Respiratory Infections

Question 1

What is the treatment for viral pneumonia?

Answer 1

1. Supportive therapy

Question 2

What is first line treatment for hospital acquired pneumonia?

Answer 2

Vancomycin, tazo

Question 3

What antibiotics are to go to for atypical CAP pneumonia?

Answer 3

1. Clarithromycin
2. Doxycylin
3. Levofloxacin

Question 4

How soon should treatment be initiated for patients with hypotension and suspected pneumonia?

Answer 4

As soon as possible, but within 6 hours to prevent increases in mortality

Question 5

Legionella

Answer 5

1. acid fast bacilli (aerobic, G-) that causes atypical pneumonia
2. Reservoir of infection is water ( shower, spa…). Is not transmitted person to person
3. Typically starts with respiratory so but can have GI SX
4. 5: test with urinary antigen
5. Notifiable
6. Treatment is with Clarithromycin/doxycycline/levofloxacin

Question 6

Aspiration pneumonia

Answer 6

1. Infection of lungs by mouth flora, including anaerobes
2. Cause 80% of lung abscesses
3. May present with particularly foul sputum, or a refractory pneumonia
4. Treat with ceftriaxone and metronidazole/ Amox-clav (OFTEN DONT NEED ABX)

Question 7

Why might a pneumonia not improve?

Answer 7

1. Wrong bug: is it different than thought? Is there an additional hospital acquired or aspiration pneumonia? Is it an unusual pathogen?
2. Wrong drug/dose: is the organism resistant to drugs? Check local antibiogram. Is it going to be absorbed/ reach the site of infection ?
3. Wrong diagnosis: think about PE/ autoimmune/neoplasia
4. Complication: lung access (alcoholic?), empyema

Question 8

What is the CURB-65 score?

Answer 8

1. Confusion
2. Urea >7
3. RR> 30
4. BP ( 65
5. If score is 0-1, manage as outpatient.
6. If score is 2 or greater, mortality rate is greater, manage as inpatient

Question 9

What are the physical exam signs of consolidation?

Answer 9

1. Dull to percussion
2. Bronchial breath sounds (over Lobes)
3. Egophony
4. Whispered pectoriloquy
5. Increased tactile fremitus

Question 10

What is the differential for cavitary lung lesions ?

Answer 10

1. TB
2. Squamous cell lung cancer
3. Aspergillosis
4. Wegeners
5. sarcoid

Question 11

What are the risk factors for active tb?

Answer 11

Immunocompromised or HIV, renal failure, diabetes, less than 5

Question 12

What are the risk factors for latent TB?

Answer 12

1. From endemic country, lots of exposure, homeless, jail

Question 13

How do we treat latent TB?

Answer 13

1. ***ensure they do not have active disease, otherwise could make them resistant with drug regime for latent
2. Consider risks vs benefits- those at high risk for active disease will benefit most