Pneumonia

Question 1

Most likely bacteria in CAP for alcoholics

Answer 1

S. pneumoniae anaerobes

Question 2

4 most likely bacteria in CAP for COPD and/or smoking

Answer 2

• S. pneumoniae
• H. influenzae
• M. catarrhalis
• Legionella

Question 3

Most likely bacteria in CAP for SNF residents

Answer 3

S. pneumoniae

Gram negative bacilli

H. Influenza

S. aureus

anaerobes

C. pneumoniae

Question 4

Most likely bacteria in CAP for poor dentition

Answer 4

Anaerobes

Question 5

Most likely pathogen in CAP if exposed to bats or soil with bird droppings

Answer 5

Histoplasma

Question 6

Most likely pathogen in CAP if exposed to birds

Answer 6

Chlamydia psittaci

Question 7

Most likely pathogen in CAP if exposed to rabbits

Answer 7

Francisella tularensis

Question 8

Components of CURB-65 score

Answer 8

1. Confusion (new onset)
2. Urea > 7
3. Respirations > 30
4. BP < 90 systolic or 60 diastolic
5. Age 65 or greater

Question 9

CURB-65 score treatment decisions

Answer 9

• 0 to 1
  
  • < 3% 30 day mortality
  • Outpatient care
• 2
  
  • 9% risk 30 day mortality
  • Hospital ward
• 3 to 5
  
  • 15-40% risk 30 day mortality
  • Inpatient care, possible ICU

Question 10

ATS/IDSA major criteria for severe pneumonia

Answer 10

1. Requirement of mechanical ventilation
2. Septic shock

Question 11

ATS/IDSA minor criteria of severe pneumonia

Answer 11

• Must have 3 or more
  
  • respirations > 30
  • Confusion
  • Uremia (BUN > 20)
  • Leukopenia (< 4)
  • Systolic BP < 90
  • Multilobar infiltrates
  • PO2/FIO2 ratio < 250
  • Thrombocytopenia (< 100k)
  • Hypothermia (< 36 C)
  • Hypotension requiring fluid management

Question 12

3 serotypes of S. pneumoniae associated with mechanical ventilation

Answer 12

Serotype 3

Serotype 19A

Serotype 19F

Question 13

Which serotype of S. pneumoniae is associated with septic shock

Answer 13

Serotype 3

Question 14

Emperic antibiotic regimen for CAP on the hospital ward

Answer 14

beta lactam + macrolide

OR

Respiratory fluoroquinolone

Question 15

Empiric antibiotic regimen for CAP in ICU

Answer 15

Beta lactam + Macrolide

OR

Beta Lactam + fluoroquinolone

Question 16

What preventative measure has been shown to reduce mortality in VAP?

Answer 16

Selective digestive decontamination

Question 17

Can VAP be diagnosed on clinical criteria alone or should additional tests such as CRP or procalcitonin be used

Answer 17

Clinical criteria alone

Question 18

Coverage for VAP should include what 3 pathogens

Answer 18

S. aureus, pseudomonas, and gram-negative bacilli

Question 19

Criteria for 2 drug pseudomonal coverage

Answer 19

• VAP (not HAP) with any of the following
  
  • A risk factor for resistance
  • If ICU has > 10% resistant to the drug being used
  • If local susceptibility rates are not available
  • High risk of mortality

Question 20

5 Risk factors for MDR VAP

Answer 20

Prior IV antibiotic use in the last 90 days

Septic shock at the time of VAP

ARDS preceding VAP

5 or more days of hospitalization prior to VAP

Acute RRT prior to VAP

Question 21

6 Beta lactams with anti-pseudomonal activity

Answer 21

1. Zosyn
2. Cefepime
3. Ceftazidime
4. Imipenem
5. Meropenem
6. Aztreonam

Question 22

7 Non-beta lactams with antipseudomonal activity

Answer 22

1. Ciprofloxacin
2. Levofloxacin
3. Amikacin
4. Gentamycin
5. Tobramycin
6. Colistin
7. Polymyxin B

Question 23

First line choice for empiric treatment of ESBL pathogens

Answer 23

Carbapenems

Question 24

First line treatment for Acenitabacter HAP/VAP

Answer 24

Carbapenem

Ampicillin/sulbactam

Question 25

Regimen for carbapenem resistent pathogens

Answer 25

IV polymixin (either colistin or polymyxin B)

AND
Inhaled colistin

Question 26

Duration of treatment for HAP

Answer 26

7-8 days

Question 27

Treatment for pulmonary tularemia

Answer 27

Streptomycin

Question 28

Treatment for cryptococcus in transplant patients

Answer 28

Amphotericin and flucytosine until 2 weeks culture negative

then

8 weeks high dose fluconazole

then

1 year of low dose fluconazole