PNA

Question 1

What is Hospital Acquired Pneumonia (HAP)?

Answer 1

PNA ≧48Hrs after hospital admission!

Question 2

Risk Factors of Pneumonia (PNA)? (name 3)

Answer 2

Age, chronic comorbidities, viral respiratory infection, impaired airway protection, smoking, EtOH, crowded living conditions, residence in low-income settings, toxins!

Question 3

Name three Typical Bacteria that cause Pneumonia (PNA)?

Answer 3

• Streptococcus pneumonias- 65%, most common, rust color sputum
• Haemophilus influenzae- 2nd most common, COPD, smoker, EtOH
• Moraxella catarrhalis- COPD
• Staphylococcus aureus- often seen after viral illness (flu)
• Group A streptococci
• Aerobic gram-negative bacteria
• Microaerophilic bacteria and anaerobes (associated with aspiration)

Question 4

Name three Atypical Bacteria that cause Pneumonia (PNA)?

Answer 4

-Legionella species- contaminated water, air
conditioner (aerosolized), hot tubs, cruise, travel, GI sx
-Mycoplasma pneumoniae- walking pneumonia,
young, college students, bullous myringitis
-Chlamydia pneumoniae
-Chlamydia psittaci- bird exposure
-Coxiella burnetii- exposure to farm animals (sheep), Q fever

Question 5

What are symptoms of Pneumonia (PNA)? (name 4)

Answer 5

• Fever/ Chills
• Cough
• Pleuritic chest Pain
• Hemoptysis
• Headache
• -Myalgias
• Nausea
• Infants/children-poorfeeding, restless
• Nightsweats

Question 6

What lung sound is most suggestive of Pneumonia (PNA)?

Answer 6

-Rales (crackles)

Question 7

What is the main cause of viral Respiratory Pneumonia (PNA) in adults?

Answer 7

-Influenza A and B viruses- main cause in adults

Question 8

What are the findings on Chest X-Ray for Pneumonia (PNA)? Describe both typical and atypical pneumonia

Answer 8

• isolated Lobar consolidation (typical)

- multilobar Interstitial infiltrates (atypical)

Question 9

Which medications are typically used for outpatient Treatment of Pneumonia (PNA)? (name 3)

Answer 9

Azithryomycin, Doxycycline, less likely Levofloxacin

Question 10

What medication is used to treat Inpatient Pneumonia (PNA)?

Answer 10

Levofloxacin

Question 11

What type of organism should be considered in aspiration pneumonia?

Answer 11

Anearobic organisms

Question 12

What is the best antibiotic Treatment for Aspiration Pneumonia?

Answer 12

Ampicillin-sulbactam (IV Unasyn), Amoxicillin-clavulanate (Oral Augmentin)

Question 13

What is the most common opportunistic infection associated with HIV/AIDS

Answer 13

Pneumocystis pneumonia (PCP)

Question 14

What tool (scoring system) is available to determine if a patient ought to be hospitalized for pneumonia? And what are the features of the scoring system?

Answer 14

CURB-65 (admit pts with score >70) (>90 ICU)
Confusion
Urea >7 (BUN >19)
RR >30
BP less than 90 systolic or less than 60 diastolic
Age 65 or older

Question 15

What is the main risk factors for MRSA pneumonia?

Answer 15

*Recent ICU admission/intubation (especially if known to have MRSA exposure)

Question 16

What are conditions that predispose patient to aspiration (4)

Answer 16

1. Altered consciousness
2. Dysphagia
3. Neurologic disorder
4. Mechanical disruption of the usual defense barrier (NGT, ETT, trach, EGD, bronch)

Question 17

What is used for prevention of PCP pneumonia in an immunocompromised patient?

Answer 17

Trimethoprim-sulfamethoxole (TMP-SMX) (Bactrim)

-SS daily or DS 3x/week