Pneumonia and CAP

Question 1

Determine the condition that results in lung tissue filling up with fluid or pus, inflammatory cells, and fibrin.

Asthma

Infection and inflammation of one or both lungs

Emphysema

Chronic bronchitis

Answer 1

Infection and inflammation of one or both lungs

Question 2

Recommend treatment for community-acquired pneumonia that does not require hospitalization.

Cephalosporin + azithromycin

Amoxicillin + erythromycin

Clarithromycin + quinolone

Amoxicillin + clarithromycin

Answer 2

Cephalosporin + azithromycin

Question 3

While studying the vocal resonance in a patient’s physical assessment report, a provider observes that the egophony, bronchophony, and whispered pectoriloquy are bringing out crackle in the patient. Predict the condition that the provider can infer from the readings.

The patient is suffering from tuberculosis (TB).

The patient is suffering from COPD.

The patient is suffering from infection and inflammation of one or both lungs.

The patient is suffering from lung abscess.

Answer 3

The patient is suffering from infection and inflammation of one or both lungs.

Question 4

Propose a statement that describes community-acquired pneumonia (CAP) in the elderly.

The high incidence of CAP in the elderly population has been related to a series of physiological changes associated with the immune system (both innate and adaptive) impairment.

Everyone has the same risk of losing his or her self-care abilities.

The study of the lung function is relevant in patients who bear a high comorbidity burden, having found an important association between chronic kidney disease and the development of respiratory clinical events.

All types of patients generally have a similar degree of comorbidity.

Answer 4

The high incidence of CAP in the elderly population has been related to a series of physiological changes associated with the immune system (both innate and adaptive) impairment.

Question 5

Empyema can develop after a patient has pneumonia. Many different types of bacteria may cause pneumonia. Select the most common pathogen that can cause this complication.

E. coli

Pneumococci

Aerobic gram-negative

Streptococcus pneumoniae

Answer 5

Streptococcus pneumoniae

Question 6

Determine an age-related change in the respiratory system that is responsible for an increased susceptibility to pneumonia in older clients.

Arrhythmias

Calcified costal cartilage

Diminished gag reflex

Renal impairment

Answer 6

Diminished gag reflex

Question 7

Determine the component of the blood that surrounds and consumes foreign material in phagocytosis.

Mature monocytes

Blood plasma

Blood platelets

Mastocytes

Answer 7

Mature monocytes

Question 8

Determine the most common symptom of pneumonia due to Haemophilus Influenzae.

Fever

Hemoptysis

Pleuritic pain

Dyspnea

Answer 8

Fever

Question 9

A provider is teaching a student about C-reactive proteins. Determine the statement made by the student that indicates effective teaching and learning.

“They identify the presence of foreign material in the immune system.”

“They identify the presence of tubercles.”

“They start the inflammatory response.”

“They stimulate gastric mucous production.”

Answer 9

“They identify the presence of foreign material in the immune system.”

Question 10

Propose an accurate statement regarding the clinical characteristics of pneumonia presented by a frail elderly compared to an adult with the same diagnosis.

Both types of patients generally have a similar degree of comorbidity.

They have the same risk of losing their self-care abilities.

Age modifies empirical antibiotic therapy of community-acquired pneumonia.

An important and consistent clinical difference between younger and older patients is the broader range of bacterial respiratory pathogens found in the elderly.

Answer 10

An important and consistent clinical difference between younger and older patients is the broader range of bacterial respiratory pathogens found in the elderly.

Question 11

A 72-year-old man is a nonsmoker or drinker and is diabetic controlled with metformin. He goes to the emergency department after presenting 2 days of evolution of cough, purulent expectoration, and fever of 101.3°F. On physical examination, the patient is conscious and oriented in time and space and has a TA of 100/70 mm Hg, a heart rate of 110 bpm, and a respiratory rate of 30 rpm. Pulmonary auscultation shows the presence of thick crepitant rales and a tubal murmur in the right anterosuperior field. The blood count shows the existence of 18,000 leukocytes per mm3 with deviation to the left. Emergency biochemical determinations, including renal function and ions, are normal, except for a blood glucose level of 180 mg / dL. Select the best treatment for the case.

IV cephalosporin and IV macrolide-type antibiotic

Oral clarithromycin, 1 gram every 24 hours

Amoxicillin/oral clavulanic acid, 875/125 mg every 8 hours

Acetaminophen, 1 gram orally every 8 hours, and surveillance at home

Answer 11

IV cephalosporin and IV macrolide-type antibiotic

Question 12

A 65-year-old woman smokes 20 cigarettes per day. She goes to the emergency department after 10 days of mucopurulent cough, pain in the right hemithorax, asthenia, and night sweats. There is pulmonary auscultation with decreased vesicular murmur at the level of the upper third of the right lung with abundant rhonchi in both fields. The following are recorded: analytical Hb 10 g/dL, platelets 629,000/uL, and leukocytes 16,000/uL with 83% neutrophils. A chest RX is performed. Predict the best management plan.

Empirical antibiotic therapy with coverage for anaerobes

Percutaneous drainage

Bronchoscopy with bronchoalveolar lavage

CT-guided aspiratory transthoracic puncture

Answer 12

Empirical antibiotic therapy with coverage for anaerobes

Question 13

You are providing instruction to a group of nursing students about pneumonia. Propose a statement that shows proper learning about pneumonia by the students.

The pseudomonas microorganism is responsible for pneumonia that is spread through water.

Hospital-acquired pneumonia (HAP) is a lung infection that is contracted immediately when a client is admitted to the hospital.

The alveoli attempt to open and close against the purulent exudate. Sounds heard over the alveoli opening against the exudative fluid are crackles.

The most common pathogenic etiologies include influenza A, influenza B, parainfluenza virus, and respiratory syncytial virus.

Answer 13

The alveoli attempt to open and close against the purulent exudate. Sounds heard over the alveoli opening against the exudative fluid are crackles.

Question 14

Predict the respiratory condition which clinical manifestations of inspiratory crackles, increased tactile fremitus, egophony, and whispered pectoriloquy are indicative of.

Emphysema

Thromboembolism

Infection and inflammation of one or both lungs

Asthma

Answer 14

Infection and inflammation of one or both lungs

Question 15

Predict the bacterium that is not responsible for pneumonia in a patient with human immunodeficiency virus (HIV) infection.

Mycoplasma avium complex

Mycobacterium tuberculosis

Non-TB mycobacteria

Mucormycosis species

Answer 15

Mucormycosis species

Question 16

To prevent pneumonia in the elderly, infants, and children with risk factors, pneumococcal vaccine is recommended. Determine the most accurate fact about the pneumonia vaccine.

Use the trivalent influenza shot made with adjuvant.

The CDC recommends two safe and effective pneumococcal vaccines, and one of these is PPSV23 for all adults 65 years and older.

Vaccination has been shown to have many benefits, including the reduction of the risk of pneumonia illnesses, hospitalizations, and even the risk of pneumonia-related death in the elderly.

An annual seasonal pneumonia vaccine is the best way to help protect people against the disease.

Answer 16

The CDC recommends two safe and effective pneumococcal vaccines, and one of these is PPSV23 for all adults 65 years and older.

Question 17

Recommend treatment for community-acquired pneumonia that does not require hospitalization.

Clarithromycin + quinolone

Ceftriaxone + azithromycin

Amoxicillin + erythromycin

Amoxicillin + clarithromycin

Answer 17

Ceftriaxone + azithromycin

Question 18

Empyema can develop after a patient has pneumonia. Many different types of bacteria may cause pneumonia. Select the most common pathogen that can cause this complication.

Aerobic gram-negative

Pneumococci

Staphylococcus aureus

E. coli

Answer 18

Staphylococcus aureus

Question 19

A patient reports fever and shortness of breath. The complete blood count with differential shows a white blood cell count of 16,000 cells/mL with 90% neutrophils, 2% eosinophils, and 1% basophils. Determine the condition that the patient has developed.

Nonviral and nonfungal pneumonia

Asthma

Viral pneumonia

Fungal infection

Answer 19

Nonviral and nonfungal pneumonia

Question 20

65-year-old woman smokes 20 cigarettes per day. She goes to the emergency department after 10 days of mucopurulent cough, pain in the right hemithorax, asthenia, and night sweats. There is pulmonary auscultation with decreased vesicular murmur at the level of the upper third of the right lung with abundant rhonchi in both fields. The following are recorded: analytical Hb 10 g/dL, platelets 629,000/uL, and leukocytes 16,000/uL with 83% neutrophils. A chest RX is performed. Predict the best management plan.

Bronchoscopy with bronchoalveolar lavage

Percutaneous drainage

Medications to kill the bacteria

CT-guided aspiratory transthoracic puncture

Answer 20

Medications to kill the bacteria

Question 21

A 56-year-old woman has a history of well-controlled schizophrenia without toxic habits. She was admitted for pneumonia in the middle lobe with a small associated metaneumonic pleural effusion and in treatment with levofloxacin 500 mg/24h. It presents good clinical evolution except for the persistence of fever and leukocytosis on the 6th day of treatment. No microbiological studies are available. Recommend the most appropriate management plan.

Associate corticosteroids at doses of 0.5 mg/kg/day to antibiotic treatment.

Confirm empyema through puncture and extraction of pleural fluid. If confirmed, it will require treatment with antibiotics and drainage tube.

It is considered a therapeutic failure, and you should modify the antibiotic treatment.

Perform bronchoscopy with biopsy, aspiration, and bronchoalveolar lavage.

Answer 21

Confirm empyema through puncture and extraction of pleural fluid. If confirmed, it will require treatment with antibiotics and drainage tube.

Question 22

A 72-year-old man is a nonsmoker or drinker and is diabetic controlled with metformin. He goes to the emergency department after presenting 2 days of evolution of cough, purulent expectoration, and fever of 101.3°F. On physical examination, the patient is conscious and oriented in time and space and has a TA of 100/70 mm Hg, a heart rate of 110 bpm, and a respiratory rate of 30 rpm. Pulmonary auscultation shows the presence of thick crepitant rales and a tubal murmur in the right anterosuperior field. The blood count shows the existence of 18,000 leukocytes per mm3 with deviation to the left. Emergency biochemical determinations, including renal function and ions, are normal, except for a blood glucose level of 180 mg / dL. Select the best treatment for the case.

Intravenous ceftazidime, 1 gram every 8 hours, associated with intravenous tobramycin, 6 mg/kg every 24 hours

Oral clarithromycin, 1 gram every 24 hours

Ceftriaxone IV associated with intravenous azithromycin, 500 mg/24 hours

Acetaminophen, 1 gram orally every 8 hours, and surveillance at home

Answer 22

Ceftriaxone IV associated with intravenous azithromycin, 500 mg/24 hours

Question 23

A 72-year-old man is a nonsmoker or drinker and is diabetic controlled with metformin. He goes to the emergency department after presenting 2 days of evolution of cough, purulent expectoration, and fever of 101.3°F. On physical examination, the patient is conscious and oriented in time and space and has a TA of 100/70 mm Hg, a heart rate of 110 bpm, and a respiratory rate of 30 rpm. Pulmonary auscultation shows the presence of thick crepitant rales and a tubal murmur in the right anterosuperior field. The blood count shows the existence of 18,000 leukocytes per mm3 with deviation to the left. Emergency biochemical determinations, including renal function and ions, are normal, except for a blood glucose level of 180 mg/dL. Select the best discussion for the case.

The persistence of fever in the context of pneumonia and pleural effusion requires to rule out empyema as an agent causal for which it is recommended to perform thoracentesis.

Escalated modification of antibiotic treatment constitutes the correct treatment of community-acquired pneumonia.

The normal course of pneumonia treated with antibiotics implies the disappearance of fever. Methane pneumonic effusion can stay several days until its full resolution.

Because of his age (72 years) and being diabetic, hospital admission would be indicated.

Answer 23

Because of his age (72 years) and being diabetic, hospital admission would be indicated.

Question 24

Propose an accurate statement regarding the clinical characteristics of pneumonia presented by a frail elderly compared to an adult with the same diagnosis.

A third of elderly patients with pneumonia do not require or benefit from hospitalization.

Age modifies empirical antibiotic therapy of community-acquired pneumonia.

The frail elderly requires a greater degree of rest or stay in bed to avoid complications.

Both types of patients generally have a similar degree of comorbidity.

Answer 24

A third of elderly patients with pneumonia do not require or benefit from hospitalization.

Question 25

A provider is teaching a student about C-reactive proteins. Determine the statement made by the student that indicates effective teaching and learning.

“They stimulate gastric mucous production.”

“They prevent WBC adhesion to endothelium.”

“They identify the presence of tubercles.”

“They start the inflammatory response.”

Answer 25

“They prevent WBC adhesion to endothelium.”