Community Acquired Pneumonia

Question 1

Define Pneumonia

Answer 1

Infection of the lower respiratory tract. Microbial invasion happens via inhaled aerosolized particles, bloodstream, aspiration of orophyaryngeal contents

Question 2

List MRPs… case specific, just memorize

Answer 2

Fever
Chills
Productive cough
Brownish rusty sputum
Initial dry hacking cough
Shortness of breath (norm is 18breathes/min)
Pain in right lower part of chest
Breathing difficulties
Poor skin turbo, dry mucus membranes and dehydration
Age above 65
Kidneys unresponsive to Glibenclamidr stimulating insulin production
Thiazides cause impaired glucose metabolism and hyperkalemia
On Enalapril and has a dry cough
She’s taking Dextromethorphan (suppressant) with Guaifensein (expectorant) with antagonistic effects

Question 3

What labs do you look at for CAP

Answer 3

FBG
RR and HR
BUN
SCr

Question 4

What Criteria determines whether the patient should be treated as in patient or out?

Answer 4

CRB-65
°Age above 65
°Confusion
°Respiratory rate 38breaths/min
°Blood pressure SBP<90 DBP<60

0- home
2- hospital referral
3- urgent admission

Question 5

Common causative pathogens for CAP

Answer 5

Strep pneumonia
Haemopgilus influenzae
Chlymydia pneumonia

Question 6

What Gram +v cocaine could cause CAP?

Answer 6

Streptococcus pneumonia

Question 7

What is the empiric therapy for Strep. pneumonia

Answer 7

High dose Amoxycillin-clavulanate 1g/125mg/kg 6months q8h
Macrolide e. g Azithromycin 500mg OD
ALTERNATIVE
Doxycycline 4. 4mg/kg

Question 8

If patient has risk factors, Amoxycillin-clavulanate is given with a macrolide.If no risk,them amoxycillin-clavulanate is given alone. What are these risk factors that will affect patient treatment?

Answer 8

DM
Alcohol
Malignancy
Spleen removed
Cardiac/Respiratory/Hepatic problem
Antibiotics in last 90 days
Hospitalized within last year
MRSA

Question 9

Patient presents with all above comorbidities and was admitted into hospital. How would you treat them?

Answer 9

SUS LEGIONELLA AND STREP PNEUMONIA
High dose Amoxycillin-clavulanate 1g/125mg q8h
ALTERNATIVE
IV Ceftriaxone inpatient
IM Ceftriaxone outpatient

Question 10

Compare NASA treatment with MRSA

Answer 10

MSSA give Cloxacillin
MRSA GIVE Vancomycin or Linezolide

Question 11

Compare Vancomycin and Linezolide

Answer 11

Equal efficacy
Van is IV Line is PO
Van may worsen renal impairment
Van more appropriate if clinical because IV

Question 12

Optimal cafe for patient

Answer 12

O2
Empaglifloxin 10mg PO q24H for diabetes (weight loss,reduce fluid retention,reduce CV events,reduce BP)
Empiric= Ceftriaxone IV and Azithromycin OD

Question 13

Compare Ceftriaxone and cefotaxime

Answer 13

Cefotaxime
q8h is undesirable vs q12
No effect on normal flora vs candida and clostridium proliferation
35% protein binding vs 95% causing immune heamolytic anaemia

Question 14

Compare Doxycycline and Macrolide

Answer 14

Doxycycline causes normal flora proliferation
Better against atypical
Azithromycin causes GI disturbance

Question 15

Imipenem vs meropenem

Answer 15

Imipenem good against G+
Meropenem good against G-
Meropenem high risk of seizure

Question 16

HAP OPTIMAL CARE

Answer 16

RA- short Course Prednisone 10mg/kg 3months
follow with methotrexate SMART 7. 5mg q24

Question 17

pseudomonas coverage in HAP

Answer 17

Piperacillin tazobactm and Vancomycin

Question 18

BM TREATMENT

Answer 18

dexamethasone and Vancomycin and cefotaxime
colloid IV FLUID e. g albumin

Question 19

BM PROPHYLAX

Answer 19

Ceftriaxone/rifampicin