PCAP II Flashcards
1
Q
What age range do the guidelines for Pediatric Community-Acquired Pneumonia apply to?
A
3 months to 18 years
2
Q
Which organizations endorsed the 2021 Clinical Practice Guidelines for Pediatric Community-Acquired Pneumonia?
A
Philippine Pediatric Society, Inc.
3
Q
What is the primary focus of the 2021 Clinical Practice Guidelines?
A
Evaluation and management of uncomplicated community-acquired pneumonia in immunocompetent infants and children
4
Q
What clinical signs and symptoms can accurately diagnose community-acquired pneumonia in children?
A
- Cough or fever
- Tachypnea
- Retractions or chest indrawing
- Nasal flaring
- O2 saturation <95% at room air
- Grunting
5
Q
What is the definition of tachypnea for infants aged 3 months to 12 months?
A
≥50 breaths per minute
6
Q
What is the definition of tachypnea for children aged 1 year to 5 years?
A
≥40 breaths per minute
7
Q
What is the definition of tachypnea for children aged 5 years to 12 years?
A
≥30 breaths per minute
8
Q
What is the definition of tachypnea for adolescents aged over 12 years?
A
≥20 breaths per minute
9
Q
What is chest indrawing defined as?
A
Inward movement of the lower chest wall when the child breathes in, indicating respiratory distress
10
Q
What is the cut-off for oxygen saturation that indicates a potential pneumonia diagnosis?
A
<95% at room air
11
Q
What was the reference standard used in the studies for diagnosing pneumonia?
A
Chest radiograph
12
Q
What approach was used for quality assessment in the guideline development?
A
GRADE approach
13
Q
What are the levels of recommendation strength according to GRADE?
A
- High
- Moderate
- Low or Very Low
- No evidence
14
Q
What constitutes a ‘strong’ recommendation in the GRADE system?
A
Should [or should not] be recommended
15
Q
What constitutes a ‘conditional’ recommendation in the GRADE system?
A
Is [or is not] suggested/considered
16
Q
What major factors were considered during the formulation of recommendations?
A
- Facilitators
- Barriers to implementation
17
Q
What is the purpose of the dissemination and monitoring plan for the guidelines?
A
To assess compliance and applicability of the formulated guidelines
18
Q
What is the clinical question regarding empiric treatment for bacterial etiology in Pediatric Community-Acquired Pneumonia?
A
What empiric treatment is effective if a bacterial etiology is considered?
19
Q
What is the recommendation regarding the addition of a macrolide to standard empiric regimen for bacterial pneumonia?
A
Will the addition of a macrolide improve treatment outcome?
20
Q
What is the significance of stakeholder consultation in the development of the guidelines?
A
To gather feedback on clarity, acceptability, and applicability of the CPG
21
Q
What is the goal of the literature search conducted for the guideline development?
A
To include and appraise evidence relevant to the clinical questions
22
Q
What is one potential barrier to the implementation of the recommendations?
A
Lack of economic evaluation of health interventions
23
Q
True or False: The consensus for recommendations was defined as 50% agreement among members.
A
False
24
Q
Fill in the blank: The 2021 PCAP CPG was formulated under the guidance of the _______.
A
Philippine Pediatric Society
25
What is the inward movement of the lower chest wall when a child breathes in a sign of?
Respiratory distress
26
What oxygen saturation cut-off value is considered important based on expert opinion?
<95%
27
What is the sensitivity and specificity of cough in diagnosing Community-Acquired Pneumonia (CAP) in children?
Sen = 78.5-88, Sp = 16-30.2
28
What are the positive and negative likelihood ratios for cough when diagnosing CAP?
+LR = 1.3, -LR = N/A
29
What is the sensitivity range for fever in diagnosing CAP?
Sen = 47-94
30
What is the specificity range for fever in diagnosing CAP?
Sp = 36-68
31
What is the positive likelihood ratio for fever in diagnosing CAP?
+LR = 1.7-1.8
32
What is the sensitivity of oxygen saturation ≤96% in diagnosing pneumonia?
Sen = 64 (49-78)
33
What is the specificity of oxygen saturation ≤96% in diagnosing pneumonia?
Sp = 77 (73-81)
34
True or False: A normal chest radiograph excludes the presence of pneumonia.
False
35
What are the clinical parameters indicating high risk for pneumonia-related mortality?
* Cyanosis/Hypoxemia
* Head bobbing
* Chest indrawing/Retractions
* Apnea
* Grunting
36
What is the significance of a sustained oxygen saturation of <90% at room air?
Associated with hypoxemia
37
What does altered sensorium indicate in children with pneumonia?
Increased risk of mortality
38
What are the implications of chest indrawing in children with pneumonia?
Associated with severe outcomes
39
What is the risk classification for pneumonia-related mortality based on respiratory signs?
* Low Risk: No respiratory signs
* High Risk: Presence of respiratory signs
40
What is the evidence level for the association of age <6 months with pneumonia treatment failure?
Moderate
41
What is the positive likelihood ratio for grunting in diagnosing pneumonia?
+LR = 5.210
42
What does refusal or inability to drink or feed indicate in a child with pneumonia?
High risk for pneumonia-related mortality
43
What is the association of weight for age with pneumonia-related mortality?
Low weight (< -2 Z-score) increases risk
44
What is the importance of correlating chest radiograph findings with clinical findings?
Essential for accurate diagnosis of pneumonia
45
What is the recommendation for patients with oxygen saturation <90%?
Oxygen therapy should be initiated
46
What is the significance of dehydration in children with pneumonia?
Indicates high risk for pneumonia-related mortality
47
What is multifocal involvement associated with in pneumonia outcomes?
Independent risk factor for poor outcomes including:
* ICU admission (OR = 5.38)
* Longer LOS (>9 days) (OR = 9.75)
* Tube thoracotomy (OR = 20.12)
## Footnote
Outcomes indicate significant severity and resource utilization in pneumonia cases.
48
What is the odds ratio (OR) for moderate or large effusions associated with ICU admission?
OR = 3.2; 95% CI = 1.1–8.9
## Footnote
Indicates increased risk of severe outcomes in pneumonia patients.
49
What is the OR for mechanical ventilation in patients with moderate or large effusions?
OR = 14.8; 95% CI = 9.8–22.4
## Footnote
Highlights the severity of pneumonia with large effusions.
50
What does impaired perfusion on lung ultrasound indicate?
Lung necrosis; longer hospital stay expected if moderate- to-massive pleural effusion is observed (OR = 3.08; 95% CI = 1.15–8.29)
## Footnote
Suggests that ultrasound findings correlate with clinical outcomes.
51
What are the new classifications for pneumonia-related mortality as per the 2021 CPG recommendations?
Non-Severe PCAP (Low-Risk) and Severe PCAP (High Risk)
## Footnote
Change aligns with international guidelines for assessing pneumonia risk.
52
What indicates the need for admission in pediatric patients with pneumonia?
Presence of one parameter in Severe or High Risk for Mortality category
## Footnote
This classification focuses on mortality risk rather than severity.
53
What should be done if a patient classified as having non-severe PCAP shows no clinical improvement?
Admit if no improvement or signs of deterioration appear within 48 hours
## Footnote
Includes specific symptoms like hypoxemia and altered sensorium.
54
What diagnostic aid is strongly recommended for severe PCAP?
Chest X-ray
## Footnote
It is the initial diagnostic aid of choice due to its critical importance.
55
What is the recommendation regarding point-of-care chest ultrasonography (POCUS) for severe PCAP?
Strongly recommended as a diagnostic aid
## Footnote
Effective for immediate assessment in critical settings.
56
What is procalcitonin (PCT) used for in diagnosing bacterial PCAP?
Recommended to be used alongside clinical presentation and imaging
## Footnote
PCT helps in distinguishing bacterial pneumonia from other types.
57
What is the sensitivity (Sn) and specificity (Sp) of chest X-ray for diagnosing pneumonia?
Sn: 86.80%; Sp: 98.20%
## Footnote
High diagnostic accuracy supports its use in clinical settings.
58
What are the advantages of using chest ultrasonography (CUS) for diagnosing pneumonia?
Advantages include:
* Performed at point-of-care
* Feasible and less costly
* Less affected by movement
* Free of ionizing radiation
## Footnote
Highlights the practical benefits of ultrasound in pediatric care.
59
What limitations are associated with ultrasound imaging in pneumonia diagnosis?
Limitations include:
* Operator dependency
* Inability to visualize whole lung
* Potential misinterpretation of other structures
## Footnote
These factors can affect diagnostic accuracy.
60
What is the significance of sputum Gram stain and culture in diagnosing bacterial CAP?
Highly specific for diagnosing S. pneumoniae and H. influenzae
## Footnote
Sensitivity and specificity values indicate its utility in clinical practice.
61
What is the importance of selecting good-quality specimens for Gram staining?
A good-quality specimen contains ≥25 leukocytes and <10 squamous epithelial cells
## Footnote
Ensures higher diagnostic yield in bacterial pneumonia cases.
62
What is the evidence regarding the routine use of culture and sensitivity for severe PCAP?
Insufficient evidence to support routine use
## Footnote
Indicates the need for further research in clinical practices.
63
What is the clinical question regarding antibiotic treatment in children with community-acquired pneumonia?
What clinical and ancillary parameters will determine the need for antibiotic treatment in infants and children aged 3 months to 18 years with community-acquired pneumonia?
64
What parameters suggest bacterial etiology in community-acquired pneumonia?
Elevated white blood cell count (WBC), elevated C-reactive protein (CRP), elevated procalcitonin (PCT), imaging findings such as alveolar infiltrates in chest radiograph, unilateral lung consolidation, air bronchograms, and pleural effusion in lung ultrasound.
65
What is the sensitivity and specificity of CRP for differentiating bacterial from viral pneumonia?
Sensitivity: 63.5 - 75%, Specificity: 53.8 - 90%
66
What are the pooled sensitivity and specificity of procalcitonin for diagnosing bacterial pneumonia in children?
Pooled Sensitivity: 0.64 (95% CI: 0.53–0.74), Pooled Specificity: 0.72 (95% CI: 0.64–0.79)
67
What does a CRP concentration of ≥ 40 mg/L with radiological confirmation suggest?
It suggests bacterial pneumonia.
68
What findings on imaging are indicative of bacterial pneumonia?
Alveolar infiltrates, unilateral consolidation, air bronchogram.
69
True or False: Laboratory tests are routinely requested before starting antibiotic therapy for pneumonia.
False
70
What is the recommended empiric treatment for non-severe community-acquired pneumonia?
Amoxicillin trihydrate at 40-50mg/kg/day Q8 for 7 days OR Amoxicillin-clavulanate at 80-90mg/kg/day Q12 for 5 to 7 days.
71
What treatment is suggested for severe community-acquired pneumonia with complete Hib vaccination?
Start Penicillin G at 200,000 units/kg/day Q6.
72
What is the treatment for patients with non-type 1 hypersensitivity to penicillin?
Cefuroxime or Ceftriaxone.
73
What is the treatment for patients with type 1 hypersensitivity to penicillin?
Azithromycin, Clarithromycin, or Clindamycin.
74
Fill in the blank: Elevated _______ counts can indicate bacterial pneumonia.
white blood cell
75
What is the clinical significance of imaging findings in pneumonia diagnosis?
They help differentiate between bacterial and viral pneumonia.
76
What does the presence of pleural effusion on lung ultrasound suggest?
It suggests a bacterial etiology in pneumonia.
77
What is the pooled positive likelihood ratio (LR) for procalcitonin?
2.3 (95% CI: 1.8–3.0)
78
What is the pooled negative likelihood ratio (LR) for procalcitonin?
0.50 (95% CI: 0.38–0.66)
79
What is a critical recommendation regarding antibiotic use in pneumonia?
Avoid unnecessary use of antibiotics and provide optimal pathogen-directed care.
80
What does a low or normal level of biomarkers not exclude?
It does not exclude bacterial pneumonia.
81
What is the recommended treatment for Staphylococcal pneumonia?
Add Clindamycin or Vancomycin in severe cases.
82
What does the term 'empiric therapy' refer to?
Starting treatment based on clinical signs before confirming the exact cause.
83
What is the importance of differentiating bacterial from viral pneumonia?
To avoid unnecessary antibiotic use and ensure appropriate treatment.
84
What is the recommended treatment for Type 1 hypersensitivity to Penicillin?
Azithromycin at 10mg/kg/day for 3 days or 10mg/kg/day on day 1 followed by 5mg/kg/day for days 2 to 5, Clarithromycin at 15mg/kg/day for 7 days, Clindamycin at 10-40mg/kg/day for 7 days (conditional recommendation, low-grade evidence)
## Footnote
Adjustments may be made based on the patient's clinical response and specific pathogen identification.
85
What is the recommended macrolide treatment when an atypical pathogen is suspected?
Azithromycin at 10mg/kg/day for 5 days or 10mg/kg/day on day 1 followed by 5mg/kg/day for days 2 to 5, Clarithromycin at 15mg/kg/day for 7 to 14 days (conditional recommendation, low-grade evidence)
## Footnote
Particularly important for infants under 6 months old suspected of having pertussis.
86
What should be done when a specific pathogen is identified?
Modify the empiric treatment based on the antibiotic susceptibility pattern and/or the drug of choice (strong recommendation, high-grade evidence)
## Footnote
This ensures more effective treatment tailored to the identified pathogen.
87
What is the recommended duration of treatment for uncomplicated bacterial pneumonia?
7 to 10 days treatment is considered, but longer duration may be required based on clinical response and complications (conditional recommendation, low-grade evidence)
## Footnote
Treatment duration may vary depending on the virulence of the organism.
88
What percentage of Streptococcus pneumoniae isolates showed penicillin resistance in 2020?
1.1%
## Footnote
This data is part of the antimicrobial resistance surveillance pattern from 2016 to 2020.
89
What is the resistance pattern of Haemophilus influenzae to ampicillin in 2020?
7.2%
## Footnote
This reflects the resistance rates over the years as part of the surveillance data.
90
What is the resistance rate of Staphylococcus aureus to oxacillin in 2020?
47.6%
## Footnote
This shows the trend of resistance over the years from 2016 to 2020.
91
What are the most commonly detected bacteria in pediatric pneumonia according to Nathan et al. 2020?
H. influenzae, S. aureus, and S. pneumoniae
## Footnote
This finding is based on a cohort study.
92
What is the recommended treatment for children >1 month old with pneumonia who do not require hospitalization?
Oral amoxicillin (45 mg/kg/dose 12-hourly) remains the preferred antibiotic
## Footnote
Treatment duration should be 5 days, but longer may be needed for severe cases.
93
True or False: The length of therapy for uncomplicated bacterial pneumonia should not exceed 7 days.
False
## Footnote
Length of therapy can be extended based on clinical response.
94
What are the important bacterial causes of pneumonia in children younger than 5 years?
* Streptococcus pneumoniae
* Haemophilus influenzae
* Streptococcus pyogenes
* Moraxella catarrhalis
## Footnote
Viruses like Respiratory Syncytial Virus (RSV) are also common in this age group.
95
What is a significant consideration regarding antimicrobial resistance in pediatric pneumonia treatment?
Judicious use of antibiotics is essential due to the global emergence of antimicrobial resistance.
## Footnote
Empiric antibiotics should be guided by rational antibiotic use principles.
96
What is the recommended treatment for bacteremic staphylococcal pneumonia?
14-28 days of treatment, depending on complications and response
## Footnote
Uncomplicated presumed staphylococcal pneumonia may be managed with a 10-day course.
97
What is the evidence level for the recommendation of using macrolide antibiotics for suspected atypical pneumonia?
High
## Footnote
This includes Azithromycin and Clarithromycin as treatment options.
98
What is the significance of high-dose amoxicillin in treating suspected penicillin-resistant S. pneumoniae?
It is effective as higher drug concentrations can overcome resistance
## Footnote
This contrasts with the common presumption that oral cephalosporins are superior.
99
What is the main focus of the South African Thoracic Society guidelines?
Management of community-acquired pneumonia in children
## Footnote
The guidelines were published in the South African Medical Journal in 2020.
100
What type of guidelines were published in the National Antibiotic Guidelines 2018?
Antibiotic use guidelines for healthcare
## Footnote
These guidelines are aimed at improving antibiotic prescribing practices.
101
Who are the authors of the study on community-acquired pneumonia management?
Reubenson, G., Avenant, T., Moore, D. P., Itzikowitz, G., Andronikou, S., Cohen, C., Green, R. J., Jeena, P., Masekela, R., Nicol, M. P., Pillay, A., Madhi, S. A., Zar, H. J., & Argent, A.
## Footnote
The study was published in the South African Medical Journal.
102
What edition of The Harriet Lane Handbook was published in 2021?
22nd Edition
## Footnote
This handbook is a key resource for pediatric care.
103
What type of data does the Antimicrobial Resistance Surveillance Pattern 2020 Annual Report provide?
Surveillance data on antimicrobial resistance patterns
## Footnote
This report is crucial for understanding resistance trends in pathogens.
104
Fill in the blank: The South African Thoracic Society guidelines were published in the __________.
South African Medical Journal
## Footnote
The specific issue is 110(8), pages 734–740.
105
True or False: The National Antibiotic Guidelines were published in 2019.
False
## Footnote
They were published in 2018.
106
What is the purpose of the National Antibiotic Guidelines?
To establish standards for antibiotic prescribing
## Footnote
These guidelines help combat antibiotic resistance.
