medicine

Question 1

Causes of pneumonia

Answer 1

bacteria
virus
fungi(rare)

Question 2

definition of pneumonia

Answer 2

infection of the pulmonary parenchyma resulting in a respiratory and constitutional symptoms accompanied by clincal examinations findings and/or a new infiltrate on chest x-ray consistent with pneumonia.

Question 3

Anatomical classification

Answer 3

lobar pneumonia
bronchopneumonia
interstitial pneumonia

Question 4

clinical classification

Answer 4

CAP(Typical and atypical)
Nosocomial - HAP/VAP/HCACP
Aspiration pneumonia
Pneumonia in immunocompromised host

Question 5

CAP

Answer 5

occurs without prior contact to the healthcare system in OPD or within 48hours of hospital admission.

Question 6

HAP

Answer 6

occurs 48 hours after admission and no signs of pulmonary infection on admisson

Question 7

VAP

Answer 7

develops 48 hours or more on mechanical ventilation

Question 8

HCAP

Answer 8

Occurs in non-hospitalized patients who has had significant contact with the health care system

Question 9

what causes the clinical syndrome of pneumonia

Answer 9

the body’s inflammatory response against it causes the clinical syndrome of pneumonia

Question 10

rare causes of pneumonia pathogenesis

Answer 10

Pneumonia can also rarely result from a hematogenous or contiguous focus of infection (e.g., tricuspid valve endocarditis, hepatic abscess etc.

Question 11

predisposing factors to pneumonia

Answer 11

1. smoking
2. alcholism
3. recent upper respiratory tract infections
4. pre-existing lung diseases(COPD, bronchiectasis, lung cancer)
5. Factors that reduce the host defenses against pnemonia
6. Aspiration of gastric or nasopharyngeal secretions
7. Bacteria introduced into lower respiratory tract.

Question 12

still on predisposing

which medications

Answer 12

PPI

Question 13

factors that reduce host defenses against penumonia

Answer 13

Reduce immune defenses and comorbid conditions (e.g Malignancy, diabetes, corticosteroid treatment, heart failure, renal failure) • Reduce cough reflex (e.g. stroke, sedating medications) • Disordered mucociliary clearance (e.g. anaesthetic agents ) • Bulbar or vocal cord palsy

Question 14

CAP related microorganisms

Answer 14

S. pneumonia
S. aureus
K. pneumoniae
H. influenzae and M. catarrhalis
P. aeruginosa

Question 15

features of K. pneumonia

Answer 15

seen in alcholics or smokers. greater tendency for abscess formation

Question 16

features of H. influenza and M.catarrhalis

Answer 16

Pneumonia in elderly and patients with COPD

Question 17

most common pathogen in atypical pneumonia

Answer 17

Mycoplasma pneumoniae

Question 18

features of mycoplasma pneumoniae

Answer 18

skin rashes
erythema
arthritis
aseptic meningitis

Question 19

note this

Answer 19

viral or fungal infections are uncommon immunoomptetent hosts

Question 20

HAP, VAP and HCAP related microorganisms

Answer 20

Pseudomonas aeruginosa,Klebsiella pneumoniae, Escherichia coli, Enterobacter spp, Serratia spp, Staphylococcus aureus

note they are usually drug resistant

Question 21

immunocompromised patient microorg

Answer 21

P. jiroveci
M. tuberculosis
Norcardia spp
Asperigullus spp

Question 22

features of sputum in pneumonia

Answer 22

Rust-coloured sputum: S tr e p t o c o c c u s p n e u m o n i a e
• Green sputum: P s e u d o m o n a s , H a e m o p h il u s , and Pneumococcal species
• Red currant-jelly sputum: K l e b si e ll a species • Foul-smelling sputum: Anaerobic infections

Question 23

what about cough in atypical pneumonia

Answer 23

prolonged dry cough

Question 24

presence of rigors

Answer 24

pneumococcal pneumonia

Question 25

Atypical pneumonia

Answer 25

In atypical pneumonia, constitutional symptoms such as headache, low-grade fever, malaise often predominate over respiratory symptoms

Question 26

Aspiration risks

Answer 26

Alcoholism
altered mental status
dysphagia
GERD
seizure

Question 27

comorbid conditions

Answer 27

asthma
COPD
HIV
DM
smoking

Question 28

Chest examination findings

Answer 28

Reduced chest expansion,
Increased tactile fremitus 
• Dullness to percussion 
• Decreased intensity of breath sounds, Bronchial breath sounds,
 Coarse inspiratory crackles, 
Whispering pectoriloquy, 
bronchophony or egophony, 
Pleural friction rub 
• Increased vocal resonance

Question 29

gold standard investigation

Answer 29

chest xray

Question 30

two widely used clinical prediction rules to admission and triage decisions

Answer 30

PSI - Pneumonia severity index

CURB-65

Question 31

CURB65

Answer 31

Confusion – Altered mental status • Urea – BUN level greater than 7mmol/L • Respiratory rate – greater than 30 breaths per minute • BP – Systolic pressure < 90 mm Hg or diastolic pressure < 60 mm Hg • Age 65 years or more

Question 32

interpretation of score

Answer 32

Score of 0-1 – Outpatient treatment
• Score of 2 – Admission to medical ward
• Score of 3 or higher – Admission to intensive care unit (ICU)

Question 33

differentials for pneumonia if it’s not resolving

Answer 33

PTB
Sarcoidosis
malignancies
congestive heart failure

Question 34

pneumonia complications

Answer 34

SLAP HER
Septicemia
lung abscess
ARDS
para pneumonic effusions
hypotension
empyema
respiratory failure or renal failure

Question 35

leukopenia sign of

Answer 35

sepsis

Question 36

only chest sign in atypical pneumonia

Answer 36

Mild crackles

Question 37

what stain for P.jiroveci

Answer 37

Silver stain

Question 38

Legionella pneumonia: how it presents

Answer 38

Bradycardia, fever, diarrhea

Question 39

txt - OPD

which med for previously healthy patient who hasnt taken antibiotics within the past 3 months

Answer 39

Macrolide(clari or azi)

Question 40

txt - OPD

pt with comorbid medical conditions

Answer 40

respiratory fluoroquinolone - moxifloxacin
OR
a macrolide plus beta- lactam - amoxicillin clavulanate, cefuroxime

Question 41

when should clinical response to antibiotuc therapy be evaluated

Answer 41

within 48 - 72 hours of initiation