Pneumonia

Question 1

Pneumonia defination

Answer 1

Acute infection of pulmonary parenchyma

Question 2

Pneumonia defination

Answer 2

Acute infection of pulmonary parenchyma

Question 3

CAP

Answer 3

Not hospitalized or hospitalized less than 48 hrs

Question 4

HAP

Answer 4

Pneumonia after 48 hrs of hospitalization

Question 5

VAP

Answer 5

arises 48 hrs after endotracheal intubation

Question 6

Contagious

Answer 6

Aspiration of bacteria
Inhalation of aerosolized droplets
Hematogenous spread
Direct enocultaion

Question 7

Complication

Answer 7

Septicemia
Bacteria
Lung abscesses
Emyempa effusion

Question 8

Symptoms

Answer 8

High fever
Chills
Cough with sputum or phlegm
SOB
pleuritic chest pain
Nausea vomiting
Low blood pressure

Question 9

Outpatient CAP pathogens
S. Pneumonia
M.catarrhalis
M.pneumonia
S.aureus
H.influenzae
Respiratory viruses including influenza and COVID

Answer 9

Non ICU patient
Possibility of gram negative bacilli in addition to above

Question 10

Inpatient ICU

Answer 10

S. Pneumonia
S aureus including MRSA
H.influenzae
Legionella spp
Enterobacteriales

Question 11

VAP AND HAP

Answer 11

S.aureus MRSA
P.aeroginosa

Question 12

Lab findings or diagnostics

Answer 12

X ray gold standards
CT
MRI
Culture and sensitivity for severe cases

Question 13

PSI and Curb-65 to determine hospitilizations - mortality and morbidity

Answer 13

Admit patients PSI more than 71

CURB 65
Confusion,
Uremias,
RR> 30 breaths per min
BP <90/60
Age> 65 or more

Question 14

COPD

Answer 14

Increases risk of infection from H.influenzae possible Pseudomonas

Question 15

Goals

Answer 15

Eradicate pathogen
Signs and symptoms
Prevent complications
Minimize side effects
Narrow a/bs for shortest duration possible

Question 16

General considerations

Answer 16

Use of empirical therapy
Local resistance patterns
Once pathogen has been identified change to targeted therapy
Symptoms usually improve after 3 to 5 days
Treat infection for 5 to 7 days ( at least patient should have no fever for 72 hrs considered clinically stable
Multi drug resistance if DRIP score more than or equals to 4

Question 17

Major risk

Answer 17

Abs within 60 days
LTC residents
NG:Og feeds
Hx Of MDR pneumonia in last year

Question 18

Major risk

Answer 18

Abs within 60 days
LTC residents
NG:Og feeds
Hx Of MDR pneumonia in last year

Question 19

Minor risk

Answer 19

Hospitalizations within 60 days
Pulmonary disease
Poor functional status
H2RA PPI in last 14 days

Question 20

Empiric Therapy for CAP OUTPATIENT NO MODIFYING FACTORS

Answer 20

Amoxicillin
Doxycycline
Macrolide azith or Clarith

Question 21

CAP outpatient with modified factors means
Immunologic
Respiratory
Circulatory
Rheumatologic
Hepatic or renal
Endocrinology

Answer 21

Beta lactams
Amoxi clav or sec gen cephalosporin
+
Macrolide or doxycycline
Or
Respiratory floroquinolones

Question 22

Inpatient Non-ICU

Answer 22

Respiratory FQS
Beta lactam IV or PO
ceftriaxone ceforaxime ir Amoxi clav + Macrolide

For children
IV ampicillin or po amoxicillin

Question 23

ICU

Answer 23

Third gen cephalos IV and azithromycin IV or FQ IV

Question 24

Inpatient ICUs pseudomonas suspected

Answer 24

Anti pseudomonas’s pip-tazo, cefipime, meropenem, ceftazidime + Cipro or levofloxacin

Anti pseu beta lactams +!aminos+ azithro

Question 25

CAP

Answer 25

S pneumonia pen/ amoxi/ cefotaxime or ceftriaxone
H inf amoxi:clav
M catarrhalis 2nd or 3rd generation
Mycoplasma Macrolide doxycycline FQS
Legionella azith fqs and doxys
MSSA cloxacillinIV /cefazolin / cephalexin
MRSA vancomycin or linezolid