Pneumonia

Question 1

Outpatient pneumonia involving MDR pathogens

Answer 1

HCAP

Question 2

Pathogen with exclusive risk from home infusion therapy and home wound care

Answer 2

MRSA

Question 3

Possible pathogens for antibiotic use the preceding 3 months

Answer 3

Pseudomonas

MDR Enterobacteriaceae

Question 4

MC mode of entry of microbial pathogen

Answer 4

Aspiration from oropharynx

Question 5

Triggers the clinical syndrome of pneumonia

Answer 5

Host inflammatory response

NOT the proliferation if microorganisms

Question 6

Caused by inflammatory mediators released by macrophages and newly recruited neutrophils

Answer 6

Capillary leak

Question 7

4 stages of pneumonia

Answer 7

Edema/Congestion
Red Hepatization
Gray Hepatization
Resolution

Question 8

Stage with presence of proteinaceous exudates and bacteria in alveoli

Answer 8

Edema/Congestion

Question 9

Presence of erythrocytes in the cellular intraalveolar exudate with occasional bacteria recognized on collected pathologic specimens

Answer 9

Red hepatization

Question 10

No new erythrocytes are extravasating; predominant cells are neutrophils; abundant fibrin deposits with disappearance of bacteria; corresponds to the successful containmentof infection and improvement in gas exchange

Answer 10

Gray hepatization

Question 11

Macrophages predominate

Answer 11

Resolution

Question 12

Pattern MC in nosocomial pneumonia

Answer 12

Bronchopneumonia

Question 13

Pattern MC in CAP

Answer 13

Lobar pneumonia

Question 14

Pattern MC in VAP

Answer 14

Respiratory bronchiolitis

Question 15

May present as alveolar process in radiography

Answer 15

Viral

Pneumocystis pneumonias

Question 16

Complications of anaerobic pneumonia

Answer 16

Abscess formation
Empyemas
Parapneumonic effusions

Question 17

Complicates Influenza infection

Answer 17

S.aureus pneumonia

Question 18

Serious consequence of MRSA

Answer 18

Necrotizing pneumonia

Question 19

Adequate sputum specimen fo CS

Answer 19

> 25 neutrophils/hpf

<10 squamous epthelial cells/lpf

Question 20

Most frequently isolated pathogen in blood culture

Answer 20

S.pneumoniae

Question 21

Urine antigen test is highly specific and sensitive

Answer 21

Legionella pneumophila

Pneumococcal

Question 22

Standard of diagnosis of respiratory viral infection

Answer 22

PCR of nasopharyngeal swabs

Question 23

PCR determination of the pathogen is associated with inc risk of septic shock, need for mech vent and death

Answer 23

Pneumococcal pneumonia

Question 24

Useful biomarker to identify worsening disease or treatment failure

Answer 24

CRP

Question 25

Useful biomarker to determine the need for antimicrobial therapy

Answer 25

Procalcitonin

Question 26

Variables in CURB-65

Answer 26

``` Confusion Urea >7 mmol/L RR >/= 30 BP = 90 systolic; = 60 diastolic Age >/= 65 ```

Question 27

Obvious indication for ICU care

Answer 27

Septic shock | Respiratory Failure at ER

Question 28

Primary organisms with resistance issues

Answer 28

S.pneumoniae | CA-MRSA

Question 29

Most important risk factor for antibiotic-resistant pneumococcal infection

Answer 29

Use of a specific antibiotic within the previous 3 months

Question 30

Mechanism of resistance to penicillins

Answer 30

Presence of low-affinity penicillin-binding proteins

Question 31

MIC penicillin susceptible

Answer 31

= 2 mcg/ml

Question 32

MDR strains

Answer 32

Isolates resistant to >/= 3 drugs of antimicrobial classes with different mechanisms of action

Question 33

Resistant to cephalosporins

Answer 33

Enterobacter spp. Tx: Fluoroquinolones or Carbapenems (used in ESBL-producing bacteria)

Question 34

Main risk factors for P.Aeruginosa

Answer 34

Structural lung disease (bronchiectasis) | Recent treatment with antibiotics or glucocorticoids

Question 35

Longer duration of treatment of pneumonia

Answer 35

``` Bacteremia Metastatic infection Pseudomonas MRSA Ineffective initial treatment Severe CAP ```

Question 36

Causes polymicrobial lung abscess from pneumonia

Answer 36

Typical with aspiration pneumonia, mixed aerobes/anaerobes

Question 37

Increased risk of MDR in HCAP

Answer 37

Recent hospitalization in 90 days

Question 38

Highest hazard ratio in developing VAP

Answer 38

First 5 days

Question 39

Three factors critical in the pathogenesis of VAP

Answer 39

Colonization if oropharynx with pathogenic microorganisms Aspiration of organisms from the oropharynx into the lower respiratory tract Compromise of normal host defense mechanisms

Question 40

Most obvious risk factor which bypass the normal mechanical factors that prevent aspiration

Answer 40

Endotracheal tube

Question 41

Major risk factor for infection with MRSA and ESBL-positive strains

Answer 41

use of B-lactam drugs (cephalosporins)

Question 42

Meds added for patients with active influenza or with history of influenza within 2 weeks of CAP

Answer 42

Vanco or Linezolid

Question 43

Increases the bioavailability of oral ampicillin

Answer 43

Sulbactam

Question 44

Indication for repeat CXR in CAP

Answer 44

Failure to improve after 72 hours of treatment

Question 45

De-escalation of antibiotics

Answer 45

``` (-) fever >24 hours Normal RR and less cough No bacteremia Etiologic agent not high risk No unstable comorbids No organ dysfunction Competent GIT ```

Question 46

Duration of treatment for MRSA-CAP

Answer 46

non-bacteremic: 7-21 days (Pseudomonas: 14-21 days) bacteremic: up to 28 days

Question 47

Duration of treatment of MSSA-CAP

Answer 47

non bacteremic: 7-14 days | bacteremic: up to 21 days

Question 48

Duration of treatment for Mycoplasma and Chlamydophila

Answer 48

10-14 days

Question 49

Duration of treatment for Legionella pneumonia

Answer 49

14-21 days

Question 50

During 24 hours prior to discharge

Answer 50

``` Temp 36-37.5 Pulse <100/min RR 16-24/min SBP >90 mmHg O2 sat >90 % Functioning GIT ```