Mehlman. pneumonia 04-21 (4)

Question 1

Lobar pneumonia = mo/s?

Answer 1

Strep pneumoniae

Question 2

Lobar pneumonia CP?

Answer 2

right lower lobe consolidation with dullness to percussion

Question 3

Bilateral interstitial pneumonia (aka atypical pneumonia) in immunocompetent patients = mos?

Answer 3

Mycoplasma

Question 4

Lobar pneumonia where they say “interstitial markings” and Strep pneumo isn’t listed -> answer = mos?

Answer 4

Mycoplasma (the word “interstitial” wins over
location).

Question 5

Bilateral interstitial / “ground-glass” pneumonia in AIDS patient = mos?

Answer 5

Pneumocystis jirovecii pneumonia (PJP).

Question 6

Lobar pneumonia in AIDS patient = mos?

Answer 6

Strep pneumo, not PJP

Question 7

Bacterial pneumonia specifically post-influenza infection?

Answer 7

staph aureus

Question 8

Bilateral pneumonia + low Hb or (+) Coombs test = mos?

Answer 8

Mycoplasma -> can cause cold agglutinins, which means IgM against RBCs -> hemolysis).

Question 9

Pneumonia + hyponatremia and/or diarrhea -> mos?

Answer 9

Legionella

Question 10

Pneumonia + business conference or residential home (implies air conditioners) -> mos?

Answer 10

Legionella

Question 11

Pneumonia in 3-wk-old neonate who had conjunctivitis 1-2 weeks ago = mos?

Answer 11

Chlamydia trachomatis (the STI; drains through nasolacrimal duct to lungs).

Question 12

Pneumonia in newborn first few days of life
+ gram (+) cocci = mos?

Answer 12

Group B Strep (Strep agalactiae), which is gram (+) cocci.

Question 13

Pneumonia in newborn first few days of life + gram (+) rods = mos?

Answer 13

Listeria.

Question 14

Pneumonia in newborn first few days of life + gram (-) rods = mos?

Answer 14

E. coli

Question 15

Pneumonia + rabbits = mos?

Answer 15

Francisella.

Question 16

Pneumonia + bird keeper = mos?

Answer 16

Chlamydia psittaci.

Question 17

Pneumonia + southwest US and/or earthquake dust = mos?

Answer 17

Coccidioides.

Question 18

Patients who have lung cancer are prone to obstructive pneumonias (on 2CK)

Answer 18

.

Question 19

Pneumonia in CF = mos?2

Answer 19

Pseudomonas or S. aureus

Question 20

Pneumonia in patient with central venous catheter + right upper lobe lesion –> answer = mos? on nbme

Answer 20

Staph epidermidis (on NBME). Cather = biofilms

Question 21

USMLE wants for pneumonia CP?2

Answer 21

adventitious/bronchial (i.e., abnormal) breath
sounds + ­ tactile fremitus (air vibrates due to movement through infective consolidation within alveoli

Question 22

Community-acquired pneumonia (CAP) empiric Tx = ? on 2CK buvo

Answer 22

azithromycin on 2CK (on NBME). This covers the atypicals (Mycoplasma, Legionella, Chlamydia) as well as S. pneumo.

Question 23

If patient has been on antibiotics in the past 3 months or has severe lung disease –> what can be first line abs?

Answer 23

Levofloxacin (respiratory fluoroquinolone)

Question 24

CAP that results in sepsis or septic shock -> abs?

Answer 24

give ceftriaxone (if listed, choose cefotaxime for peds)

Question 25

Nosocomial pneumonia (i.e., hospital- or ventilator-acquired) requires coverage for? 2 mos

Answer 25

MRSA and Pseudomonas

Question 26

Nosocomial pneumonia. what abs want usmle?

Answer 26

vancomycin PLUS either ceftazidime (a 3rd-gen cephalosporin) or cefepime (a 4th-gen ).

Question 27

For fungal pneumonia Tx?

Answer 27

fluconazole.

Question 28

For fungal pneumonia + fungemia (high fever, chills) = Tx?

Answer 28

Amphotericin B

Question 29

NBME for 2CK wants you to know what needs to be done in all patients with pneumonia who are septic?

Answer 29

sputum culture, followed by blood cultures

Question 30

Septic pneumonia patient. What they do in this patient is give you patient who has sputum culture performed, then they ask what should be done next for diagnosis?

Answer 30

blood culture.

Question 31

If you get Pneumocystis pneumonia, Dx?

Answer 31

bronchoalveolar lavage

Question 32

If you get a patient who has CXR or CT showing cavitary lesions in the lungs filled with a mass (likely Aspergillus fungus ball), they want what confirmatory test?

Answer 32

“open lung biopsy”

Question 33

When a pneumonia fully resolves and USMLE asks why the CXR is normal after the fact, the answer is?

Answer 33

“maintenance of integrity of basement membranes"

Question 34

2CK wants you to know that pneumonias can occur in patients distal to areas of lung obstructed by tumors.

Answer 34

.

Question 35

Patient has tumor + distal pneumonia. why?

Answer 35

“endobronchial obstruction"

Question 36

NBME wants you to know rituximab (monoclonal antibody against CD20 on B cells) increases the risk of...

Answer 36

bacterial pneumonia

Question 37

What medication inc. risk of bacterial pneumonia?

Answer 37

rituximab (monoclonal antibody against CD20 on B cells)

Question 38

NBME wants you to know rituximab (monoclonal antibody against CD20 on B cells) increases the risk of bacterial pneumonia. This makes sense, since B cells are required for antibody production as part of humoral immunity against bacteria.

Answer 38

.

Question 39

HIV + pneumo. Lobar?

Answer 39

Strep. pneumonia

Question 40

HIV + pneumo. Bilateral?

Answer 40

PJP

Question 41

Right lower lobe consolidation with dullness to percussion –> Strep pneumo. Treat empirically with?

Answer 41

Azithro.

Question 42

Bilateral interstitial infiltrates in immunocompetent patient –> Mycoplasma or PJP. But the USMLE wants PJP. What Dx, What Tx?

Answer 42

Do BAL to Dx, then Tx with TMP-SM.

Question 43

Bilateral interstitial infiltrates in immunocompetent patient –> Mycoplasma or PJP. But the USMLE wants PJP. IF patient is already on PJP proph --> it cannot be PJP then. What mos and Tx?

Answer 43

So the assumption would be Mycoplasma –> give azithro