Pneumonia And ARDS - Dr. Miller

Question 1

Pneumonia SX

Answer 1

Rales on lower lung field, dullness to percussion, increased tactile fremitus
Fever, low O2 sat, higher RR, higher BP
= HIGH WBC , HIGH PLT
= HIGH BUN and CR (low BF to renal, dehydration….)

Question 2

Pneumonia TX ACUTE

Answer 2

ABs

Question 3

Pleural effusion CXR

Answer 3

You don’t see diaphragm borders

Question 4

Pneumonia CXR

Answer 4

Consolidations white in lung usually lower , you still see diaphragmatic borders

Question 5

Most common community acquired pneumonia

Answer 5

1. Streptococcus pneumonia

2l Haemophilus influenza

Question 6

Most common pneumonia in children

Answer 6

Mycoplasma pneumonia

Question 7

Pseudomonas aeruginosa pneumonia is from what

Answer 7

Hospital acquired, ventilation acquired

DM

Question 8

Risk for pneumonia severity in community acquired is done what what

Answer 8

CURB-65 score

Question 9

Hospitalized pt for pneumonia TX

Answer 9

IV Piperacillin/tazobactum + ciprofloxacin = ANTI-pseudomonas
Azithromycin (macrolides) + Ceftriaxone (B-Lactam) = COMMUNTIY ACQUIRED
Quinolone + Moxifloxacin + Levofloxacin (ORAL for outpatient management)

Question 10

Children pneumonia tx

Answer 10

Amoxicillin (B-lactam)

Question 11

Easiest and cheapest drug for pneumonia

Answer 11

Azithromycin

Question 12

Pleural effusion can happen from

Answer 12

Pneumonia = exudattive

Question 13

Pleural effusion fluid is assessed for

Answer 13

1. Protein
2. LDH
   and compare with serum

Protein f : Protein s > 0.5
LDH f : LDH s > 0.6
LDH > 0.67 x upper limit serum LDH

Question 14

Light’s criteria

Answer 14

Exudate or transudate effusion

Protein f : Protein s > 0.5
LDH f : LDH s > 0.6
LDH > 0.67 x upper limit serum LDH
= EXUDATE

Question 15

Pt has had pneumonia and then follows up and CXR looks the same after SX are over

Answer 15

Normal, follow up 6 weeks to repeat CXR

Question 16

Pneumonia pt cleared sx then comes back after 2 weeks with new onset SOB, fever, cough
TX and what is it

Answer 16

Hospitalization causing pneumonia
Pseudomonas aeruginosa
MRSA (STAPH AURES)
= Cefepime (pseudomonas) + Vancomycin (S. AURES)

Question 17

Community acquired pneumonia tx

Answer 17

1. B-lactam

2. Macrolide OR respiratory fluoroquinolone (oral, if not severe)

Question 18

Pleural Effusion DX And sx

Answer 18

Pleuriric pain , SOB, Cough, asymptomatic

CXR

Question 19

COVID SX and labs

Answer 19

Tachy, 76% O2 sat, high RR, 
= wheezing, 
= loss of taste , SOB, fever, cough
= high WBC, Plt, BUN, Cr
= HIGH D-dimer, CRP

Question 20

COVID CXR

Answer 20

Ground glass appearance: hazy all over like ARDS