PULM

Question 1

MCC of CAP

Answer 1

strep pneumo

Question 2

Which type of pneumo is most common in pts with underlying pulm dz such as COPD, Bronchiectasis, CF?

Answer 2

Haemophilus Influenzae

Question 3

Which pneumo is MC found in school aged, college students, military recruits

Answer 3

mycoplasma

Question 4

What is the Cpx of pts with mycoplasma pneumo (atypical pneumo)?

Answer 4

• pharyngitis
• bullous myringitis

Question 5

What are the symptoms associated with Legionella Pneumophila?

Answer 5

GI sxs: Increased LFTs, hyponatremia

Question 6

When is staph aureus mainly seen?

Answer 6

after viral illness

Ex: flu

Question 7

With what conditions would you expect to see a pt with klebsiella pneumonia?

Answer 7

Alcoholics

debiliated

chronic illness

aspirators

Question 8

which pneumo is most associated with cavitary lesions?

Answer 8

klebsiella pneumonia

Question 9

Risk factors for pseudomonas aerignosa

Answer 9

immunocompromised (HIV, neutropenic, s/p transplant)

CF

bronchiectasis

Question 10

What is the MC viral cause of pneumo in infants/small children?

Answer 10

parainfluenza & RSV

Question 11

MC viral cause in adults of pneumo

Answer 11

influenza

Question 12

What kind of hosts would you see Pneumocystis jiroveci carinii (PCP) in?

Answer 12

compromised host w/ fatigue, dry cough, dyspnea on exertion

Question 13

This fungus/parasite is found in Mississippi & Ohio river valley and is contaminated with bird/bat droppings

Answer 13

Histoplasma capsulatum

Question 14

What is the most common hospital acquited agent that causes pneumonia?

Answer 14

Pseudomonas

Question 15

What two situations are considered as part of Community acquired pneumonia?

Answer 15

1. acquired outside of the hospital setting
2. pt that was ambulatory prior to admission who develops pneumonia within 48 hours of initial hospital admission

Question 16

What is considered Hospital acquired (nosocomial) pneumo?

Answer 16

pneumonia occurring >48hours after hospital admission

Question 17

HAP is usually caused by what two agents?

Answer 17

pseudomonas & MRSA

Question 18

What are the clinical manifestations of typical pneumonia?

Answer 18

rigors** in strep pneumo

Question 19

What will you see in physical exam of typical pneumo?

Answer 19

signs of consolidation

bronchial breath sounds

dullness on percussion

Inc. Tactile fremitus, egophony

Question 20

Dx workup for mycoplasma

Answer 20

serum cold agglutinins**

Question 21

What must you order if you suspect mycoplasma?

Answer 21

serum cold agglutinins

Question 22

Dx workup for pneumonia

Answer 22

1. CXR/CT scan
2. Sputum (gram stain/culture)

Question 23

What would you see in CXR if suspecting staph aureus?

Answer 23

abscess formation

Question 24

What would you see in CXR if Klebsiella?

Answer 24

R upper lobe with bulging fissure, cavitations

Question 25

pathogen of rusty blood tinged gram stain

Answer 25

strep pneumo

Question 26

pathogen of currant jelly on gram stain

Answer 26

klebsiella

Question 27

PE findings of pneumonia

Answer 27

dullness to percussion due to the fluid filled alveoli

increased fremitus

+ bronchial breath sounds

+ egophany