Pneumonia

Question 1

MCC of Typical Pneumonia
-Symptoms of all types of typical
-Symptoms specific to the MCC
-What is heard on exam for typical
-What does the MCC look like on gram-stain?

Answer 1

-Strep Pneumo MCC of CAP
-Fever, productive cough, dyspnea, pleuritic chest pain, SOB.
-Rigors and blood-tinged rusty sputum
-Tachycardia, bronchial breath sounds, dullness to percussion, increased tactile fremitus, egophony, crackles
-Gram positive diplococci

Question 2

The second MCC of typical pneumonia, _______, is more common in extremes of age, immunocompromised, and those with underlying pulmonary disease.

On the other hand, another common cause of CAP, _________, is common in those with chronic alcoholism. What are some symptoms of this type and what should you look for on CXR?

Answer 2

-H. Flu

-Klebsiella
-Purple-colored, currant jelly sputum
-Cavitary lesions, although nonspecific

Question 3

MCC of atypical PNA
-RF for this type
-Symptoms (including extrapulmonary symptoms)
-What is one complication you should remember with this type?
-Test of choice for this type
-Treatment

Answer 3

-Mycoplasma PNA
-Young, healthy individuals
-low fever, dry cough, pharyngitis and URI prodrome, bullous myringitis, pulmonary exam NORMAL often
-Cold autoimmune hemolytic anemia (IgM)
-PCR (cold agglutinins)
-Macrolides (Azithromycin) or Doxycycline

Question 4

Another cause of atypical PNA, Legionella, is transmitted via….

-Symptoms of this type, specifically.
-Diagnostic
-Treatment

Answer 4

-outbreaks of contaminated water sources
-GI symptoms (diarrhea, hyponatremia), neurologic symptoms (headache, confusion, AMS)
-NAAT (PCR, urine antigen)
-Macrolides or respiratory Fluoro (Levofloxacin)

Question 5

PNA Treatment
-CAP Outpatient
-CAP Inpatient

Answer 5

-Outpatient: Macrolide or Doxy
–Fluoro: used if recent ABX use

-Inpatient: Ceftriaxone + Macrolide (beta-lactam)/Doxycycline OR Levofloxacin

Question 6

PNA Treatment
-HAP (increased risk of Pseudomonas)

Answer 6

-Piper/Tazo, Ceftazidime, Cefepime + Amikacin/Gentamicin OR Azithromycin
-MRSA: Add Vanco or Linezolid
-Legionella: Add Levo or Azithromycin

Question 7

Aspiration PNA, MC in what part of the lungs?

-Symptoms specific to this type
-Treatment choices

Answer 7

-Right lower lobe (due to vertical angle of bronchus)
-Foul-smelling rotten egg sputum
-Ampicillin-Sulbactam or Amox-Clav

Question 8

Explain the parts of the CURB-65 score and when you should admit

Answer 8

-Confusion
-Uremia > 30
-RR > 30
-BP: SBP < 90, DBP < 60
-Age: > 65

Admit if 2 or more, each is 1 point

Question 9

Pneumocystis Pneumonia (PCP) is a yeast-like fungus. It is the MC opportunistic infection in HIV, especially if CD4 < _____.

-Symptoms: There is a specific triad
-What is seen on CXR
-What other lab should you look for with this type?
-Drug of choice for treatment x 21 days
-What should you add if HIV+ and hypoxic?

Answer 9

CD4 < 200

-progressive dyspnea on exertion, fever, nonproductive cough
-Diffuse bilateral interstitial infiltrates
-Increased LDH (>200)
-Bactrim x 21 days is drug of choice
-Add Prednisone if HIV + and hypoxic

Question 10

What is the dosing schedule for the PCV-13 vaccine?

Answer 10

-4 doses, from 6 weeks - 5 years old
At 2, 4, 6, 12-15 months of age

Question 11

Who should get the PCV-23 vaccine?

-What if they have never had the PCV–13 vaccine?

Answer 11

-All adults 65 or older

-If they didn’t have PCV-13, get one dose of it, then 8 weeks later get PCV-23

Question 12

Can you get the pneumonia vaccine if you are pregnant?

Answer 12

Yes***