Pneumonia

Question 1

What are clinical signs of infection?

Answer 1

Inflammation, redness, heat, pus.

Question 2

What are systemic signs of infection?

Answer 2

Fever, increased heart rate (HR), increased respiratory rate (RR), and increased white blood cell count (WBC).

Question 3

What are the characteristics of a fever?

Answer 3

Fever is the most common and non-specific feature of infection, defined as >37.5°C (oral/armpit) or >38°C (tympanic/rectal). Very young and elderly may not respond with a fever. HR increases by 10-15 BPM for each 1°C increase.

Question 4

What are potential results of an untreated fever?

Answer 4

Enhanced leukocyte migration, augmented lymphocyte function, reduced microbial replication, improved survival.

Question 5

What is the normal range for white blood cell count (WBC)?

Answer 5

4.0-11.0 x 10^9/L (4,000-11,000/mm^3).

Question 6

What is a common cause of fever besides infection?

Answer 6

Drug fevers, transfusion reactions, lymphoma, or post-myocardial infarction (MI).

Question 7

What is the most common bacterial pathogen causing community-acquired pneumonia (CAP)?

Answer 7

Streptococcus pneumoniae.

Question 8

What are the risk factors for resistant S. pneumoniae?

Answer 8

Antibacterial use in the past 3 months, age >65, exposure to children from daycare, alcoholism, and immunosuppression.

Question 9

What is the typical presentation of Mycoplasma pneumoniae infection?

Answer 9

Gradual onset of fever, headache, malaise, followed by a persistent hacking cough, often with non-pulmonary symptoms like nausea, vomiting, and skin rashes.

Question 10

What is the role of procalcitonin (PCT) in diagnosing bacterial infections?

Answer 10

PCT is a biomarker used to predict the likelihood of bacterial infection and can guide antibacterial therapy, especially in respiratory infections and sepsis.

Question 11

What are the 2016 IDSA/ATS guidelines for procalcitonin use in HAP/VAP?

Answer 11

Procalcitonin levels plus clinical criteria should be used to guide discontinuation of antibiotic therapy in HAP/VAP (weak recommendation, low-quality evidence).

Question 12

What are the clinical signs of pneumonia?

Answer 12

Fever >37.8°C, hypothermia, rigors, sweats, new cough with sputum, chest discomfort, dyspnea, and abnormal breath sounds (rales, rhonchi).

Question 13

What are the risk factors for poor outcomes in pneumonia?

Answer 13

Respiratory rate >30, systolic BP <90, acute renal dysfunction, malnourishment, functional impairment, and leukopenia <4 x 10^9/L.

Question 14

What is the CURB-65 score used for?

Answer 14

It is a risk assessment tool for community-acquired pneumonia (CAP) to determine the need for hospitalization based on confusion, uremia, respiratory rate, blood pressure, and age >65.

Question 15

What is the first-line empiric treatment for outpatient CAP with no comorbidities?

Answer 15

Amoxicillin 1 g PO TID or doxycycline 200 mg PO once, then 100 mg PO BID.

Question 16

What is the empiric treatment for severe CAP requiring ICU admission?

Answer 16

Ceftriaxone 1-2 g IV daily plus azithromycin 500 mg IV/PO daily. If MRSA is suspected, add vancomycin or linezolid.

Question 17

What are the criteria for clinical stability in pneumonia patients?

Answer 17

Temperature ≤37.8°C, heart rate ≤100 bpm, respiratory rate ≤24 breaths/min, systolic BP ≥90 mmHg, O2 saturation ≥90%, ability to maintain oral intake, and normal mental status.

Question 18

What are the common pathogens in nursing home-acquired pneumonia (NHAP)?

Answer 18

S. pneumoniae, H. influenzae, S. aureus, Enterobacterales, and C. pneumoniae.

Question 19

What is the empiric treatment for late-onset hospital-acquired pneumonia (HAP)?

Answer 19

Ceftriaxone 1-2 g IV daily or levofloxacin 750 mg PO/IV daily, plus gentamicin if P. aeruginosa is suspected.

Question 20

What are the prevention strategies for ventilator-associated pneumonia (VAP)?

Answer 20

Elevate the head of the bed 30-45°, mouth care, remove NG/ET tubes ASAP, continuous sub-glottic suctioning, and hand hygiene.

Question 21

What are the common pathogens in aspiration pneumonia with risk factors for gut anaerobes?

Answer 21

S. pneumoniae, H. influenzae, S. aureus, Enterobacterales, and anaerobes.

Question 22

What is the empiric treatment for aspiration pneumonia with risk factors for gut anaerobes?

Answer 22

Amoxicillin/clavulanate or ceftriaxone 1-2 g IV daily plus metronidazole 500 mg IV/PO BID.

Question 23

What is the most common cause of acute bronchitis?

Answer 23

Viral infections (≥90% of cases).

Question 24

What is the recommended supportive treatment for acute bronchitis?

Answer 24

Increased humidity, smoking cessation, antitussives, and bronchodilators (if needed).

Question 25

What is the mortality rate for outpatients with pneumonia?

Answer 25

Less than 1%.

Question 26

What is the mortality rate for hospitalized patients with pneumonia?

Answer 26

Approximately 14%.

Question 27

What are the common non-infectious outcomes of pneumonia?

Answer 27

Acute cardiac events (e.g., myocardial infarction, atrial fibrillation) and worsening heart failure.

Question 28

What is the Pneumonia Severity of Illness (PSI) scoring system used for?

Answer 28

To assess the severity of community-acquired pneumonia (CAP) and guide treatment decisions.

Question 29

What are the common symptoms of *Chlamydia pneumoniae* infection?

Answer 29

Mild respiratory symptoms, fever, headache, and gradual onset, with re-infection common in older adults.

Question 30

What is the typical presentation of *Haemophilus influenzae* pneumonia?

Answer 30

Bronchopneumonia or acute exacerbation in COPD patients, with cough, fever, and pleuritic chest pain.

Question 31

What are the common pathogens in early-onset ventilator-associated pneumonia (VAP)?

Answer 31

Enterobacterales, *S. pneumoniae*, *H. influenzae*, and *S. aureus*.

Question 32

What is the empiric treatment for early-onset VAP?

Answer 32

Ceftriaxone 1-2 g IV daily or levofloxacin 750 mg IV/PO daily. If MRSA is suspected, add vancomycin or linezolid.

Question 33

What is the empiric treatment for late-onset VAP with risk factors for multidrug-resistant pathogens?

Answer 33

Piperacillin/tazobactam 4.5 g IV q6h or meropenem 500 mg IV q6h, plus tobramycin or ciprofloxacin. If MRSA is suspected, add vancomycin or linezolid.

Question 34

What are the common pathogens in aspiration pneumonia without risk factors for gut anaerobes?

Answer 34

*S. pneumoniae*, *H. influenzae*, *S. aureus*, and Enterobacterales.

Question 35

What is the empiric treatment for aspiration pneumonia without risk factors for gut anaerobes?

Answer 35

Ceftriaxone 1-2 g IV daily or levofloxacin 750 mg IV/PO daily.

Question 36

What are the common symptoms of viral pneumonia?

Answer 36

Upper respiratory symptoms, patchy pulmonary infiltrates, and normal or minimally elevated white blood cell count.

Question 37

What is the recommended duration of antibacterial therapy for CAP?

Answer 37

Minimum of 3-5 days and until clinically stable.

Question 38

What are the common pathogens in hospital-acquired pneumonia (HAP)?

Answer 38

Enterobacterales, *P. aeruginosa*, *S. aureus*, and *S. pneumoniae*.

Question 39

What is the empiric treatment for mild-moderate hospital-acquired aspiration pneumonia?

Answer 39

Amoxicillin/clavulanate or ceftriaxone 1-2 g IV daily plus metronidazole 500 mg IV/PO BID.

Question 40

What is the empiric treatment for severe hospital-acquired aspiration pneumonia?

Answer 40

Piperacillin/tazobactam 4.5 g IV q6h or meropenem 500 mg IV q6h.

Question 41

What are the common symptoms of influenza pneumonia?

Answer 41

Sudden onset of flu-like syndrome, upper respiratory symptoms, and positive diagnostic test for influenza virus.

Question 42

What is the role of macrolides in pneumonia treatment?

Answer 42

Macrolides have immunomodulatory effects, suppressing inflammatory cytokines and reducing morbidity and mortality in CAP when added to β-lactams.

Question 43

What are the common symptoms of lobar pneumonia?

Answer 43

Sudden onset of fever, chills, cough, and pleuritic chest pain, often with dense consolidation on chest X-ray.

Question 44

What is the recommended follow-up for pneumonia patients?

Answer 44

Follow-up chest X-ray at 6 weeks for patients with extensive/necrotizing pneumonia, smoking history, alcoholism, or weight loss.

Question 45

What are the common symptoms of *Mycoplasma pneumoniae* infection?

Answer 45

Gradual onset of fever, headache, malaise, and persistent hacking cough, often with non-pulmonary symptoms like nausea and skin rashes.

Question 46

What is the recommended treatment for acute bronchitis?

Answer 46

Supportive care, including increased humidity, smoking cessation, antitussives, and bronchodilators if needed. Antibiotics are not recommended.

Question 47

What is the recommended treatment for *Haemophilus influenzae* pneumonia?

Answer 47

Ceftriaxone 1-2 g IV daily or levofloxacin 750 mg IV/PO daily.

Question 48

What are the common symptoms of *Streptococcus pneumoniae* pneumonia?

Answer 48

Sudden onset of fever, chills, cough, and pleuritic chest pain, often with lobar consolidation on chest X-ray.

Question 49

What is the recommended treatment for *Mycoplasma pneumoniae* pneumonia?

Answer 49

Azithromycin 500 mg PO daily or doxycycline 100 mg PO BID.

Question 50

What are the common symptoms of *Chlamydia pneumoniae* pneumonia?

Answer 50

Mild respiratory symptoms, fever, headache, and gradual onset, with re-infection common in older adults.

Question 51

What is the recommended treatment for *Chlamydia pneumoniae* pneumonia?

Answer 51

Azithromycin 500 mg PO daily or doxycycline 100 mg PO BID.

Question 52

What are the common symptoms of *Haemophilus influenzae* pneumonia?

Answer 52

Bronchopneumonia or acute exacerbation in COPD patients, with cough, fever, and pleuritic chest pain.