Pneumonia

Question 1

Abnormal inflammatory condition of the lung

Answer 1

Pneumonia

Question 2

Most common cause of pneumonia

Answer 2

Bacterial

Question 3

3rd leading cause of both morbidity and mortality in the philippines

Answer 3

Pneumonia

Question 4

Least common entry of infection (pneumonia)

Answer 4

heamtogeneous spread

• S. aureus from endocarditis
• CXR : disseminated lesions

Question 5

Spread of infection from a site near the lungs via physical infiltration

Answer 5

Contiguous

Question 6

Common mode of entry of infection (pneumonia)

Answer 6

Inhalation

Question 7

cut off size for large particle

Answer 7

> 10 um

Question 8

cut off size for small particle

Answer 8

<10 um

Question 9

Most common mechanism of entry of infection (pneumonia)

Answer 9

Aspiration

Question 10

Acute infection of the pulmonary parenchyma
Accompanied by the presence of acute infiltrate on a chest radiograph, or auscultatory findings.

not hospitalized pt or residing in long term care facility for 14 days before onset of symptoms

Answer 10

CAP

Question 11

Occurs 48 hours after admission to a hospital and not incubating at the time of admission

Answer 11

Hospital acquired oneumonia

Question 12

Arises more than 48-72 hours after endotracheal tube intubation

Answer 12

Ventilator- acquired Pneumonia

Question 13

Occurs within 90 days after receiving any form of health care

Answer 13

health care associated pneumonia

Question 14

Acute vs Chronic pneumonia

Answer 14

Acute <2 weeks

Chronic > 2 weeks

Question 15

Typical Pneumonia

Answer 15

Sudden onset of fever
Cough with purulent sputum
dyspnea
pleuritic chest pain
Consolidation of PE
Usually caused my bacteria

Question 16

Atypical Pneumonia

Answer 16

Gradual onset of fever
Dry cough
Dyspnea
Extrapulmonary symptoms
Minimal signs on PE
Atypical microorganisms

Question 17

Clinical Presentation of Pneumonia

Answer 17

COugh
Fever
chills
Chest pain
Difficulty on Breathng
malaise

Question 18

Herkerlings Score (threshold 2)

Answer 18

Temp 37.8
Pulse >100 bpm
Rales
Decreased RBS
(-) asthma

Question 19

Gennis Rule (threshold 1)

Answer 19

Tepm >37.8

RR>20

Question 20

Elements of Corrext X ray

Answer 20

Rotation
penetration
Inspiration/Epxiration

Question 21

Pathognomonic radiograph sign of pneumonia

Answer 21

Air bronchogram sign

Question 22

Air inside bronchi becomes more visible due to consolidation of suurounding lung

Answer 22

Air bronchogram sign

Question 23

Suggests that ung is filled woth fluid which forms a convexity.

Answer 23

Meniscus sign

Question 24

Presence of fluid

Answer 24

Decreased frenitus, dullness in percussion

Question 25

What modality is used to rule out malignancy (Ddx Hilar mass lesion)

Answer 25

CT Scan

Question 26

May also be metastatic lung CA, fungal pneumonia can present as mulitple nodules

Answer 26

Multiple Masses

Question 27

Seen in TB, atelectasis, Clearly defined margin showing that the right lung is being pulled down

Answer 27

RUL collapse

Question 28

Abscess or TB cavity or may also be malignancy. Pneumonia can look initially as the usual infiltrates and then necrotize and form a cavity

Answer 28

Cavitating lesion

Question 29

Light infiltrates, Miliary TB, fine diffused generalized lesions across most lung areas, disseminated

Answer 29

Millet seed

Question 30

3 most common bacterial causes of typical pneumonia

Answer 30

Streptococcus pneumoniae, hemophilus influenzae, and Moraxella catarrhalis

Question 31

______is needed to guide management (Management of Pneumonia)

Answer 31

Risk Stratification

Question 32

Management of Pneumonia

Answer 32

CAP low risk : Outpatient care CAP moderate risk : Admit to ward CAP high risk: ICU admission, may require vasopressors and mechanical ventilation

Question 33

Criteria for severe Community Acquired Pneumonia (CAP)

Answer 33

1. Major - Invasive mechanical ventilation - Septic shock with the need for vasopressors 2. Minor - Respiratory rate >30 breaths/min - PaO2/Fi2 ratio <250 - Multilobar infiltrates - Confusion/disorientation - Uremia (BUN level >20mg/L) - Leukopenia - Thrombocytopenia - hypothermia - hypotension

Question 34

Penicillin and/or drug resistant S. pneumoniae

Answer 34

* >65 yrs old * Beta lactam therapy within the previous 3 months * Alcoholism * Immune-suppresice illness * multiple medical commorbidities * Exposure to child in day care

Question 35

Enteric gram (-)

Answer 35

``` Moderate to severe types Residence in a nursing home Underlying cardiopulmonary disease Multiple medical commorbidities Recent antibiotic Use ```

Question 36

Pseudomonas aerugionasa

Answer 36

``` Structural lung disease Corticosteroid Therapy (>10 mg) Broad spectrum antibiotic therapy (>7days) Malnutrition Associated with increased mortality ```

Question 37

Pulmonary TB

Answer 37

COugh more than 2 weeks

Question 38

Pneumonia in patient post chemotherapy or immunocompromised

Answer 38

Broaden empiric coverage for possible etiologies

Question 39

Pneumonia in HIV patients

Answer 39

PCP | Fungal etiologies

Question 40

Low Risk COP

Answer 40

``` RR <30 DBP >60 SBP >90 PR <135 T <40 ```

Question 41

Moderate Risk COP

Answer 41

``` RR >30 Pulse >125 T <35 or >40 Chest X ray with bilateral or multilobar involvement Pleural effusion Abscess Suspected aspiration ```

Question 42

High Risk COP

Answer 42

CXR as in moderate risk CAP plus Unstable (Impending or frank respiratory, hemodyanamic alterations, altered mental state, DBP <60, SBP<90, urine Output <30

Question 43

Empiric therapy for Low risk CAP

Answer 43

Amoxicillin or extended macrolide (Clarithromycin or Azithromycin) With satble comorbid illness: Beta lactam/ BLIC

Question 44

Empiric therapy for Moderate Risk CAP

Answer 44

IV non pseudomonal Beta lactam , BLIC (+) Extended macrolide or Respiratory fluoroquinolone

Question 45

Empiric therapy for high risk CAP

Answer 45

Depends on whether Pseudomonas is present or not. BLIC, cephalosporin + IV macolide or IV quinolone Risk of pseudomonas IV pseduomonal coverage PLUS IV extended MAcrolide (+/-) aminoglycoside or IV Ciprofloxaxin