LRTI

Question 1

confirming pneumonia

Answer 1

systemic
- fever, chill, malaise, elderly change in mental status, tachycardia, hypotension

localised
- cough, pruritic chest pain (cough pain), SOB, tachypnoea (24-25 breathe/min), hypoxia (< 95%)
- increased sputum production

Question 2

definition of community acquired pneumonia (CAP)

Answer 2

onset in community or < 48h after admission

Question 3

CAP outpaitient no comorbidities

Answer 3

1) amoxicillin
2) levo, moxi

Question 4

CAP outpaitient comorbidities

Answer 4

1) augmentin, cefuroxime + clari/azithro OR doxy
2) levo or moxi

Question 5

inpatient, non severe, normal pathogen (Strep pneumo, haemo influenzae, atypical)

Answer 5

1) augmentin or cefuroxime or ceftriaxone + calri/azi OR doxy
2) levo or moxi

Question 6

MRSA risk factor

Answer 6

1) respiratory isolation of MRSA in past 1 year
2) hospitalisation/parenteral Abx in past 90 days + MRSA PCR +ve

Question 7

CAP inpatient, non severe, MRSA risk factor

Answer 7

non severe + vanco, linezolid

Question 8

CAP, inpatient, severe, normal (all outpatient, staph auerues, other gram neg)

Answer 8

1) augmentin + ceftazidime + clari/azi
2) levo or moxi + ceftazidime

Question 9

CAP, inpatient, severe, MRSA risk factor

Answer 9

above + vanco/linezolid

Question 10

pseudomonas risk factors

Answer 10

1) respiratory isolation of pseudomonas in last 1 year
2) hospitalisation or parenteral Abx use in past 90 days

Question 11

CAP, inpatient, severe, pseudomonas risk

Answer 11

ceftazidime or levo

Question 12

CAP considerations

Answer 12

• if lung abscess or emphysema and X anerobic cover then add IV/PO metronidazole or clindamycin
• adjunctive corticosteroid to reduce lung inflammation if septic shock refractory ro fluid resuscitation and vasopressor support

Question 13

CAP treatment duration

Answer 13

• min 5 days therapy
• 7 days if suspected/proven MRSA/pseudomonas
• longer if elderly or comorbidities

Question 14

nosocomial pneumonia definition

Answer 14

HAP + VAP
1) hospital acquired pneumonia (HAP)
- onset > 48 hrs after hospitalisation

2) ventilator associated pneumonia (VAP)
- onset > 48 hrs after mechanical ventillation

Question 15

nosocomial pseudomonas, other GNR (enterobacter spp, klebseilla spp, e.coli)

Answer 15

1) antipseudomonal beta lactam

• pip-tazo
• cefepime, ceftazidime
• mero, imi

2) +/- antipseudomonal (cipro)

3) maybe aminoglycosides (amikacin)

Question 16

nosocomial pseudomonas MRSA

Answer 16

add IV vanco or IV/PO linezolid