Pneumonia

Question 1

Pneumonia

Answer 1

Infiltrates of the lower respiratory tract as micro organisms gain access by aspiration, inhalation, or hematogenous dissemination

Question 2

Most common microorganism in  CAP

Answer 2

Strep pneumoniae

Question 3

Signs and symptoms of pneumonia

Answer 3

Fever
Shaking chills
Purulent sputum
Lung consolidation on physical exam
Malaise
Increased fremitus

Question 4

Lab and Diagnostics for pneumonia

Answer 4

Elevated WBC‘s
Infiltrates by chest x-ray
Consider a sputing gram stain and culture if indicated
Chest x-ray and consider three blood cultures
ABG if respiratory failure suspected

Question 5

CURB 65 Criteria

Answer 5

Confusion with abbreviated mental test score less than eight
BUN > 19 
RR > 30
SBP < 90 or DBP < 60
Age > 65

Low risk 0–1: consider home treatment
Moderate risk 2 : consider brief hospital admission with supervised treatment
High risk > three: hospital mission for severe pneumonia; consider anticipate unit

Question 6

outpatient CAP management

Low Risk

Answer 6

Low severity: amoxicillin 1 g TID or doxycycline 100 mg b.i.d. or macrolide if less than 25% resistance (azithromycin or clarithromycin if > 25%)

Question 7

Outpatient CAP management
Moderate to high severity
MRSA

Answer 7

Augmentin or cephalosporin
Cefpodoxime/cefuroxime + macrolide or doxycycline OR
Mono therapy with respiratory fluoroquinolone

Question 8

Outpatient CAP management

Viral < 48 hours

Answer 8

Oseltamivir or zanamivir

Question 9

Inpatient CAP management
Non severe
S.pneumoniae, H. Influenzae, M. Pneuminiae, C. Pneumoniae, legionella

Answer 9

Beta lactam + macrolide OR

Mini therapy with respiratory fluoroquinolone

Question 10

Inpatient CAP management
Severe

S.pneumoniae, S. Aureus, legionella, gram neg bacilii, H.influenzae

Answer 10

Beta lactam + IV fluoroquinolone or IV azithromycin

Question 11

Inpatient CAP management

Pseudomonas

Answer 11

Zosyn or meropenem or cefepime
Plus
AMinoglycosides/azithromycin

Question 12

Inpatient CAP management

MRSA

Answer 12

PLUS Vanco or Linezolid

Question 13

Inpatient CAP management

Viral

Answer 13

Oseltamivir
Peramivir
Zanamivir
+- ABX for secondary infection

Question 14

B-lactam

Answer 14

Ceftriaxone , cefotaxime, Ceftaroline, unasyn ( ampicillin-sulbactam)
Zosyn, cefepime, meropenem
Aztreonam

Question 15

Fluoroquinolone

Answer 15

Levofloxacin or moxifloxacin

Question 16

HAP

Answer 16

Pneumonia that occurs 48 hours or more after admission, which was not incubated at the time of admission.

Staphylococcus aureus, streptococcus pneumoniae, and H influenzae are the most common closet of organisms

Question 17

Empiric therapy for HAP

With no factors increasing likelihood of MRSA, not at high risk for mortality

Answer 17

Zosyn
Cefepime
Levofloxacin
Meropenem

Question 18

Empiric therapy for HAP

With factors increasing the likelihood of MRSA, Not at high risk for mortality

Answer 18

Zosyn
Cefepime or ceftazidime 
Levofloxacin or ciprofloxacin 
Meropenem 
aztreonam 

PLUS Vanco or Linezolid

Question 19

Empiric therapy for HAP

High risk of mortality or IV antibiotic within previous 90 days

Answer 19

TWO ( avoid 2 beta-lactam )

Zosyn
Cefepime or ceftazidime 
Levofloxacin or ciprofloxacin
Meropenem 
Amikacin or gentamycin or tobramycin
Aztreonam

PLuS Vanco or Linezolid

Question 20

VAP

Answer 20

Pneumonia that arises more than 48–72 hours after endotracheal intubation

Pseudomonas is the most causative organism

Question 21

VAP management

ABX with MRSA activity

Answer 21

Vanco or Linezolid

Question 22

VAP Management
Gram neg ABX with antipseudomonal activity
Beta-lactam based

Answer 22

Zosyn or
Cefepime, Ceftazidime or
Imipenem, meropenem or
Aztreonam

Question 23

VAP Management
Gram neg ABX with antipseudomonal activity
Non beta-lactam based

Answer 23

Levofloxacin

Ciprofloxacin

Question 24

Macrolide

Answer 24

Azithromycin

Question 25

Fluoroquinolone

Answer 25

Levofloxacin

Question 26

AMinoglycosides

Answer 26

Tobramycin

Gentamycin