Pneumonia

Question 1

What do you need (3 things) to make the diagnosis of pneumonia?

Answer 1

1. Sx
2. Exam findings
3. CXR (CANNOT dx pneumonia without an X-Ray!)

Question 2

What is the typical distribution of pneumonia?

Answer 2

Asymmetric

Question 3

How sick do the atypical pneumonias make you?

Answer 3

Usually not as sick, EXCEPT for legionella

Question 4

What are the most common causes of community acquired pneumonia?

Answer 4

1. S. Pneumo
2. Atypicals
3. Viruses

Question 5

What causes regular community acquired pneumonia?

Answer 5

1. S pneumo
2. atypicals
3. viruses

Question 6

How do you treat regular community acquired pneumonia?

Answer 6

Azithromycin (Covers atypicals! Also covers gram positives and some gram negatives)

Question 7

What organisms are your worried about in a CAP that is serious enough to be admitted to the ICU?

Answer 7

Staph
Strep pneumo
Viruses

Question 8

If a pt acquired pneumonia from the hospital, what organisms are you worried about?

Answer 8

Staph and GNR. If acquired in the hospital, you’re not worried about atypical agents

Question 9

What would you treat someone with CAP in the ICU?

Answer 9

Azithromycin + ceftriaxone (Ceftriaxone gives gram positive–(staph+strep) and negative coverage)

OR

Fluoroquinolone

Question 10

What do you do if CAP in ICU becomes very severe?

Answer 10

Add vanco. You’re worried about resistant strep pneumo or staph

Question 11

How do you treat ventilator acquired pneumonia?

Answer 11

Vancomycin and piperacillin/tazao
Vanc and ceftazidine
-Consider adding a quinolone to cover more GNR

Question 12

How do you treat aspiration pneumonia?

Answer 12

Azithromycin+metro/clinda

Question 13

What could cause treatment failure in pneumonia?

Answer 13

1. empyema
2. resistance
3. metastatic infectin
4. wrong dx

Question 14

What do inflammatory cells release in pneumonia?

Answer 14

IFN-alpha, reactive O2, and IL-1

Question 15

Major causes of CAP

Answer 15

mycoplasma pneumonia
s pneumo
chlamydophilia
Influenza

Question 16

How do you treat pneumonia caused by seasonal influenza?

Answer 16

Osetamivir

Question 17

Gardener with pneumonia

Answer 17

nocardia

Question 18

Construction worker with pneumonia

Answer 18

aspergillus

Question 19

Kid vaccine for s pneumo

Answer 19

prevnar (7 valent, conjugated)

Question 20

Adult vaccine for s pneumo

Answer 20

pneumovax (23 valent, capsular)

Question 21

Who should get pneumovax?

Answer 21

>65
CHF, COPD
DM
Alcoholic, cirrhotic pts
CSF leak

Question 22

Silver stain culture and metabolic acidosis are buzzwords for what pneumonia-causing agent?

Answer 22

legionella

Question 23

What are the causes of atypical pneumonia?

Answer 23

RSV
Mycoplasma
Chlamydophilia

Question 24

Why is ceftriaxone inadeuqte for CAP?

Answer 24

Doesn’t cover the atypicals

Question 25

What is a good treat for pneumonia that is NOT resolving with ceftriaxone+azithromycin?

Answer 25

Levofloxacin. It covers gram +/-, AND atypicals.

Question 26

Why is cipro a bad drug for pneumonia?

Answer 26

Because it does NOT cover strep pneumo. Mostly for gram negatives like in UTIs

Question 27

Describe the very GENERAL coverage of 
1. Vanco
2. Ceftriaxone
3. Cipro
4. Levo
Azithro
Meropenem

Answer 27

Vanco: Gram positives, and resistant Gm +
Ceftriaxone: Gm +/-
Cipro: Gm - and atypicals
Levo/Azithro: atypicals, gm +/-
Meropenem: Gm +/- but NOT atypicals. DOES cover pseudomonas