Pneumonia

Question 1

2 types of pneumonia

Answer 1

Lobar and interstitial

Question 2

Does lobar or interstitial pneumonia have better oxygenation?

Answer 2

lobar bc you can cough it out

Question 3

A pneumonia that is acquired outside the hospital or within 48hrs admit

Answer 3

Community Acquired Pneumonia (CAP)

Question 4

Top 3 CAP bacteria

Answer 4

S. pneumoniae (15%) (G+)
H. influenza (3-10%) (G-)
Mycoplasma Pneumonia (atypical)

Question 5

CAP Viral

Answer 5

Question 6

CAP Fungal Causes

Answer 6

• Coccidiomycosis “cactusidiomycosis”
• Histoplasmosis “ohio river valley”
• Blastomycosis “blasting leaves”

in HIV -> Pneumocystis jirovecii

Question 7

ppl <5 yo usually get (viruses/bac)
ppl >/=5yo usually get (viruses/bac)

Answer 7

Question 8

Bacterial infx = ____ cough. Viral infx = ____ cough

Answer 8

bacterial = WET Cough
Viral = DRY Cough

Question 9

Signs of CAP

Answer 9

Fever, tachypnea, tachychardia, crackles, egophony E->A changes, increased tactile fremitus,

infants: nasal flaring, accessory muscle use, cyanosis

Question 10

Pneumonia symp

Answer 10

cough, fever, chills, malaise, dyspnea, chest pain

Question 11

pt presents to ER with acute dyspnea. Order what to diff pneumonia vs heart failure

Answer 11

Serum procalcitonin levels

procalcitonin is produced in response to bac infections and tissue injury

Question 12

Criteria to determine if pt needs to be admitted to the hosp

Answer 12

CURB-65

Question 13

does this pt need to go home, be admitted, or ICU?

confused, BUN 21mg/dL, RR 35bpm, hypotensive, 70yo man

Answer 13

ICU

Question 14

pts must maintain an O2 of > ____% (norm) OR > _____% (COPD)

Answer 14

> 92% Norm
88% COPD

Question 15

CAP Steroid Rx

inpt and outpt

Answer 15

• inpt -> methylprednisolone
• outpt -> prednisone

Question 16

Because cultures have low yield, when empirically treating pneumonia, we must cover for all most common types…

Answer 16

G+: Strep pneumoniae
G-: H. Influenza
Atypicals: Mycoplasma, Chlamydia

Question 17

Strep Pneumo Trmnts

Answer 17

Amoxil only for kids
Macrolides (Z-pak) for adults

Question 18

what & CXR findings?

Pneumonia + high fever, rusty purulent sputum

Answer 18

Question 19

what, CXR findings, & trmnt?

Pneumonia + COPD Smoker

Answer 19

Question 20

what, CXR findings, trmnt

Pneumonia + WATER exposure, diarrhea, wet cough

Answer 20

Question 21

what, CXR findings, & trmnt?

College teen living in dorm has pneumonia over WEEKS with dry cough

Answer 21

Question 22

What & trmnt

Child with LOW FEVER, persistent DRY COUGH, H/A, ST, and hoarseness. PE: wheezing and ronchi

Answer 22

Question 23

What, etiology, & trmnt

Alcoholic with Pneumoniae symptoms

Answer 23

Question 24

what, etiology,

Chronic WET COUGH, NIGHT SWEATS, WT LOSS, HEMOPTYSIS, pleuritic CP, foul smelling sputum

Answer 24

Question 25

# CXR findings and trmnt Chronic WET COUGH, NIGHT SWEATS, WT LOSS, HEMOPTYSIS, pleuritic CP, foul smelling sputum

Answer 25

Question 26

HIV pt has fever, cough, dyspnea, and clear lungs. Wdyd?

Answer 26

order a serum test for CD4 count. always be suss for pneumonia in immunocompromised

Question 27

Pneumocystis Jirovecii symptoms

Answer 27

HIV pts get this. They are immunocomp, so their only symptom may be fever

Question 28

Pneumocystitis Jirovecii trmnt and prevention

Answer 28

IV Bactrim (sulfamethoxazole/trimethoprim) Prevention: BACTRIM FOR LIFE

Question 29

Pneumocystitis Jirovecii CXR fingings

Answer 29

diffuse interstitial infiltrates

Question 30

# what & orders? Pneumonia + from Arizona, red bumps and circles on skin

Answer 30

Question 31

# trmnt Coccidiomycosis trmnt

Answer 31

Question 32

# what & trmnt Pneumonia + birds/bats

Answer 32

Itraconazole unless mod-severe-> amphotericin B for a lil bit and then -> itraconazole

Question 33

Coccidiomycosis presentation

Answer 33

May be Asymptomatic aside from slight cold symptoms and skin lesions

Question 34

Pneumonia with hemoptysis, wt loss, night sweats, and chunky/slimy jelly sputum. What, etiology, and trmnt?

Answer 34

Lung abscess from aspiration pneumonia Gram (-) Klebsiella Rx Augmentin (Amoxil/clavulanate for G- ) or Clindamycin (for anaerobes)

Question 35

Lung abscess most common anaerobic pathogens?

Answer 35

Bacteroides, peptostrep, fusobacterium, prevotella

Question 36

Lung abscess most common aerobic pathogens?

Answer 36

Strep and staph (G+) Klebsiella (G-)

Question 37

Pt who is an AC mechanic presents with flu like symptoms including high fever, myalgia, cough, and diarrhea had a (+) urine antigen test. What is it?

Answer 37

Legionella (legionnaire’s disease)

Question 38

Special test for Legionella?

Answer 38

Urinary legionella antigen

Question 39

# Aspiration pneumonia at risk population, microbes, Rx, complication?

Answer 39

Inhaling your own vomit at risk -> Alcoholic, stroke, anything effecting swallowing Microbes -> Anaerobes, G + (strep), G - (H. flu, Klebsiella), bacteroides Rx -> Augmentin or clindamycin Complication -> Lung abscess