Pneumonia

Question 1

initial phase of pneumonia

presence of a proteinaceous exudate and often of bacteria in the alveoli

Answer 1

edema,

Question 2

initial phase of pneumonia

presence of bacteria—in the alveoli

Answer 2

edema,

Question 3

presence of erythrocytes in the cellular intraalveolar exudate; neutrophil influx

Answer 3

red hepatization

Question 4

no new erythrocytes are extravasating, and those already present have been lysed and degraded

Answer 4

gray hepatization

Question 5

the macrophage reappears as the dominant cell type in the alveolar space, and the debris of neutrophils, bacteria, and fibrin has been cleared, as has the inflammatory response

Answer 5

resolution,

Question 6

the macrophage reappears as the dominant cell type in the alveolar space, and the debris of neutrophils, bacteria, and fibrin has been cleared, as has the inflammatory response

Answer 6

resolution

Question 7

pattern is most common in nosocomial pneumonias

Answer 7

bronchopneumonia

Question 8

more common in bacterial CAP

Answer 8

lobar pattern

Question 9

pattern is most common in nosocomial pneumonias

Answer 9

bronchopneumonia

Question 10

pattern more common in bacterial CAP

Answer 10

lobar pattern

Question 11

Exposure to birds

Answer 11

Chlamydia psittaci

Question 12

Exposure to rabbits

Answer 12

Francisella tularensis

Question 13

Exposure to sheep, goats, parturient cats

Answer 13

Coxiella burnetii

Question 14

Local influenza activity

Answer 14

Influenza virus, S. pneumoniae, S. aureus

Question 15

Stay in hotel or on cruise ship in previous 2 weeks

Answer 15

Legionella spp.

Question 16

Travel to Southeast Asia

Answer 16

Burkholderia pseudomallei, avian influenza virus

Question 17

Travel to southwestern United States

Answer 17

Hantavirus, Coccidioides spp.

Question 18

Travel to Ohio or St. Lawrence river valley

Answer 18

Histoplasma capsulatum

Question 19

Lung abscess

Answer 19

CA-MRSA, oral anaerobes, M. tuberculosis, endemic fungi, atypical mycobacteria

Question 20

Lung abscess

Answer 20

CA-MRSA, oral anaerobes, M. tuberculosis, endemic fungi, atypical mycobacteria

Question 21

To be adequate for culture, a sputum sample must__

Answer 21

> 25 neutrophils and

Question 22

yield of positive cultures from sputum samples is

Answer 22

50%.

Question 23

sensitivity and specificity of the findings on physical examination

Answer 23

58% and 67%, respectively

Question 24

curb

Answer 24

confusion (C); 
urea >7 mmol/L (U); 
respiratory rate 30/min (R); 
BP  (90/60 mmHg) (B); 
age 65 years (65)

Question 25

curb scoring

Answer 25

0: 30-day mortality rate is 1.5%, can be treated outside the hospital.
2: the 30-day mortality rate is 9.2%: admitted to the hospital

Question 26

most important risk factor for antibiotic-resistant pneumococcal infection

Answer 26

se of a specific antibiotic within the previous 3 months

Question 27

Bacteria are occasionally seen in pathologic specimens collected during this phase

Answer 27

red hepatization

Question 28

necrotizing pneumonia

Answer 28

MRSA

Question 29

necrotizing pneumonia

Answer 29

MRSA

Question 30

antibiotics active against atypicals

Answer 30

macrolide
fluoroquinolone
tetracycline

Question 31

possible cause

Structural lung disease (e.g., bronchiectasis)

Answer 31

P. aeruginosa, Burkholderia cepacia, Staphylococcus aureus

Question 32

possible cause

Dementia, stroke, decreased level of consciousness

Answer 32

Oral anaerobes, gram-negative enteric bacteria

Question 33

possible cause

Lung abscess

Answer 33

CA-MRSA, oral anaerobes, endemic fungi, M. tuberculosis, atypical mycobacteria

Question 34

possible cause

Lung abscess

Answer 34

CA-MRSA, oral anaerobes, endemic fungi, M. tuberculosis, atypical mycobacteria

Question 35

RF for CAP

Answer 35

alcoholism, 
asthma, 
immunosuppression
institutionalization, 
age of 70 years versus 60-69 years

Question 36

Risk factors for pneumococcal pneumonia include

Answer 36

dementia, seizure disorders, heart failure, cerebrovascular disease,
alcoholism, tobacco smoking, COPD, and
HIV infection.
“losing head and heart over vices”

Question 37

particular problem in patients with severe structural lung disease, such as bronchiectasis, cystic fibrosis, or severe COPD.

Answer 37

P. aeruginosa

Question 38

RF: diabetes, hematologicmalignancy, cancer, severe renal disease, HIV infection, smoking, male gender, and a recent hotel stay or ship cruise.

Answer 38

Legionella

Question 39

nfect patients who have recently been hospitalized and/or received antibiotic therapy or who have comorbidities such as alcoholism, heart failure, or renal failure

Answer 39

Enterobacteriaceae

Question 40

% of cultures of blood from patients hospitalized with CAP are positive

Answer 40

5-14%

Question 41

The sensitivity and specificity of the Legionella urine antigen test

Answer 41

90% and 99%

Question 42

The pneumococcal urine antigen test sensitivity and specificity

Answer 42

80% and >90%

Question 43

When to drain pleural fluid

Answer 43

pH 1000 U/L

(+) bacteria

Question 44

CXR pneumonia resolution

Answer 44

4-12 weeks

Question 45

Empirical RX HCAP:

Patients without Risk Factors for MDR Pathogens

Answer 45

Ceftriaxone
Ampisul
Moxifloxacin/ciprofloxacin / levofloxacin/
Ertapenem

Question 46

Empirical RX HCAP:

Patients WITH Risk Factors for MDR Pathogens

Answer 46

B Lactam (Ceftazidime/Piptaz/Imipenem/Meropenem)
Gram neg (Genta/Tobra/Cipro)
Gram positive (Linezolid/Vancomycin)

Question 47

standard recommendation for patients with risk factors for MDR infection

Answer 47

three antibiotics: two directed at P. aeruginosa and one at MRSA

Question 48

VAP caused by MRSA is associated with ___ clinical failure rate when treated with standard-dose vancomycin

Answer 48

40%

Question 49

preferred agent in patients with renal insufficiency and in those infected with high-MIC isolates of MRSA

Answer 49

Linezolid