Infections of upper and lower respiratory tracts

Question 1

Most common cause of CAP

Answer 1

S. pneumo

Question 2

Most common bacterial causes of nosocomial pneumonia

Answer 2

GNRs (E. coli, Pseudomonas), and S. aureus

Question 3

Type of pts to give pneumococcal vaccine

Answer 3

Elderly (>65 y/o)

Question 4

Common bacterial agents in CAP

Answer 4

S. pneumo (60%), H. influenza (15%), aerobic GNRs (6%-10%) and Klebsiella, S. aureus (2-10%)

Question 5

How do you distinguish upper from lower respiratory tract infection clinically?

Answer 5

URTI are more likely to have nasal discharge, sore throat, or ear pain

Question 6

How do you differentiate pneumonia from bronchitis?

Answer 6

CXR! Clinical features are very similar

Question 7

Most common cause of atypical pneumonia

Answer 7

Mycoplasma pneumoniae

Question 8

Bacterial causes of atypical pneumonia

Answer 8

M. pneumo (most common), chlamydia pneumo, chlamydia psitacci, Coxiella burnetti (Q fever), Legionella

Question 9

Viral causes of atypical pneumonia

Answer 9

Influenza A & B, adenoviruses, parainfluenza, RSV

Question 10

In alcoholics, think of what cause of pneumonia?

Answer 10

Klebsiella

Question 11

In immigrants, be suspicious for what cause of pneumonia?

Answer 11

TB

Question 12

What kind of pts is legionella common in?

Answer 12

Organ transplant pts, pts w/ renal failure, pts w/ chronic lung disease, and smokers. Rare in healthy people.

Question 13

Silver stain diagnoses what cause of pneumo

Answer 13

Pneumocystis jiroveci

Question 14

What test do you use to diagnose legionella

Answer 14

Urinary antigen assay

Question 15

When should you admit a pt w/ pneumonia to the hospital?

Answer 15

If they are hypoxic or hypotensive

Question 16

Outpatient treatment of community acquired pneumo in pts younger than 60

Answer 16

Macrolides (azithromycin or clarithromycin) or doxycycline

Question 17

Outpt treatment of CAP in elderly and pts w/ comorbidities

Answer 17

Fluoroquinolone (levofloxacin or moxifloxacin), or a 2nd or 3rd gen cephalosporin

Question 18

For hospitalized patients w/ CAP

Answer 18

Third gen ceph + macrolide; Ceftriaxone + azithromycin

Question 19

Treatment of hospital acquired pneumo geared toward what kind of organisms

Answer 19

Gram-negative rods

Question 20

Specific treatment options for nosocomial pneumonia

Answer 20

Cephalosporins w/ pseudomonas coverage (ceftazidime or cefepime), carbapenims (imipenem), or piperacillin/tazobactam (zosyn).

Question 21

What kind of antibiotics are NOT used in nosocomial pneumos?

Answer 21

Macrolides

Question 22

Typical cause of lung abscess

Answer 22

Aspiration of large volume of oropharyngeal contents or food

Question 23

Bacteria in lung abscesses

Answer 23

Prevotella, peptostreptococcus, fusobacterium, bacteriodies; bacteria that colonize the oropharynx

Question 24

What kinds of bacteria should you cover in treating lung abscesses?

Answer 24

Gram+ cocci, anaerobes, maybe GNRs

Question 25

Treatment regimen for lung abscesses

Answer 25

Ampicillin or amoxicillin/clavulanic (or sulbactam), or vancomycin for gram + cocci; clindamycin or metronidazole for anaerobes, and fluoroquinolones or ceftazadime if you suspect GNRs