Pneumonia

Question 1

Typical organisms of pneumonia

Answer 1

S. Pneumoniae
H. Influenzae
Gram neg bacilli (k. Pneumoniae, p. Aeruginosa)

Question 2

Atypical organisms of pneumonia

Answer 2

Mycoplasma pneumonia
Chlamydia pneumonia
Legionella species
Respiratory viruses: adenovirus, RSV

Question 3

Significant implications on Atypical Pneumonia causative agents

Answer 3

Cannot be seen on Gram stain/standard media culture

RESISTANT TO BETA LACTAM AGENTS!!!!!

***susceptible to MACROLIDES, FLUOROQUINOLONES, TETRACYCLINE

Question 4

At what age is a person susceptible to CAP in general?

Answer 4

70 years old and above

Dec cough and gag reflexes, reduced antibody & toll-like receptor responses

Question 5

Classic triad of pneumonia?

This triad presents with

Answer 5

Fever, Cough, Dyspnea

Shortness of breath, tachypnea, tachycardia, hypoxemia with at least 1 chest abnormal finding: 
Diminished breath sounds
Rhonchi
Crackles
Wheeze

Question 6

Gross hemoptysis is suggestive of_____?

Answer 6

CA-MRSA

Question 7

T/F CAP can present with Pleuritic chest pain

Answer 7

T. If the pleura is involved

Pleuritic chest pain is chest pain that worsens with inspirationr

Question 8

Request for what Xray views of the chest while the patient ________

Answer 8

Request for PA and lateral views of the chest in full inspiration

Question 9

What can be seen on Chest Xray on CAP?

Answer 9

Diffuse, interstitial infiltrate

Lobar consolidation

Suggestive of severe disease and poor prognosis:

Question 10

When is microbiologic studies recommended?

Answer 10

Moderate/High risk CAP because additional pathogens like enteric gram negs, P. Aeruginosa, S. Auerus, L. Pneumophila may be causing worsening of sypmtoms

*2 sites of blood culture
*Sputum gram stain and culture
(Bronchoscopic aspirate, bronchoalveolar lavage fluid or brush catheter specimen)

Question 11

Rationale why request:
ABG
CBC
BUN
Crea
Liver function test
Electrolytes
Urinalysis

Answer 11

ABG - to identify and monitor acid-base disturbances of patients in respiratory distress/failure ; O2 supplementation

BUN - help in classification of the patient according to CURB 65

Creatinine - determine GFR and evaluate need for renal dose adjustment especially mag administer antibiotics

AST, ALT - help in deciding drug dosing; decrease clearance of drugs among those with liver failure

ELECTROLYTES - establish baseline results; detect presence of electrolyte imbalances for immediate correction brought about by the infection

URINALYSIS - help assess dehydration status of the patient