Respiratory Infections

Question 1

What are the 3 As of Klebsiella?

Answer 1

Klebsiella pneumonia = red jelly sputum

• Aspiration pneumonia
• Alcoholics and diabetics
• Abscess in the lungs

Question 2

What are the clinical signs on PE that suggest a consolidation?

Answer 2

Dull to percussion
Bronchial breath sounds
Egophony
Whispering pectoriloquy
Increased tactile fremitus

Question 3

T or F a negative sputum C+S rules out pneumonia.

Answer 3

F = The C+S sensitivity is ~50%. Therefore, a negative result does not rule out pneumonia.

Question 4

What are the factors in the CURB65 criteria for admission?

Answer 4

Confusion
Urea BUN >7
RR>30
BP less than 90/60
Age greater than 65

Question 5

Things that cavitate (4 bugs)…

Answer 5

S. aureus
MRSA
Aspergillus
TB

+Malignancy: squamous cell carcinoma
+GPA (Wegener’s)

Question 6

Who is at an increased risk for a S. pneumoniae lobar pneumonia?

Answer 6

Risk Factors for S. pneumoniae:

• Immunodeficiency
• Multiple myeloma patients
• Asplenic patients
• Vaccination history?
• HIV infection

Question 7

What is the best treatment for CAP inpatients?

Answer 7

Ceftriaxone and Azithromycin (or Levofloxacin)

CAP inpatients: S. pneumo>Others (including atypicals)

Question 8

CAP inpatient with septic shock should get antibiotics within how many hours?

Answer 8

Less than 6 hours! The best outcomes are with antibiotics within an hour of presentation.

Question 9

What are the values for the CURB65 criteria?

Answer 9

Confusion
Urea BUN>7
RR>30
BP less than 90/60
Age greater than 65

Question 10

What is the treatment for a CAP outpatient?

Answer 10

Clarythromycin or Doxycycline

Atypicals > S. pneumo

Question 11

What is the time period required for HAP?

Answer 11

HAP >/= 48 hours after admission

Question 12

What is the time period required for VAP?

Answer 12

Ventilator Associated Pneumonia

-Infection >48 hours after intubation

Question 13

What is the treatment for an aspiration pneumonia/abscess?

Answer 13

Amoxicillin-Clavulanate (PO)

Ceftriaxone and Metronidazole (IV)

Question 14

If the patient is not getting better, it may be a case of wrong bug. Some drug resistant ones include…

Answer 14

MRSA, Pseudomonas, TB, Viral, Fungal

Question 15

A patient presents with a productive cough with foul sputum, and pleuritic chest pain. The patient also reports weight loss and night sweats. On exam you notice poor dentition. What type of pneumonia might this be?

Answer 15

This is the clinical presentation of a patient with pneumonia who has developed an abscess.

Do you drain the abscess? NO - increased risk of bronchopleural fistula.

Question 16

How is the physical exam different for a pleural effusion compared to a consolidation?

Answer 16

Pleural effusion: dull to percussion, decreased breath sounds, no egophony, no whispering pectoriloquy, decreased tactile fremitus

Consolidation: dull to percussion, bronchial breath sounds, egophony, whispering pectoriloquy, increased tactile fremitus

Question 17

Which groups of people are at the highest risk for the development of active TB?

Answer 17

AIDS patients
HIV infection
Transplant patients
Silicosis patients
Chronic renal failure requiring hemodialysis
Carcinoma of the head and neck
Recent TB infection

Question 18

Who is at moderate risk for developing active TB?

Answer 18

Patients on TNF alpha inhibitors (rheum patients)
Diabetes mellitus patients
Patients on glucocorticoids
People who are infected with TB at a young age (0-4 years)

Question 19

What is the diagnostic tool for active TB?

Answer 19

AFB

Question 20

Who is at increased risk for miliary TB?

Answer 20

Miliary TB: progressive disseminated hematogenous TB

-Elderly patients, immunocompromised, systemic illness, adrenal insufficiency

Question 21

What is the best test for the diagnosis of a miliary TB?

Answer 21

Live biopsy

Question 22

What is the first line treatment for TB?

Answer 22

Isoniazid (INH), Rifampin, Ethambutol, Pyrazinamide (PZA)

• Stop ethambutol once found to be fully susceptible
• 6 months of treatment if can use PZA (only need the first two months)
• 9 months of treatment if can’t use PZA
• Outcome is very good with medication (90% cure rate)
• DOTs

Question 23

What is the preventive therapy for latent TB?

Answer 23

INH 300 mg po od x 9 months
INH & Rifampin x 3 months
Isoniazid/Rifapentine once weekly for 12 weeks

Question 24

In the context of a potential pneumonia what types of patients might you send for bronchoscopy?

Answer 24

Severely ill patients and immunocompromised patients

Question 25

What is the MOA and gram coverage of ceftriaxone?

Answer 25

Ceftriaxone: 3rd generation cephalosporin
MOA: cell wall inhibitor
Coverage: gram + and -

Question 26

What is the MOA and gram coverage of Azithromycin?

Answer 26

Azithromycin: macrolide
MOA: protein synthesis inhibitor
Coverage: gram + > gram -

Question 27

What is the MOA and gram coverage of Vancomycin?

Answer 27

Vancomycin
MOA: cell wall inhibitor
Coverage: gram +

Question 28

What is the MOA and gram coverage of Doxycycline?

Answer 28

Doxycycline
MOA: protein synthesis inhibitor
Coverage: gram + and gram -

Question 29

What is the MOA and gram coverage of Amoxicillin?

Answer 29

Amoxicillin
MOA: cell wall inhibitor
Coverage: gram +

Question 30

What is the MOA and coverage of Metronidazole?

Answer 30

Metronidazole
MOA: DNA synthesis inhibitor
Coverage: gram + and gram - AND anaerobes

Question 31

What is the treatment for Strep throat?

Answer 31

Group A Beta Hemolytic Streptococcus

Treat with amoxicillin.