise, sore throat, HA, and NVD

Answer 13

Symptoms of atypical pneumonia

Question 14

What does the PE of a patient with atypical pneumonia look like?

Answer 14

Often normal without signs of consolidation

Question 15

Which type of atypical organisms causes hoarseness and fever which then turns to respiratory symptoms a few days later?

Answer 15

Chlamydia

Question 16

Which type of atypical organisms causes ear pain, bullous myringitis, a persistent nonproductive cough, and an erythematous pharynx?

Answer 16

Mycoplasma

Question 17

Which type of atypical organisms causes GI and neuro symptoms, increased LFTs, and hyponatremia?

Answer 17

Legionella

Question 18

If you see abscess formation on a CXR, what organism could be causing it?

Answer 18

S. aureus
Klebsiella
Anaerobes

Question 19

If you see that the upper lobe (esp RUL) has a bulging fissure or cavitations, what organism could be causing that type of pneumonia?

Answer 19

Klebsiella

Question 20

What organism causes rust blood tinged sputum?

Answer 20

Strep pneumonia

Question 21

What organism causes currant jelly sputum?

Answer 21

Klebsiella

Question 22

What organism causes green sputum?

Answer 22

H flu, pseudomonas

Question 23

What organism causes foul smelling sputum?

Answer 23

Anaerobes

Question 24

With pneumonia, there is:

_____ on perussion
_____ tactile fremitus
___ and ____ breath sounds

Answer 24

Dullness on percussion
Increased tactile fremitus
Bronchial and egophony breath sounds

Question 25

What is the DOC for Outpatient CAP treatment?

Answer 25

Macrolide or doxycycline*

Question 26

What is the DOC for Inpatient CAP treatment?

Answer 26

Beta lactam + macrolide (or doxy) | OR broad spectrum floroquinolone

Question 27

What is the DOC for inpatient CAP in the ICU?

Answer 27

B lactam + macrolide OR | B lactam + broad spectrum FQ

Question 28

What is the DOC for treatment of hospital acquired PNA?

Answer 28

Anti-pseudomonal beta lactam and anti-pseudomonal AG or FQ

Question 29

What do you add to the treatment of hospital acquired pneumonia (Anti-pseudomonal beta lactam and anti-pseudomonal AG or FQ) if you suspect MRSA?

Answer 29

Vanco

Question 30

How do you treat aspiration pneumonia?

Answer 30

Clindamycin or augmentin +/- metronidazole

Question 31

When should you change inpatient pneumonia therapy from IV abx to oral?

Answer 31

When clinically responding and able to take PO for 7-10 days

Question 32

What is the pneumococcal vaccine for children?

Answer 32

PCV13

Question 33

When should doses of pneumococcal vaccine be given to children?

Answer 33

2 months, 4 months, 6 months, after 4 years

Question 34

What ist he adult pneumococcal vaccine?

Answer 34

PCV23

Question 35

The PCV23 vaccine is a capsular _____

Answer 35

polysaccharide

Question 36

Borders of the heart lost when similar density (pneumonia) lies adjacent?

Answer 36

Silhouette sign

Question 37

Your patient presents with a 10 days history of increasing cough, purulent sputum, SOB, pleuritic chest pain, hypothermia, sweats, and rigors. What do you suspect?

Answer 37

CAP

Question 38

Is a PE enough to diagnose pneumonia?

Answer 38

NO

Question 39

What specific level would lead you to believe a pneumonia was caused by a bacterial origin vs a viral one?

Answer 39

Procalcitonin

Question 40

When should you hospitalize a patient who has pneumonia?

Answer 40

When they have neutropenia, involvement of more than one lobe, or poor host resistance Consider for those over 50 with comorbidities, etc.

Question 41

How many strains does PCV23 or Pneumovax contain of pneumonia?

Answer 41

23

Question 42

Who is at the highest risk of hospital acquired pneumonia?

Answer 42

Vent patients

Question 43

What is the second most common cause of hospital acquired infection?

Answer 43

Hospital acquired pneumonia

Question 44

What is the most likely pathogen to cause pneumonia in the ICU?

Answer 44

Pseudomonas

Question 45

With hospital acquired pneumonia, what bacterial should you always treat against?

Answer 45

Pseudomonas

Question 46

Inflammation of trachea/bronchi (conducting airways)

Answer 46

Bronchitis

Question 47

What is bronchitis most commonly caused by?

Answer 47

Viruses

Question 48

Which viruses commonly cause bronchitis?

Answer 48

Rhinovirus adenovirus coronavirus RSV

Question 49

What are some bacterial causes of bronchitis?

Answer 49

S. pneumonia H. influenzae M. catarrhalis Mycoplasma

Question 50

Bronchitis often follows a ____

Answer 50

URI

Question 51

What is hallmark symptoms of bronchitis?

Answer 51

Cough that can be productive but doesn't have to, lasts 1-3 weeks

Question 52

How do you diagnose bronchitis?

Answer 52

Clinically

Question 53

Is a CXR usually indicated for bronchitis?

Answer 53

Nah

Question 54

How do you manage bronchitis?

Answer 54

Symptomatic tx of choice | Fluids, rest, antitussives, bronchodilators

Question 55

Do antibiotics have any benefit at all in healthy patients with bronchitis?

Answer 55

NO don't use them!

Question 56

Is sputum color predictive of bacterial involvement?

Answer 56

NO damnit

Question 57

Cough with or without sputum, dyspnea, fever, sore throat, headache, myalgia, substernal discomfort, PE: Expiratory rhonchi or wheezes

Answer 57

Bronchitis