URTI & Pulmonary Infections

Question 1

What are the components and interpretation of the CURB-65 score?

Answer 1

Confusion
RR > or = 30 per min
sBP < 90 or DBP < 60
Age > or = 65

Score 0-1 = Outpatient
Score > or = 2 = Likely admission

Question 2

What are the options for outpatient treatment of pneumonia in patients without comorbidities?

Answer 2

Amoxicillin 1 g TID
Doxycycline 100 mg PO BID
Azithromycin 500 mg x 1, then 250 mg (not appropriate for majority of Canada)

Question 3

What are the treatment options for outpatient management of CAP in patients with comorbidities, including alcoholism?

Answer 3

Amoxicillin-clav
Cephalosporin + macrolide OR doxy
Respiratory fluoroquinolones (moxi, levo)

Question 4

What are the guidelines for inpatient treatment of severe CAP requiring admission to the ICU, without risk factors for MRSA or Pseudomonas?

Answer 4

Beta-lactatam AND macrolide

Beta-lactam AND a resp fluoroquinolone

Question 5

What are the recommendations for empiric anaerobic coverage in suspected aspiration PNA?

Answer 5

RECOMMEND AGAINST empiric anaerobic coverage UNLESS empyema or abscess present

Question 6

What are the risk factors for Pseudomonas pneumonia?

Answer 6

1. Known colonization or previous infection.
2. Hospitalization with receipt of abx in the previous 3 months
3. Pulmonary comorbidities

gram negative bacilli in a good quality sputum sample also warrants Pseudomonas coverage

Question 7

What is the duration of antimicrobial therapy recommended for CAP?

Answer 7

5 days if afebrile x 48 hrs and clinically stable.

Question 8

What are the core pathogens in VAP/HAP?

Answer 8

S. Pneumoniae
MSSA
H. Influenzae
GNB (including Pseudomonas)

Question 9

What is the empiric coverage for VAP/HAP?

Answer 9

1. MSSA & Pseudomonas Coverage
   - Piptazo OR cefepime OR carbapenem OR levofloxacin

PLUS
2. MRSA Coverage (vanco, linezolid)

PLUS

3. 2nd GN activity with anti-pseudomonas coverage
   - ceftazidime/cefepime/piptazo/carbapenem
   - ciprofloxacin/levofloxacin
   - aminoglycoside
   - colistin

Question 10

What are the risk factors for MRSA infection (5)?

Answer 10

(1) Recent hospitalization or antibiotic use (particularly in the last 3 months)
(2) Recent influenza like illness
(3) Necrotizing or cavitary PNA
(4) Comorbid: Immunosuppression, ESRD
(5) Social: IVDU, incarceration, MSM

Question 11

When should you treat with Oseltamivir?

Answer 11

For influenza, if symptoms for less than 48 hours or the patient is hospitalized.

Question 12

What are the recommended isolation duration precautions in those who test + for COVID?

Answer 12

Minimum 10 days and until symptom improvement (24 hours symptom free).

Question 13

How long do people with a COVID contact have to self-isolate for?

Answer 13

14 days, can segregate if asymptomatic

Question 14

What are the benefits of dexamethasone in treatment of COVID-19 infection?

Answer 14

Reduction in 28 day mortality for those who require supplemental oxygen - greatest benefit in those who are on mechanical ventilation or ECMO

Question 15

What are the typical symptoms of a measles infection (5)?

Answer 15

(1) Fever
(2) Cough with Coryza
(3) Conjunctivitis
(4) Koplik Spots
(5) Centrifugal Rash

Question 16

What are the complications of measles infection (3)?

Answer 16

Pneumonia
Encephalitis
Subacute Sclerosing Panencephalitis

Question 17

What precautions does a patient with measles require?

Answer 17

Airborne Precautions