Bronchitis and Pneumonia

Question 1

only bacterial cause of AB (Acute Bronchitis) responds to abx

Answer 1

B. pertussis

Question 2

AB is febrile or afebrile?

Answer 2

afebrile unless etiology is flu

Question 3

rhonchi in AB

Answer 3

clears with coughing , no rales

Question 4

procalcitonin

Answer 4

elevated in bacterial infection, drop of 80% =>d/c abx

Question 5

management of AB

Answer 5

symptomatic, OTC, antitussives, beta 2 agonists

Question 6

abx needed for AB?

Answer 6

no but 60-90% are given. educate pts

Question 7

1 cause of transmission of pneumonia

Answer 7

aspiration from oropharynx

Question 8

classification of Pneumonia

Answer 8

CAP, HAP, VAP, HCAP

Question 9

most common cause of CAP

Answer 9

s. pneumo

Question 10

clinical signs of CAP-general

Answer 10

fever, RR>24, Tachycardia, rales, consolidation

Question 11

clinical signs of CAP-atypical

Answer 11

confusion, weakness, FTT, delirium, abd pain, tachypnea, HA, N/V/D, myalgia/arthralgia

Question 12

Dx labs for CAP

Answer 12

leukocytosis (15-30) with left shift

Question 13

Dx CXR for CAP

Answer 13

infiltrate /consolidation

Question 14

types of consolidation in CAP

Answer 14

lobar, interstitial, cavitation (straight line)

Question 15

CURB 65

Answer 15

confusion, urea>7, RR>30, BP, >65

Question 16

ICU

Answer 16

3-5 on CURB65

Question 17

Admit

Answer 17

2 on CURB65

Question 18

out pt

Answer 18

0-1 on CURB65

Question 19

CAP tx: healthy no abx use w/in past 3 months

Answer 19

macrolide/doxycycline

Question 20

CAP tx: macrolide resistant/abx use w/in 3 months

Answer 20

respiratory fluroquinolone/betalactam+macrolide

Question 21

first line beta lactam

Answer 21

high dose amoxicilin/ amoxicilin-clavulanate

Question 22

alternative to beta lactam

Answer 22

ceftriaxone, cefpodoxime, cefuroxime

Question 23

CAP-inpt-nonICU tx

Answer 23

respiratory fluoroquinolone/ anti-pneumoccocal beta lactam+macrolide

Question 24

CAP-ICU tx

Answer 24

anti-pneumococcal beta lactam + azithromycin/ anti-pneumococcal beta lactam + resp. fluoroquinolone/ resp. fluoroquinolone+ aztreonam

Question 25

CAP tx Pen allergy

Answer 25

resp. fluoroquinolone+ aztreonam

Question 26

CAP ICU w/ pseudomonas risk

Answer 26

Antipneumococcal, antipseudomonal beta lactam + either ciprofloxacin or levofloxacin/ above beta-lactam+ an aminoglycoside + azithromycin/ above beta-lactam + an aminoglycoside + a respiratory fluoroquinolone

Question 27

CAP ICU w/MRSA

Answer 27

add vancomysin or linezolid

Question 28

pathophysiology for HAP, VAP, HCAP

Answer 28

altered upper respiratory tract flora: pharyngeal colonization

Question 29

Dx for HAP, VAP, HCAP

Answer 29

new or progressive infiltrate on lung imaging + 2 of (fever, purulent sputum, leukocytosis)

Question 30

sputum gram stain and culture are indicated for ?

Answer 30

HAP, VAP, HCAP

Question 31

are considered at risk for drug resistance

Answer 31

HCAP

Question 32

what has long duration of tx? (14-21 days)

Answer 32

pseudomonas aeroginosa

Question 33

Tx of HAP, VAP, HCAP

Answer 33

Antipneumococcal, antipseudomonal beta lactam + respiratory fluoroquinolone + vancomycin/linezolid

Question 34

monotherapy can be used for HAP/VAP if

Answer 34

no resistent pathogen

Question 35

prevention of VAP

Answer 35

no acid-blocking meds, decontamination of oropharynx and gut, probiotics, positioning (not supine) , subglottic drainage

Question 36

common cause of viral CAP

Answer 36

flu=>secondary bacterial common (staph)

Question 37

fungal pneumonias

Answer 37

Histoplasmosis, Blastomycosis, Coccidiodomycosis

Question 38

pneumonia a/w HIV

Answer 38

Pneumocystis jirovecii pneumonia

Question 39

what is the most common symptoms of Pneumocystis jirovecii pneumonia?

Answer 39

fever, cough, progressive dyspnea

Question 40

test results for Pneumocystis jirovecii pneumonia?

Answer 40

high LDH and low CD4

Question 41

tx of Pneumocystis jirovecii pneumonia?

Answer 41

bactrim

Question 42

common cause of aspiration pneumonia

Answer 42

G- and anaerobic

Question 43

risk factors for aspiration pneumonia

Answer 43

post op, neurologic compromise, anatomical defect

Question 44

common site of aspiration pneumonia

Answer 44

RLL

Question 45

abx for aspiration pneumonia

Answer 45

Piperacillin/tazobactam or ampicillin/sulbactam; or Clindamycin; or moxifloxacin