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Question 1

Historically, the lung has been considered sterile. However, culture-independent techniques discovered that

Answer 1

complex and diverse communities of microbes that reside within the alveoli

Question 2

Macrolide resistance rates vary regionally but are generally

Answer 2

> 25 percent

Question 3

Estimates of doxycycline resistance

Answer 3

In the United States, rates tend to be less than 20 percent

Question 4

Beta-lactam resistance rates also vary regionally but to a lesser extent than macrolide and doxycycline resistance. In the United States

Answer 4

<20 percent of isolates are resistant to penicillin and

<1 percent to cephalosporins

Question 5

Fluoroquinolone resistance tends to be

Answer 5

2

Question 6

predictive of MRSA infection.

Answer 6

Gram-positive cocci on sputum Gram stain

Question 7

factors that should raise suspicion for MRSA infection

Answer 7

receipt of intravenous antibiotics within the past three months

Question 8

Risk factors for MRSA

Answer 8

Kidney disease 
Crowded living 
Injection drug use
Homosexual relationship
Contact sports

Question 9

●Pseudomonas is also an uncommon cause of CAP and tends to occur more frequently in patients with

Answer 9

known colonization or prior infection with Pseudomonas spp recent hospitalization or antibiotic use, underlying structural lung disease (eg, cystic fibrosis or advanced chronic obstructive pulmonary disease [bronchiectasis]), and immunosuppression.

Question 10

In some cases, CAP might also arise from uncontrolled replication of microbes that normally reside in the alveoli. The alveolar microbiome is similar to

Answer 10

oral flora and is primarily comprised of anaerobic bacteria (eg, Prevotella and Veillonella) and microaerophilic streptococci

Question 11

Hypothetically, exogenous insults such as a viral infection or smoke exposure might alter the composition of the alveolar microbiome and trigger

Answer 11

overgrowth of certain microbes.

Question 12

●Pulmonary signs and symptoms

Answer 12

Cough, dyspnea, and pleuritic chest pain, tachypnea, increased work of breathing, and adventitious breath sounds including rales/crackles and rhonchi. Tactile fremitus, egophony, and dullness to percussion

Question 13

Hypoxemia can result from

Answer 13

the subsequent impairment of alveolar gas exchange

Question 14

●Systemic signs and symptoms

Answer 14

fever, chills, fatigue, malaise, chest pain (which may be pleuritic), and anorexia

Question 15

Inflammatory markers specific to bacterial infections?

Answer 15

procalcitonin

Question 16

leading cause of sepsis

Answer 16

CAP

Question 17

initial presentation may be characterized (of sepsis)

Answer 17

hypotension, altered mental status, and other signs of organ dysfunction such as renal dysfunction, liver dysfunction, and/or thrombocytopenia

Question 18

hypoxia

Answer 18

oxygen saturation <95 percent