Lower Respiratory Tract Infection

Question 1

What is pneumonia?

Answer 1

acute infection of alveoli causing inflammation & fluid or pus accumulation

Question 2

LRTI Signs and Symptoms

Answer 2

Sputum production
Tachycardia
Tachypnea
Hemoptysis
Pleuritic chest pain
Increased WBC
Diminished Breath Sounds
Dyspnea

Question 3

Gram +ve diplococci

Answer 3

S. pneumoniae

Question 4

Cluster of gram +ve cocci

Answer 4

S. aureus

Question 5

Tiny gram -ve coccobacilli

Answer 5

H. influenzae

Question 6

gram -ve diplococci

Answer 6

M. catarrhalis

Question 7

plump gram -ve rods

Answer 7

Klebsiella

Question 8

Gram -ve rods

Answer 8

P. aeruginosa

Question 9

Diagnosis of LRTI

Answer 9

Sputum Culture in severe hospitalized

***obtain before ABx

Question 10

Other LRTI Diagnostic

Answer 10

• Bronchoalveolar Lavage (BAL)

Question 11

CURB - 65

Answer 11

Confusion = 1
Uremia (BUN>20)
Resp Rate (>30/min) = 1
SBP <90/DBP <60
Age >65 yrs = 1

Question 12

CURB-65 ratings

Answer 12

0-1 = outpatient
2 = inpatient
>3 = ICU

Question 13

HAP

Answer 13

48 hrs after admission
community pts w/ IV ABx within 90 days of admission

Question 14

VAP

Answer 14

> 48 hrs after endotracheal intubation

Question 15

CAP

Answer 15

no exposure to healthcare system

Question 16

Most common CAP pathogens?

Answer 16

S. pneumoniae

Question 17

CAP pathogens covered empirically>

Answer 17

S. pneumoniae
H. influenzae
Atypicals

Question 18

Typical Pneumonia (primary pulmonary symptoms)

Answer 18

Abrupt onset
Unilateral infiltrate
Significant fever, chills
Purulent sputum production

Question 19

Atypical Pneumonia (extrapulmonary symptoms)

Answer 19

Gradual onset
Dry cough
Diffuse infiltrates

Question 20

CAP Outpatient Treatment in Healthy Patients

Answer 20

PO Amoxicillin
PO Doxycycline
PO Macrolides (Azithro/Clarithro)

Question 21

CAP Outpatient Treatment in ppl with comorbidities

Answer 21

PO Augumentin
Cephalosporin + Macrolide (A/C)
Respiratory Fluoroquinolone (Levo/Moxi)

Question 22

CAP Inpatient Treatment Non-Severe

Answer 22

IV B-Lactam + Macrolide
IV B-Lactam + Respiratory Fluoroquinolone

Question 23

CAP Inpatient Treatment Severe

Answer 23

IV B-Lactam + Macrolide
IV B-Lactam +Respiratory Fluroquinolone

Question 24

IV B-Lactam used in CAP

Answer 24

Ampicillin/Sulbactam (Unasyn)
Ceftriaxone

Question 25

What respiratory cultures should you take and possibly treat?

Answer 25

MRSA and Pseudomonal

Question 26

Duration of Therapy for CAP Treatment

Answer 26

Minimum of 5 days (~7)
Afebrile for 48 - 72 hours

Question 27

Pretreatment for CAP

Answer 27

sputum and blood culture - antiMRSA and antiPseudomonal

Question 28

Test for severe CAP

Answer 28

urinary Ag test for Legionella & S. pneumoniae

Question 29

Bacterial Etiology for VAP

Answer 29

gram -ve organisms within 3 - 5 days

Question 30

When do you cover pseudomonas empirically?

Answer 30

prior IV ABx use in 90 days
severe presentation (sepsis/ventilator)
previous pseudomonal infection
immunosuppression

Question 31

ABx for HAP Pseudomonas

Answer 31

Piperacillin/Tazobactam (Frequent dosing)
Cefepime (No Anerobic)
Ceftazidime

Question 32

HAP culture test

Answer 32

sputum sample non-invasively then BAL if possible

Question 33

VAP culture test

Answer 33

non-invasive of semi-quantitative cultures

Question 34

Duration of HAP ABx Treatment

Answer 34

7 days

Question 35

Duration of VAP ABx Treatment

Answer 35

7 days