Pneumonia

Question 1

Community acquired pneumonia is (CAP)?

Answer 1

defined as pneumonia occurring before hospitalization or within 48 hrs of hospital admission.

Question 2

What is the most common cause of CAP ?

Answer 2

streptococcus pneumoniae.

Neither the enviromental resevoir of streptococcus pneumoniae nor its method of acquisition is known.

Question 3

Common pathogen in CAP with association of COPD ?

Answer 3

H. influenzae.

Question 4

Common pathogen in CAP with association of Recent viral infection?

Answer 4

S. aureus.

Question 5

Common pathogen in CAP with association of Alcoholism or diabetes ?

Answer 5

K. pneumoniae.

Question 6

Common pathogen in CAP with association of poor dentition or aspiration ?

Answer 6

Anaerobes.

Question 7

Common pathogen in CAP with association of Young, healthy patients ?

Answer 7

Mycoplasma pneumoniae.

Question 8

Common pathogen in CAP with association of Hoarseness ?

Answer 8

Chlamydophila pneumoniae.

Question 9

Common pathogen in CAP with association of Contaminated water sources, air conditioning, ventilation systems ?

Answer 9

Legionella

Question 10

Common pathogen in CAP with association of Birds ?

Answer 10

Chlamydia psittaci

Question 11

Common pathogen in CAP with association of animals at the time of giving birth, veterinarians, farmers ?

Answer 11

Coxiella bumetii

Question 12

Presentation of pneumonia ?

Answer 12

• Fever & cough.
• Severe infection is associated with Dyspnea.
• Dullness to percussion is found if there is an effusion.
• Severe infections are distinguished by abnormalities of vital signs (tachycardia, hypotension, tachypnea) or mental status.
• Chills or “rigors” are a sign of bacteremia.

Question 13

What are the main ways to distinguish pneumonia from bronchitis ?

Answer 13

• Dyspnea.
• High fever.
• Abnormal chest x-ray.

Question 14

Which organism is associated with this presentation, Hemoptysis from necrotizing diseases “currant jelly” sputum?

Answer 14

Klebsiella pneumonia.

Question 15

Which organism is associated with this presentation, Foul-smelling sputum “rotten eggs” ?

Answer 15

Anaerobes.

Question 16

Which organism is associated with this presentation. Dry cough, rarely severe and bullous myringitis?

Answer 16

Mycoplasma pneumoniae.

Question 17

Which organism is associated with this presentation. GI symptoms (abd pain, diarrhea) or CNS symtoms such as headache and cunfusion?

Answer 17

Legionella

Question 18

Which organism is associated with this presentation, AIDS with <200 CD4 cells ?

Answer 18

Pneumocystis

Question 19

Infections often with a “dry” or nonproductiove cough ?

Answer 19

• Mycoplasma.
• Viruses.
• Coxiella.
• Pneumocystis.
• Chlamydia.

Coz these preferentially involve the interstitial space and more often leave the air spaces of the alveoli empty. thats why there is less sputum production.

Question 20

Diagnosis of pneumonia ?

Answer 20

• Best initial test is chest X-ray. (can’t determine a specific etiology)
• Sputum gram stain and Sputum culture are the best ways to determine a specific microbial etiology.
• Many organisms won’t be visible on GS or not culturable “atypical pneumonia” like mycoplasma, chlamydophila, legionella, coxiella and viruses.
• Leukocytosis is often present, but is a nonspecific marker of infection.

Question 21

Chest x-ray: bilateral interstitial infiltrates are seen with ?

Answer 21

• Mycoplasma.
• Viruses.
• Coxiella.
• Pneumocystis.
• Chlamydia.

same organisms as dry cough.

Question 22

Tests done in severe disease with unclear etiology, or those not responding to treatment ?

Answer 22

• Thoracentesis: Analysis of a pleural effusion.
• Empyema: look for LDH (lactate dehydrogenase) above 60% of serum level and protein above 50% of serum level.
• Bronchoscopy.

Question 23

what is the initial approach in treatment of pneumonia?

Answer 23

• Determining the severity of the disease in order to determine the location in which to place the patient.
• Its the severity of the disease, not the aetiology that drives initial therapy.

Question 24

What score do we have to assess mortality ofCAP to help determine inpatient vs outpatient treatment ?

Answer 24

CRUB65

• Confusion.
• BUN >19 mg/dl (>7 mmol/L).
• Respiratory rate >30.
• BP (systolic <90) or (diastolic <60)
• Age >65.
• 0-1 = outpatient.
• 2-5 = inpatient.

Question 25

Outpatient treatment in CAP ?

Answer 25

• Healthy, mo antibiotics in past 3 months and mild symptoms:
  MACRLIDE (azithromycin or clarithrimycin) or DOXYCYCLINE.
• Comorbidities or antibiotics in the past 3 months: Respiratory FLUOROQUINOLONE (levofloxacin or moxifloxacin).

Question 26

Inpatient treatment in CAP ?

Answer 26

• Respiratory FLUOROQUINOLONE (levofloxacin or moxifloxacin).
  or
• CEFTRIAXONE & AZITHROMYCIN.

Question 27

Hospital acquired pneumonia is ?

Answer 27

Defined as a pneumonia developing more than 48 hrs after admission or after hospitalisation in the last 90 days.
- These patients have a higher incidence of gram-negative bacilli such as E.coli or pseudomonas .

Question 28

Treatment of HAP ?

Answer 28

• Antipseudomonal Cephalosporins: cefepime or ceftazidime.
  or
• Antipseudomonal penicillin: piperacillin/tazobactam.
  or
• Carbapenems: imipenem, meropenem or doripenem.

Question 29

treatment of ventilator-assocaited pneumonia?

Answer 29

Combine 3 different drugs:
1. Antipseudomonal beta-lactam: (cephalopsporins, penicillins,carbapenem).
PLUS
2. second antipseudomonal agent: (aminoglycosides, fluoroquinolone)
PLUS
3. Methicillin-resistant antistaphylococcal agent: (Vancomycin or linezolid)