Anaerobic Pneumonia and Lung Abcess

Question 1

In a patient with anaerobic pneumonia, what is a large determining factor of which lung zone will be affected?

Answer 1

Answer: since the cause is aspiration, the lung zone affected depends on how the patient was positioned during the time of aspiration

Question 2

T or F: With this type of pneumonia, patients will seek care a couple days after symptoms begin

Answer 2

Answer: False (due to the nonspecific nature of the symptoms in anaerobic pneumonia, most will present late in the course of illness, once the pneumonia has progressed to necrotizing pneumonia, lung abscess, empyema)

Question 3

If you were to culture the bacteria in anaerobic pneumonia, what is the GOLD STANDARD for obtaining this specimen?
A: Sputum expectorated from patient
B: CPT facilitated by respiratory therapist
C: Bronchoscopy
D: Blood cultures x2

Answer 3

C: Bronchoscopy

Answer: C (normal flora in mouth would skew results from expectorated sputum)

Question 4

The FNP is reviewing the chest x-ray of a patient suspected to have anaerobic pneumonia. The film is noted to have a thick-walled
solitary cavity surrounded by consolidation and air-fluid level present. What do you suspect?
A: Pleural effusion
B: Hemothorax
C: Tuberculosis
D: Lung abscess

Answer 4

D: Lung abscess

Answer: D (air-fluid level is key; must exclude TB, mycosis, cancer, infarction, granulomatosis with polyangiitis)

Question 5

The FNP knows that with the presence of purulent pleural fluid accompanying either lung abscess or necrotizing pneumonia – this
would indicate what complication?
A: Pleural effusion
B: Hemothorax
C: Empyema
D: Transudate

Answer 5

C: Empyema

Answer: C (“purulent” – REFER! order ultrasound and consult for drainage)

Question 6

The FNP is determining the tx for a patient with anaerobic pneumonia. The FNP knows the 1st line for this is what?
A: Levaquin
B: Amoxicillin
C: Clindamycin
D: Ceftriaxone

Answer 6

C: Clindamycin

Answer: C (1st line: Clindamycin IV q8hr – switch to PO with improvement OR amoxicillin-clavulanate/Augmentin q12hrs)

Question 7

The patient wants to know how long treatment for anaerobic pneumonia will be continued for. Your answer is? SELECT ALL THAT
APPLY.
A: Will not self-resolve, must REFER
B: 5-7 days
C: 4-6 weeks
D: Until chest x-ray improves

Answer 7

C: 4-6 weeks
D: Until chest x-ray improves

Answer: C, D (continued until chest x-ray improves – process could take a month or more)

Question 8

An HIV+ patient presents to your clinic with 3 days of cough, low-grade fever, and dyspnea. Your differential diagnosis includes pneumonia.
What would be a REQUIRED intervention to definitively diagnose this patient with pneumonia?
A: Chest x-ray
B: Medication reconciliation
C: Obtain WBC and blood cultures
D: Sputum culture

Answer 8

D: Sputum culture

Answer: D Sputum cx (immunocompromised patients include HIV+, WBC <1000, current/recent chemo, taking MORE THAN 5mg/day of prednisone – these types of patients that contract pneumonia often have atypical causes; expectorated sputum for bacteria, fungi,
mycobacteria, Legionella, P jirovecii = important, may help preclude need for expensive diagnostic procedures)

Question 9

In an immunocompromised patient with pneumonia, what is the MOST appropriate treatment?

Answer 9

Answer: begin empiric abx (based on severity of pulmonary infection, underlying disease, risk of empiric therapy, local expertise and
experience w/ diagnostic procedures)