LRTI

Question 1

Clinical presentation: Bronchitis

Answer 1

Acute cough for usually less than 3 weeks

Question 2

Bronchitis Vs Pneumonia: Site of infx

Answer 2

Bronchitis: Inflammation of trachea & lower airways;
Pneumonia: Lung parenchyma

Question 3

What does urinary antigen test test for?

Answer 3

• Streptococcus pneumonia
• Legionella pneumophilia

Question 4

Risk factors for drug resistant organisms

Answer 4

 Being empirically treated for MRSA or P. aeruginosa
 Were previously infected with MRSA or P. aeruginosa in the last 1 year
 Were hopsitalised or received parenteral antibiotics in the last 90 days

Question 5

When to obtain pre-treatment blood and resp gram stain and culture?

Answer 5

In patients managed in the hospital who are:
- Severe CAP
OR
- Have risk factors for drug resistant organisms

Question 6

Risk stratification using Pneumonia Severity Index (PSI)

Answer 6

Class I & II: outpatient
Class III: short hospitalization or observation
Class IV and V: inpatients

Question 7

Risk stratification using CURB-65

Answer 7

0 or 1: outpatient
2: inpatient
3-5: inpatient, consider ICU

Question 8

Criteria for CURB-65

Answer 8

Confusion
Urea > 7 mmol/L
RR ≥ 30 bpm
SBP < 90 or DBP ≤ 60
≥ 65 y/o

Question 9

Risk stratification for severe CAP

Answer 9

1 major criteria or at least 3 minor criteria

Question 10

Antibiotics that cover Atypicals

Answer 10

• FQs (except ciprofloxacin)
• Doxycycline
• Macrolides

Question 11

Organism to cover outpatient, no comorb

Answer 11

Strep pneumoniae

Question 12

Organism to cover outpatient, with comorb / inpatient, non-severe

Answer 12

Strep pneumoniae, Haemophilus influenzae & Atypicals

Inpatient - consider MRSA/ Pseudomonas risk factors

Question 13

Which antibiotic is commonly used to cover Burkholderia pseudomallei?

Answer 13

Ceftazidime

Question 14

Does ceftazidime cover strep pneumo?

Answer 14

No.

Question 14

When to cover anaerobes?

Answer 14

Radiological exams reveal:
- Lung abscess
OR
- Empyema

Question 14

Antibiotic to add if standard regimen has no anaerobic activity

Answer 14

IV/PO Metronidazole OR Clindamycin

Question 15

When to add Adjunctive corticosteroid therapy?

Answer 15

shock refractory to fluid resuscitation and vasopressor support

Question 16

Treatment duration for CAP

Answer 16

Minimal 5-days; 7 days if suspected/ proven MRSA/ Pseudomonas

Question 17

Risk factor for high mortality risk

Answer 17

need for ventilatory support due to HAP and septic shock

Question 18

When to use 2 anti-pseudomonal agents for HAP/VAP?

Answer 18

• a risk factor for antimicrobial resistance (prior IV antibiotic use within 90 d; acute renal replacement therapy prior to VAP onset; isolation of P. aeruginosa in last 1 year)
• hospitalization in a unit where >10% of Pseudomonas isolates are resistant to an agent being considered for monotherapy
• if prevalence of PA is not known but patient at high risk for mortality (include need for ventilatory support due to HAP and septic shock)

Question 19

Organism to cover for VAP/HAP

Answer 19

Pseudomonas & S. aureus

Question 20

Treatment duration for VAP/HAP

Answer 20

7 days

Question 21

Should not escalate antibiotic therapy in the first ______

Answer 21

72 hours