DSA 2

Question 1

What is the most common causative mechanism of PNA?

Answer 1

microaspiration

-other causes: hematogenous spread from a distant infected site, or direct spread from a contiguous focus, or macroaspiration that results in Aspiration PNA

Question 2

In the pathophysiological changes of PNA, what cells are involved in the local inflammatory response?

Answer 2

alveolar macrophages

Question 3

What are the four categories of PNA?

Answer 3

• -Community-Acquired
• -Hospital-Acquired
• -Ventilator-Associated
• -Healthcare-Associated

Question 4

Why is the categorization of Healthcare-Acquired PNA problematic?

Answer 4

• -the definition was overly sensitive

- -led to overTx of pts w/ broad-spectrum abx

Question 5

Which pathogens have the highest mortality?

Answer 5

• -gram-negative organisms

- -Staph aureus

Question 6

What is the most common pathogen causing Community-Acquired PNA?

Answer 6

Strep pneumo

Question 7

What pathogens causing Community-Acquired PNA cause typical PNA vs. atypical PNA?

Answer 7

Typical: Strep pneumo, Haemophilus influenzae, Staph aureus, Klebsiella, and Pseudomonas

Atypical: Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella, influenza, adenovirus, RSV

Question 8

What are risk factors for Community-Acquired PNA?

Answer 8

• alcoholism
• asthma
• immunosuppression
• institutionalization
• > 70yrs old (decreased cough/gag reflex)

Question 9

What is the most important method to achieve an accurate Dx of PNA and its most likely causative pathogen?

Answer 9

H&P

Question 10

Why is it important to narrow down a list of potential pathogens in the cause of PNA?

Answer 10

-to select appropriate Tx

Question 11

What are the clinical findings of a PNA patient?

Answer 11

General: fever, malaise, most look “sick”
Resp: tachypnea, hypoxia, cough, inspiratory crackles
Cardiac: tachy, abnormal BP, CHF exacerbation

Question 12

What decision tool would you use to predict the mortality of a PNA patient?

Answer 12

PNA Severity Index

Question 13

What decision tool would you use to help you decide whether or not you were going to admit a patient to the hospital?

Answer 13

CURB-65

Question 14

True or False: knowing comorbidities is important in guiding treatment

Answer 14

True

Question 15

What are risk factors for Pseudomonas or MRSA PNA?

Answer 15

• prior culture of these organisms

- recent hospitalization and parenteral abx within the past 90 days

Question 16

What are risk factors for Pseudomonas in Community-Acquired PNA?

Answer 16

• immunocompromised
• recent abx use
• structural lung abnormalities (CF, bronchiectasis)
• COPD exacerbations and glucocorticoid use

Question 17

What are risk factors for Pseudomonas in Healthcare-Associated PNA?

Answer 17

• elderly
• mechanical ventilation
• ICU
• admission in unit w/ high incidence of Pseudomonas

–lower probability associated w/ trauma and admission in unit w/ high patient turnover rate

Question 18

What are situations requiring a pulmonology consult?

Answer 18

• failed outpatient abx
• no improvement after 72hrs
• unusual radiograph
• airway obstruction w/ mass or foreign body
• concomitant severe obstructive/restrictive Dz

Question 19

What is the definition of Hospital-Acquired PNA?

Answer 19

infxn acquired after at least 48 hrs of hospitalization

Question 20

What is the definition of Ventilar-Associated PNA?

Answer 20

–type of Hospital-Acquired PNA that develops more than 48 hrs after endotracheal intubation