Pneumonia

Question 1

Physical exam findings of pneumonia:

Answer 1

1. Consolidation: rales on auscultation, dull on percussion, increased tactile fremitus, positive egophony
2. Pleural Effusion: decreased sounds on auscultation, dull on percussion, decreased tactile fremitus, no egophony

Question 2

Complications of pneumonia::

Answer 2

1. parapnemonic effusion
2. empyema
3. abscess
4. sepsis

Question 3

Labs:

Answer 3

1. BMP, CBC with diff, ABG if respiratory distress

2. Sputum gram stain/culture - LOW yield, good is >25PMNs,

Question 4

CXR - gold standard, what is the organism based on location in:

1. Lobar pneumonia:
2. Brnochopneumonia:
3. Interstitial pneumonia:

Answer 4

1. Lobar pneumonia - Strep pneumoniae.
2. Brnochopneumonia - Staph aureus, H. influenzae
3. Interstitial pneumonia: Mycoplasma, PCP, viruses.

Question 5

Thoracocentesis indications:

Answer 5

One of:

• New pleural effusion >1cm in lateral decubitus position.
• Parapneumonic effusion

Question 6

Chest tube indications:

Answer 6

One of::

• Loculated ( pus )
• Pleural fluid with positive gram stain or culture
• pH 3x upper normal

Question 7

Light’s Criteria:

Answer 7

If ANY of criteria is met - fluid is exudate, otherwise it’s transudate:

1. plueral fluid protein/serum protein >0.5
2. plueral fluid LDH/ serum LDH
3. Pleural fluid LDH >2/3 upper limit of normal

Question 8

Exudate suggests which disease processes?

Answer 8

pneumonia, cancer, PE, CABG surgery

Question 9

Transudate suggests which disease processes?

Answer 9

HF, cirrhosis, nephrotic syndrome

Question 10

CURB 65 (for community acquired pneumonia) scoring system get points for:

Answer 10

1 point each:

• confusion
• uremia (BUN>20)
• tachypnea >30
• hypotension 65

Hospitalize if 2+ points

Question 11

Pneumonia Severity Index (PSI) takes into account:

Answer 11

Hx, PE, Labs, Imaging

Question 12

Community acquired pneumonia microbiology:

Answer 12

• # 1: Strep. pneumoniae
• COPD, no vaccine: H. influenza, Moraxella
• Old, smokers, on TNF inhibitors: Legionella
• Young: Mycoplasma, Chlamydia, viral
• Alcoholics, Aspirators: Klebsiella
• Post-viral: Staph. aureus

Question 13

Outpatient antibiotics for community acquired pneumonia:

Answer 13

• 1st line: Macrolide: azithromycin, clarithromycin
• Doxycycline
• Flouroquinolone: levofloxacin, moxifloxacin

Question 14

Inpatient Abx for community acquired pneumonia:

Answer 14

Macrolide +3rd gen cephalosporin: cefotaxime, ceftriaxone
or
Floroquinolone

Question 15

Hospital acquired pneumonia microbes:

Answer 15

Staph. aureas/MRSA

Gram neg rods: Pseudomonas, Klebsiella, E. coli, Enterobacter, Acinetobacter, Serratia

Question 16

Abx for hospital acquired pneumonia:

Answer 16

MRSA - vancomycin

Pseudomonas - piperacillin/tazocillin, cefepime, carbapenem

Question 17

What types of immunocompromised patients get what microbes:

Answer 17

1. HIV get: S. pneumo, PCP, MAC, CMV
2. Splenectomy: capsulated orgs
3. Alcoholics: Klebsiella