Pneumonia

Question 1

MC bacteria in CAP

Answer 1

S. pneumonia

Question 2

If a patient abuses alcohol and comes in for pneumonia what is a common etiological factor?

Answer 2

Klebsiella pneumonia

Question 3

Aspiration patients: etiology

Answer 3

Pseudomonas aeroginosa

Question 4

CF pt: etiology

Answer 4

Pseudomonas aeroginosa

Question 5

Young adults: etiology

Answer 5

mycoplasma/chlamydia

Question 6

Atypical CAP etiology

Answer 6

Mycoplasma pneumonia

Question 7

HIV related pneumonia etiology

Answer 7

Pneumocystis Pneumonia (PCP)

Question 8

TB etiology

Answer 8

Mycobacterium tuberculosis

Question 9

How would you treat CAP as an outpatient w/ no comorbities?

Answer 9

Macrolides (Clarithromycin or Azithromycin) or Doxycline for 5-10 days

Question 10

How would you treat CAP as an outpatient w/ comorbidies or abx tx within the past 3 months

Answer 10

Respiratory fluroquinolone (levofloxacin, moxifloxacin, gemifloxacin)
-or- augmentin plus macrolide

(5-10 days)

Question 11

How would you treat CAP as an inpatient (non-ICU)

Answer 11

Respiratory fluoroquinolone
-or-
Beta lactam (ceftriaxone or cefotraxime) w/ macrolide

(these are all IV)

Question 12

Do you need to culture for outpatients?

Answer 12

No, broad spectrum abx usually cover it.

Question 13

Treatment of anaerobic PNA & lung abscess

Answer 13

Clindamycin or augmentin

If lung abscess/empyema: above abx plus drainage

Question 14

What do you see on CXR’s if a patient has HIV related pneumonia?

Answer 14

Ground glass infiltrates

Question 15

If HIV pneumonia is caused by PCP then what is the treatment?

Answer 15

trimethoprim/sulfamethoxazole (bacitrin), steroids if hypoxic

Tx for 21 days and then prophylaxis tx is continued

Question 16

What are typical findings on CXR in a patient with TB?

Answer 16

Ghon and Ranke complexes

Question 17

What are the 4 major 1st line drugs used to treat TB?

Answer 17

1. Isoniazid
2. Rifampin
3. Pyrazinamide
4. Ethambutol

Question 18

How would you go about treating a patient w/ TB? (HIV -)

Answer 18

6-9 month regimen

• ->2months: all 4 drugs
• ->4months: isoniazid & rifampin

Question 19

How would you go about treating a patient w/ TB who is HIV + ?

Answer 19

They need to see a specialist

Question 20

Physical Exam findings of CAP?

Answer 20

Fever
Tachypnea
Tactile fremitus + egophony
Dullness to percussion
Crackles/rales

Question 21

What is included in the Point of Care Diagnostic Testing (POC)

Answer 21

Sputum gram stain

Urinary antigen tests (for Legionella species and S. pneumonia)

Rapid antigen testing for influenza

Question 22

If you choose to get a blood culture for a PNA case then what procedures must be followed?

Answer 22

At least 2 sets from 2 separate needle sticks at 2 different sites

Question 23

How would you treat a patient w/ CAP as an ICU inpatient?

Answer 23

Macrolide or resp. fluroquinolone PLUS an antipseudomonal B-lactam

Question 24

Risk factors for HCAP

Answer 24

1. Abx therapy in past 90 days
2. Acute hospitalization for at least 2 days in preceeding 90 days
3. Resides in nursing home
4. Home infusion therapy w/in past 30 days
5. Home wound care
6. Family member w/ an infx involving MDR pathogen
7. Immunosuppressed