Pneumonia Protocols

Question 1

Types of Pneumonia

Answer 1

Community-Acquired
Hospital-Acquired
Ventilator Associated
Healthcare Associated

Question 2

Typical CAP

Answer 2

Streptococcus pneumoniae

Question 3

Atypical CAP

Answer 3

Legionella
Chlaymdophila
Mycoplasma
Viral

Question 4

Chills, cough, sputum, SOB, hemoptysis, Pleuritic CP

Fever, tachycardia, tachypnea, lung exam, cyanosis

Answer 4

Symptoms and Signs of Pneumonia

Question 5

CXR: lobar consolidation

Answer 5

bacterial cause

Question 6

CXR: bilateral diffuse incolvement

Answer 6

viral pneumonia, pneumocystis or Legionella

Question 7

CXR: interstitial patter

Answer 7

mycoplasma

Question 8

CXR: multiple nodules
CXR: cavitation

Answer 8

staph

Question 9

Sputum: Rust colored

Answer 9

pneumococcal pneumonia

Question 10

Sputum: dark red/current jelly

Answer 10

Klebsiella

Question 11

Sputum: Scant, watery

Answer 11

mycoplasma

Question 12

Gram Stain

Answer 12

> = 25 WBC (neutrophils)
<= 25 epithelial cells
a lot of epithelial cells= spit

Question 13

Sputum: foul smelling

Answer 13

anaerobic infections look for ugly teeth

Question 14

Subacute presentation
Nonproductive cough, sore throat, bullous myringitis, fever, malaise, HA
pts<40 y.o.

Answer 14

Mycoplasma
CXR looks siver than lung exam
Gram stain/sputum culture reveals bupkis
Chlamydia too

Question 15

Atypical

Answer 15

does not have a lot of sputum

Question 16

Legionnaires

Answer 16

High fever, diarrhea, rapid progression
Hyponatremia, hypophosphatemia
Multilobar
Increased LE
from a water source, air conditioning unit, water tray
renal-hematuria
neuroconfused.

Question 17

Treatment of CAP- general medical ward

Answer 17

B-lactam and macrolides
or
High dose amoxicillin or high dose amoxicillin/clavulanate+macrolides
if you are concerned about b-lactamas producing strain use a macrolide

Question 18

Admit ICU? (major criteria)

Answer 18

Major Criteria: need mech vent and septic shock

Question 19

CAP in Eldery

Answer 19

change in mental status
gradual onset
they don’t have the immune response to mount fever/chills
higher risk of mortality

Question 20

Treatment of CAP- severe/ICU

Answer 20

b-lactam+IV azithromycin or IV fluroquinolone

pseudomonas concern? add antipseudomonal agent and antipseudomonal fluroquinolone

MRSA concern? add Vancomycin or linezoline

Question 21

Admit to ICU? (minor criteria)

Answer 21

Systolic blood pressure < 90 mmHg
Multilobar disease
PaO2/FiO2 ratio 30/minute

Question 22

Nosicomial Pneumonia

Answer 22

B-lactam or Antipseudomonal agent or aztreonam
and
Antipseudomonal fluroguinolone or tobramiycin
and
vancomycn

Question 23

RF for Multidrug-Resistance

Answer 23

Antibiotic therapy in past 3 months
Hospitalized >=5 days
Increased frequency of ATB resistance in the community
RF for healthcare associated pneumonia 
Immunosuppressive disease or therapy