Pneumonia

Question 1

most prevalent cause throughout childhood

Answer 1

viruses

Question 2

confection rate

Answer 2

75%

Question 3

pneumonia that is acute, severe
secondary to inhalation of pathogen
rarely bacteremic

Answer 3

Staph pneumonia

Question 4

Radio fx of staph aureus pna

Answer 4

60% effusion or empyema
30% pneumatocele
mostly UNILATERAL alveolar infiltrates

consolidation
cavitation
air trapping

Question 5

Usually affects younger px vs HA MRSA

Answer 5

CA MRSA

Question 6

CA MRSA carries thus gene
an exotoxic gene
lethal to leukocytes causing necrosis, skin lesions, nec pna

Answer 6

Panton-Valentine Leucocid

Question 7

Meds for CA MRSA

Answer 7

Clinda
Co tri
tetracyclines

Question 8

pathogenesis

Answer 8

Question 9

Insidious onset

Answer 9

Hib

Question 10

Gradual
Malaise, headache, non productive, low grade OR no fever

Answer 10

Mycoplasma (Atypical)

Question 11

MORE SENSITiVE AND SPECIFIC than crackles

Answer 11

Tachypnea

Cut off points:
<2 months 60
2 to 12 months 50 cpm
1-5 yo 40cpm
>5 yo 30

Question 12

Gold standard

Answer 12

Lung puncture specimen OR
BAL

Question 13

Alternative to BAL

Answer 13

Sputum

Question 14

Blood culture is positive in

Answer 14

<10%

*hospitalized
*complicated pna

Question 15

pleural fluid

Answer 15

If accessible unless too small

Question 16

Viral pna

Answer 16

PCR (specimen: lung aspirate, blood, pleural fluid, respi secretions)

Question 17

Antigen and Serologic tests can be tested in

Answer 17

Influenza, RSV (Rapid immunoassay)

Myco, chlamydia, strep pna (serology) - GOLD STD is PAIRED acute and convalescent titers

Question 18

Lobar or alveolar pna

Answer 18

Bacterial

Question 19

Intersitial pna

Answer 19

Chlamydia / Mycoplasma (atypical)
Viral

Question 20

CXR NOT recommended in ____ yrs as OPD basis

Answer 20

> 2 months

Question 21

When to do repeat CXR

Answer 21

ROUND pna
Lobar collapse
Clinically deteriorating

Question 22

Lung UTZ (Bedside) vs CXR

Answer 22

Accuracy SIMILAR or HIGHER

Question 23

Non resolving pna with persistence OR recurrent radiologic findings

Answer 23

TB

Question 24

Viral pneumonia high likely if

Answer 24

BILATERAL interstitial OR
Atelectasis

Wheeze

GENERALIZED hyperinflation

Question 25

CAP without danger signs should be examined within ___ hrs

Answer 25

48 hrs

Question 26

indications for admission <2 months vs older children

Answer 26

RR >70. (Vs >50 in older children) O2 sat 90% to 92% (vs <92% in older children) Intermittent apnea Inability to feed Failure after oral therapy Severe malnutrition (Older children: signs of dehydration) Common: DOB Grunting

Question 27

O2 supplementation in pna should mt o2 sat

Answer 27

>92%

Question 28

1st choice

Answer 28

ORAL AMOXICILLIN 80 to 90 mg/kg/DAY in 2 doses

Question 29

For ill patients when considering HIGHLY RESISTANT PNEUMOCOCCUS

Answer 29

Vanco OR TEICOplanin

Question 30

Best for Staph aureus

Answer 30

(OM) Oxacillin/Methicillin

Question 31

3 weeks to 3 months old *not viral in etiology

Answer 31

MACROLIDE *Chlamydia, Bordatella, U. Urealyticum (BUC)

Question 32

4 months to 5 yo *pneumococcus high likely or VIRAL

Answer 32

AMOXICILLIN Penicillin or Ampicillin Or 3rd gen ceph *some says MACROLIDES

Question 33

If Hib status n/a

Answer 33

CO AMOX CEFU Ceftri Cefu CefPODOXIME CefPROZIL cefDINIR

Question 34

MRSA strain Antibiotic

Answer 34

Vanco

Question 35

CA-MRSA pneumonia

Answer 35

CEFTRIAXONE

Question 36

Meds by age

Answer 36

Question 37

Choice of antibiotic if typical bacteria are identified

Answer 37

Question 38

Moraxella

Answer 38

1st choice: CO AMOX Alt: Cefuroxime

Question 39

Strep Penicillin susceptible or intermediate

Answer 39

AMPI PENICILLIN HIGH DOSE AMOXICILLIN Alt: Cefu, Ceftri, AZITH

Question 40

Strep Penicillin RESISTANT MIC > 4 ug/mL

Answer 40

CEPHALOSPHORINS (2nd or 3rd) VANCOMYCIN ****no alternative *CEPH REST VAN”

Question 41

Staph auresus

Answer 41

OM Oxa/Methicillin MRSA: Vanco or Teico

Question 42

Antibiotic dose

Answer 42

Question 43

In slowly resolving pneumonia, there is persistence of clnical or radio fx after ___ hrs

Answer 43

48 to 96 hours of empiric antibiotic

Question 44

Necrotizing pneumoia, most are confined to _____ lobe

Answer 44

SINGLE lobe

Question 45

Usual etiologic agen in necrotizing pneumonia

Answer 45

Pneumococcus S aureus CA-MRSA —-> PANTON VALENTIN LEUCOCIDIN Pseudomonas (less common)

Question 46

Persistent fever Persistent distress

Answer 46

Pleural effusion and Empyema Outcome: good Full recovery

Question 47

This test is recommended in pleural effusion px but positive only in 10-22%

Answer 47

BLOOD CULTURE

Question 48

Empyema radio fx

Answer 48

ConCAVE to the side of collection (protective position to avoid pain) Scoliosis

Question 49

Small effusion is ___ mm And its management

Answer 49

<10 mm thick *antibiotics to be continued 1 to 4 weeks after discharge

Question 50

Antibiotics for effusion

Answer 50

CO AMOX, CEFUROXIME Penicillin plus fluCLOXAcillin AMOXICLLIN plus fluCLOXAcillin Clindamycin when effusion follows CAP

Question 51

First choice of treatment for empyema requiring drainage

Answer 51

Fibrinolytics *shortens treatment length and hospital stay

Question 52

Lobes prone to aspiration

Answer 52

UPPER LOBE Apical lob of LOWE LOBE

Question 53

PRIMARY vs SECONDARY ABSCESS

Answer 53

PRIMARY Gram (+) strep, staph, ***s. Pyogenes Gram (-) pseudomonas, kleb ———————-(PK) Secondary: Strep, staph, pseudomonas Anaerobic, bacteria, fungi

Question 54

Sx vs pneumonia

Answer 54

Cough progress indolently

Question 55

Other pe findings:

Answer 55

Tachypnea, LOCALLY REDUCED air entry LOCALIZED inspiratory crackles

Question 56

Characteristic xray

Answer 56

Thick walled Air fluid level

Question 57

Investigation of choice in abscess

Answer 57

CT Scan

Question 58

Mainstay of tx for abscess Duration

Answer 58

IV 4-6 weeks *Ampi sul *Cephalosphorin with Clindamycin *if CA MRSA is suspected Vancomycin - if MRSA resistant to Clinda

Question 59

Decreases hospital stay in lung abscess

Answer 59

Drainage

Question 60

Viral co infection %

Answer 60

25-30%

Question 61

Associated with reduction in lung function at 1 yo

Answer 61

Pneumonia or LRTI in the 1st yr of life

Question 62

Associated with increased risk of wheezing

Answer 62

Human rhinovirus C or RSV