Community Acquired PNA Flashcards
A patient presents to your clinic with temp 39C, tachypnea, and unilateral crackles on the left side. What is HIGH on your differential diagnosis?
Answer: bacterial pneumonia (assess for AOM, sinusitis, epiglottitis, meningitis)
What is the MOST common bacterial cause of CAP in children?
Answer: S. pneumoniae (bacterial usually follows viral lower respiratory tract infection)
What type of patient is at HIGHEST risk for bacterial CAP?
Answer: immunocompromised, malnourished, aspiration
T of F: CXR cannot distinguish viral from bacterial, but you will some differences in presentation
Answer: True
In a pediatric patient with bacterial CAP, what radiological findings do you expect to see?
Answer: lobar infiltrates (consolidation) (SEE PICTURE ABOVE)
In a pediatric patient with viral CAP, what radiological findings do you expect to see?
Answer: Perihilar streaking, increased interstitial markings, hyperinflation (SEE PICTURE ABOVE)
T or F: Bacterial CAP will present with normal or slightly elevated WBC
Answer: False, this is seen in viral CAP (Bacterial CAP has WBC elevated with left shift, a low WBC (<5000) can be on ominous finding in bacterial pneumonia = overwhelming infection)
What treatment should be provided for all pediatric patients with CAP (viral and bacterial)?
Answer: supportive measures (antipyretics, increase fluids, O2 if hypoxic)
The patients who require hospitalization with CAP include which of the following? SELECT ALL THAT APPLY! A: all infants <3mo old B: hypoxemia C: effusion on CXR D: poor feeding
A: all infants <3mo old
B: hypoxemia
C: effusion on CXR
D: poor feeding
Answer: All of the above (all infants <3mo for abx (IV or PO), any child with apnea, hypoxemia, poor feeding, effusion of CXR, moderate or severe respiratory distress, or clinical deterioration on treatment)
The FNP has determined the patient can do outpatient treatment. What is the required follow-up time for this patient? A: 12-24 hours B: 1-5 days C: 4 weeks D: 6 weeks
B: 1-5 days
Answer: B (12hr-5 days)
In a pediatric patient diagnosed with bacterial CAP, what is your treatment of choice?
Answer: Amoxicillin, 5-10 days (empiric tx aimed at S. pneumoniae)
In a pediatric patient diagnosed with viral CAP, what is your treatment of choice?
Answer: depends on underlying cause + PO abx to cover co-existent bacterial pneumonia (rsv: supportive measures; influenza: Tamiflu within 48hr of symptom onset for 5 days; Relenza only given to ages 5 and older)
A 3yr old patient with recent diagnosis of bacterial CAP comes to clinic for follow-up. Patient is favors lying on his left side, complaining of chest pain. What is the complication of bacterial CAP you suspect in this child?
Answer: parapneumonic effusion and empyema (<5 YEARS OLD, meniscus or layering fluid on lateral decubitus CXR, s.pneumoniae organism; dullness to percussion on affected side; child prefers lying on affected side; high WBC with left shift; needs IV abx)
A 5-year-old patient presents to your clinic with insidious onset of fever and dry cough, that has progressed to rales, chest pain, and fever. CXR reveals bronchopneumonic infiltrates in middle/lower lobes and a small pleural effusion. What is the likely diagnosis for
this patient?
Answer: Mycoplasma pneumonia (>5-YEAR-OLD; M. pneumoniae organism – incubation period is 2-3 wks long with slow onset of symptoms; NORMAL WBC w/diff, supportive measures + azithromycin 5 days
According to current recommendations per AAP for bronchiolitis, what testing should not be done?
Answer: no viral nasal swab for routine rsv testing (unless on palivizumab for prophylaxis); CXR (unless respiratory distress is present); albuterol/salbutamol and corticosteroids, antibiotics (only given if bacterial infection is strongly suspected)
