Pneumonia

Question 0

Agent- new born

Answer 0

E. coli, Group B streptococcus

Question 1

Health Care Associated Pneumonia

Answer 1

• Hospitalization for >48hrs
• Hospitalization for >2 days in prior 3 months
• Chronic dialysis
• Home infusion therapy
• Home wound care
• Contact with a family member with MDR infection

Question 2

Agents- 1-3 months

Answer 2

S. neumoniae

Question 3

Agents- Infants-Preschool

Answer 3

Viruses- RSV, Parainflu, Flu

Question 4

Agents- School age- adolescents

Answer 4

M. pneumoniae, S. pneumoniae

Question 5

Agents- adults

Answer 5

S. pneumoniae, M. pneumoniae

Question 6

Agents- Elderly

Answer 6

S. pneumoniae, H. influenzae

Question 7

Sx- pneumo

Answer 7

Tachypnea
Increased tactile fremitus
Dull percussion note
Bronchial breath sounds
Crackles
Pleural rub

Question 8

CXR

Answer 8

• can never rule out the dx
• DO NOT DELAY tx based on negative cxr
• start appropriate tx based on sx/signs

Question 9

Hospital admission- CURB65

Answer 9

Confusion
Uremia- BUN>20mg/dL
Respiratory rate >30/min
Blood pressure <90/60
65yrs

0-1: outpatient tx
2: admission to medical ward
3-5: admission to ICU

Question 10

Supportive therapy

Answer 10

manage dyspnea
Correction of electrolyte levels
Hydration
Chest physiotherapy

Question 11

Antimicrobial- outpatients

Answer 11

1: Macrolide
2: Doxycycline

Question 12

Antimicrobial- outpatient w co-morbidities + inpatients non-ICU

Answer 12

1: Fluoroquinolone
2: Beta-lactam + macrolide
3: Beta-lactam + doxycycline

Question 13

Antimicrobial- ICU

Answer 13

Beta-lactam+Macrolide
Beta-lactam+Quinolone
*in case of beta-lactam allergy: Aztreonam+Quinolone

MRSA: Linezolid or Vancomycin
Pseudo: beta-lactam+Aminoglycoside+Quinolone

Question 14

Antimicrobial- HCAP without MDR

Answer 14

Ceftriaxone/ Ciprofloxacin/ Ampicillin/ Ertapenem

Question 15

Antimicroial- HCAP with MDR

Answer 15

Beta-lactam+(something against gram positive + negative)

Question 16

Pleural effusion- fluid

Answer 16

pH1000U
Bacteria
-then the fluid should be drained

Question 17

TB- tests

Answer 17

random sample sputum staining for AFB (Ziehl-Neelsen staining)
chest radiography
*All pts with uncertain HIV status should be tested.

Question 18

Tuberculin test- cut offs

Answer 18

• HIV(+), Abnormal cxr, immunosuppressed, recent contact with TB pt: 5mm or more
• IV drug user, lives at nursing home, prisoners, impoverished, minority: 10mm or more
• young and good health: 15mm or more

Question 19

Tuberculin test- falses

Answer 19

False negative: infants, immunosuppressed with overwhelming TB
False positive: BCG, Non-tuberculus mycobacteria

Question 20

Other Dx for TB

Answer 20

ELISpot testing
BACTEC test
Luciferase reporter assay
Ribosomal RNA probes, DNA PCR, Ligase chain reation

Question 21

TB- isolation

Answer 21

Continue isolation until sputum smears return negative results for 3 consecutive times

Question 22

TB- tx: 6 months

Answer 22

First 2 months: INH, RIF, PZA, ETB

Final 4 months: INHH, RIF

Question 23

TB- tx: DOT (denver protocol)

Answer 23

2 weeks: INH, RIF, PZA, Streptomycin- All once daily
6 weeks: same- twice weekly
18 weeks: IN, RIF- twice weekly

Question 24

TB- tx: HIV(+)

Answer 24

Minimum of 9 months tx with at least 6 months culture negative

Question 25

TB- tx: Pregnant

Answer 25

9 months daily course of INH, RIF, ETB

• breastfeeding is okay
• PZA/Streptomycin is teratogenic