IM- CAP

Question 1

Results from the proliferation of microbial pathogens at the alveolar level and the host’s response to those pathogen

Answer 1

Pathophysiology of community acquired pneumonia

Question 2

What are the Most common mode of transmission?

Answer 2

o Aspiration from the oropharynx (Sleep, decreased sensorium)
o Inhaled as contaminated droplets
o Via hematogenous spread or contagious extension from an infected pleural or mediastinal space

Question 3

What are the mechsnical factors in regards to host defense from CAP?

Answer 3

• Hair and turbinates of the nares
• Branching architecture of the tracheobronchial tree
• Gag reflex and the cough mechanism
• Normal flora adhering to mucosal cell of the oropharynx (prevents pathogenic bacteria from binding)

Question 4

have intrinsic opsonizing properties or antibacterial or antiviral activity

Answer 4

Surfactant proteins A and D

Question 5

Initiate host inflammatory response

Answer 5

o Fever (TNF IL 1) 
o Pheripheral leukocytosis and increased purulent secretions (chemokines: IL8, GCSF)

Question 6

• Hemoptysis
• Rales
• Radiologic infiltrates
• Hypoxemia

Answer 6

Alveolar capillary leak

Question 7

• decrease compliance due to capillary leak
• hypoxemia
• increased respiratory drive
• increase secretions
• occasionally infection-related bronchospasm

Answer 7

Dyspnea

Question 8

Rarely evident in clinical or autopsy specimens bc of the rapid transition to 2nd phase

Answer 8

Edema

Question 9

• Presence of proteinaceous

- Exudate- and often of bacteria- in the alveoli

Answer 9

Edema

Question 10

Erythrocytes in the cellular intraalveolar exudate (red)

Answer 10

Red hepatization

Question 11

more important from the standpoint of host defense in the stage of red hepatization

Answer 11

Neutrophil influx

Question 12

occasionally seen in pathologic specimens collected during the phase of red hepatization

Answer 12

Bacteria

Question 13

No new erythrocytes are extravasating and those already present have been lysed and degraded, turning Gray

Answer 13

Gray Hepatization

Question 14

predominant cell in the phase of gray hepatization

Answer 14

Neutrophil

Question 15

Abundant in the gray hepatization

Answer 15

Fibrin deposition

Question 16

corresponds with successful containment of the infection → improve gas exchange

Answer 16

Gray hepatization

Question 17

Debris of neutrophils, bacteria and fibrin has been cleared, as has the inflammatory response

Answer 17

Resolution phase

Question 18

dominant cell type in alveolar space during resolution phase

Answer 18

Macrophage reappearance

Question 19

2 pathogens that causes the typical penumonia

Answer 19

o Streptococcus pneumonia

o H. Influenzae

Question 20

3 pathiogens that causes the atypical pneumonia?

Answer 20

o Mycoplasma pneumoniae
o Chlamydia pneumoniae
o Legionella pneumoniae

Question 21

What are the clinical manifestestation of Pneumonia?

Answer 21

• frequently febrile with tachycardia or may have a history of chills and or/sweats

Question 22

What is the quality of cough in Pneumonia?

Answer 22

productive/non-productive

Question 23

In Atypical Pneumonia, Up to _____ of patients may have gastrointestinal symptoms such as nausea, vomiting, and or/diarrhea

Answer 23

20%

Question 24

Its other symptoms may include fatigue, headache, mylagias and athralgias

Answer 24

Atypical pneumonia

Question 25

Crackles, bronchial breath sounds, and possibly a pleural ____ may be heard on auscultation

Answer 25

Friction rub

Question 26

In Pneumonia, severly ill pt may have ___ and evidence of ______

Answer 26

Septic shock and organ failure

Question 27

Can CAP be diagnostically accurately with history and PE alone?

Answer 27

No

Question 28

Accuracy of predicting CAP by physicians’ clinical judgment is between ________ (Grade B)

Answer 28

60-70%

Question 29

essential in the diagnosis of CAP

Answer 29

Chest x ray

Question 30

- Assess severity - Differentiate pneumoniae from other condition - For prognostication

Answer 30

Chest radiograph

Question 31

remains the reference dx standard for pneumonia

Answer 31

new parenchymal infiltrate in the chest radiograph

Question 32

should be done in patient suspected with CAP to confirm dx

Answer 32

Chest x ray

Question 33

Can we do not do CXR?

Answer 33

Yes

Question 34

What specific views of CXR should be requested?

Answer 34

Standing (1) posteroanterior and (2) lateral views of the chest in full inspiration (Grade A)

Question 35

Can CXR be “normal” in a patient with suspected pneumonia?

Answer 35

YES! Consider as “radiologic lag”

Question 36

- Not routinely done - Minimal role - Non-resolving or progressive pneumonia

Answer 36

CT Scan

Question 37

In Gram- staining and culture of sputum of CAP, Sputum should be

Answer 37

▪ >25 Neutrophils | ▪ <10 Squamous Epithelial Cells

Question 38

What does the blood culture in CAP yields?

Answer 38

disappointingly low

Question 39

Only approximately _____ of cultures of blood from pt hospitalized w/ CAP are positive

Answer 39

5-14%

Question 40

Most frequently isolated pathogens in CAP

Answer 40

S. pneumoniae

Question 41

allow narrowing of antibiotic therapy in appropriate cases.

Answer 41

Susceptibility data

Question 42

no longer considered de rigueur for all hospitalized CAP patient

Answer 42

Blood culture

Question 43

Disadvantages of Antigen test, PCR, Serology

Answer 43

o Not cost effective ▪ Low yield pf blood cultures (5 to 15%) ▪ Poor quality of samples in respiratory specimens o Availability of the tests

Question 44

Antibiotic should be initiated _____ when diagnosis is made

Answer 44

ASAP

Question 45

The choice of oral antibiotics ff initial parenteral therapy is based on:

Answer 45

``` o Available culture results o Antimicrobial spectrum o Efficacy o Safety o Cost ```

Question 46

Dosage of Amoxicillin-clavulznic acid

Answer 46

625 mg TID or 1gm BID

Question 47

Dosage of Azithromycin

Answer 47

500 mg OD

Question 48

Cefixime

Answer 48

200 mg BID

Question 49

Cefuroxime Axetil

Answer 49

500 mg BID

Question 50

Cefpodoxime Proxetil

Answer 50

200 mg BID

Question 51

Levofloxacin

Answer 51

500-750 mg OD

Question 52

Moxifloxacin

Answer 52

400 mg OD

Question 53

Sultamicilin

Answer 53

750 mg BID