pneumonia

Question 1

What is the single largest cause of death in children worldwide?

Answer 1

Pneumonia

Question 1

What is pneumonia?

Answer 1

Lower respiratory tract infection associated with fever, respiratory symptoms, and parenchymal involvement as evidenced by physical exam findings or infiltrates on CXR

Question 2

What is walking pneumonia?

Answer 2

School-aged children and young adults with clinical and radiographic evidence of PNA but with mild enough symptoms that do not interfere with normal activity

Question 3

What organism is responsible for walking pneumonia?

Answer 3

Mycoplasma pneumoniae

Question 4

What is the definition for hospital-acquired pneumonia?

Answer 4

A pneumonia that develops in a hospitalized child within 48 hours after admission

Question 5

What are common causes of bacterial pneumonia in neonates (0-3 months)?

Answer 5

Group B strep
Gram-negative bacteria

Maternal flora

Question 6

What is the most common bacterial cause of pneumonia in children >1 week old?

Answer 6

Streptococcus pneumoniae

Question 7

Pneumonia secondary to atypical organisms (e.g., Mycoplasma, Chlamydophila) is more common in what age group?

Answer 7

School-aged children (>5 years)

Question 8

What bug should be considered in cases of complicated PNA with empyema and necrosis?

Answer 8

CA-MRSA

Question 9

How does early onset pneumonia present in neonates?

Answer 9

Respiratory distress at or soon after birth (within first 3 DOL) + nonspecific sx (lethargy, apnea, tachycardia, poor perfusion)

Infection acquired from mother

Question 10

What causes late-onset pneumonia in a newborn?

Answer 10

Occurs after birth during hospitalization or after discharge
Either nosocomial acquired or due to colonization of contaminated equipment

Question 11

How does pneumococcal pneumonia typically present?

Answer 11

Lobar pneumonia
Fever, nonproductive cough, tachypnea, decreased breath sounds over affected lobe

Question 12

Wheezing in a child older than 5 years is more likely associated with what type of pneumonias?

Answer 12

Viral or atypical bacterial PNA (Mycoplasma, Chlamydia)

Question 13

Why does normal CXR NOT rule out pneumonia if there is high suspicion for it?

Answer 13

1. XR findings lag behind clinical picture
2. Dehydrated children may not have infiltrate initiallyl
3. Hard to differentiate atelectasis from PNA on one-view

Question 14

What is Lemierre syndrome?

Answer 14

Jugular vein suppurative thrombophlebitis

Caused by Fusobacterium that infects carotid sheath and spreads to lung and mediastinum

More common in adolescents and young adults

Question 15

Outpatient treatment for preschool child with CAP?

Answer 15

Amoxicillin-clavulanate (Augmentin)

Question 16

Outpatient treatment for school-aged child or teen with suspected atypical pneumonia?

Answer 16

Consider macrolide like azithromycin

Question 17

Empiric antibiotic treatment for hospitalized children with CAP?

Answer 17

Ampicillin (covers strep pneumo) OR
Ampicillin-sulbactam (Unasyn: also covers Hib, M. catarrhalis, MSSA)

Ceftriaxone (or other 3rd gen ceph like cefotaxime) if not fully immunized, high rates of pneumo penicillin resistance, or severe/complicated cases

Add macrolide if suspecting atypical PNA

Add vanc, linezolid, or clindamycin if suspecting MRSA

Question 18

Duration of antibiotics for uncomplicated pneumonia?

Answer 18

7-10 days

Question 19

Duration of antibiotics for complicated pneumonia?

Answer 19

4 weeks total OR
2 weeks after defervescence and clinical improvement

Question 20

When is necrotizing pneumonia suspected?

Answer 20

Translucent lesion is seen on CXR in a child with prolonged fever or septic appearance

Dx confirmed with CT with contrast

Most often caused by pneumococci or S. aureus

Question 21

How long does cough persist after CAP?

Answer 21

From several weeks to up to 4 months post CAP

For 3-4 months post viral PNA or pertussis

May have dyspnea on exertion for 2-3 months

Question 22

What are the most sensitive clinical signs of pneumonia?

Answer 22

Fever and tachypnea, especially after the first 3 days of illness