Pneumonia

Question 1

MC cause pneumonia

Answer 1

streptococcus pneumoniae

Question 2

Typical sx pneumonia

Answer 2

fever
productive cough
pleuritic chest pain
dyspnea
rigors (severe chills with violent shaking)

Question 3

atypical sx pneumonia

Answer 3

low grade fever
dry nonproductive cough
extra pulmonary sx (myalgias, malaise, pharyngitis, N/V/D)

Question 4

PE pneumonia - typical

Answer 4

tachypnea
tachycardia
signs of consolidation - bronchial breath sounds, dullness to percussion, increased tactile fremitus, ego phony, inspiratory rales (crackles)

Question 5

PE atypical pneumonia

Answer 5

pulmonary exam often normal
may have crackles (rales)

Question 6

MC cause of community acquired pneumonia

Answer 6

streptococcus pneumonia

Question 7

gram stain streptococcus pneumonia

Answer 7

gram positive diplococci

Question 8

what color is sputum for streptococcus pneumonia

Answer 8

blood-tinged (rusty) sputum

Question 9

klebsiella pneumonia sputum

Answer 9

current jelly - thick, mucoid and blood-tinged

Question 10

gram stain for haemophilus influenza

Answer 10

gram negative rod

Question 11

gram stain klebsiella pneumoniae

Answer 11

gram negative rod

Question 12

staphylococcus aureus and pneumonia is associated w

Answer 12

a superimposed infection after a viral infection
hospital acquired pneumonia (MRSA)

Question 13

gram stain staphylococcus aureus

Answer 13

gram positive cocci in clusters

Question 14

most common cause of atypical (walking) pneumonia

Answer 14

mycoplasma pneumonia

Question 15

community acquired pneumonia

Answer 15

outside hospital setting
< 48 hours in hospital setting

Question 16

hospital acquired pneumonia

Answer 16

> 48 hours in hospital setting

Question 17

Admission for pneumonia

Answer 17

CURB65 - admission if at least 2
Confusion
Uremia (> 30 mg/dL)
Respiratory rate >/= 30
BP low SBP < 90 or DBP < 60
Age > 65

Question 18

pneumococcal vaccines for >/= 65

Answer 18

PCV15
PCV20

Question 19

if PCV15 is given, what should you do ONE YEAR LATER

Answer 19

PPSV23

Question 20

what pneumococcal vaccine is used in childhood

Answer 20

PCV13

Question 21

tx community acquired pneumonia in otherwise healthy

Answer 21

Amoxicillin or Macrolide (Azithromycin) or Doxycycline

Question 22

Tx community acquired pneumonia in pts w comorbidities

Answer 22

Amoxicillin clavulanate or a cephalosporin plus a macrolide

or mono therapy fluoroquinolone (Levofloxacin, Moxifloxacin, Gemifloxacin)

Question 23

community acquired tx inpatient nonsevere

Answer 23

Beta lactam plus a macrolide
or fluoroquinolone

Question 24

cause of tuberculosis

Answer 24

Mycobacterium tuberculosis (acid-fast bacteria)

Question 25

major pathology of tuberculosis

Answer 25

granulomatous inflammation with caseation (central necrosis) - caseating granulomas

Question 26

patients with what type of TB are not infectious

Answer 26

latent

Question 27

sx tuberculosis

Answer 27

prolonged fever (often w diurnal pattern) cough (often mild and nonproductive and then becomes productive and foul-smelling) pleuritic chest pain dyspnea hemoptysis fever chills night sweats can affect any organ

Question 28

PE for tuberculosis

Answer 28

often normal - may have clubbing

Question 29

if chest image is suggestive of TB, what should you do

Answer 29

3 sputum samples collected and sent for acid fast bacilli staining and culture one sample tested with nucleic acid amplification (NAAT)

Question 30

how is latent TB diagnosed

Answer 30

tuberculin skin test

Question 31

cxr for TB

Answer 31

hilar adenopathy MC pleural effusions pulmonary infiltrates

Question 32

tx latent TB

Answer 32

9 month therapy of isoniazid and pyridoxine or 4 mos Rifampin if intolerant to Isoniazid

Question 33

if positive tuberculin skin test, what is done to confirm

Answer 33

interferon gamma release assay

Question 34

what do you do if tuberculin skin test positive and interferon gamma release assay are both positive

Answer 34

screen for active TB (CXR and sputum tests)

Question 35

tx active TB

Answer 35

RIPE Rifampin Isoniazid Pyridoxine Ethambutol