Community Acquired Pneumonia Exam
Questions And Answers Graded A+
What general categories can increase the likelihood of CAP?
decreased mucociliary transport
decreased host immune response
decreased cough reflex (aspiration risk)
List factors that decrease mucociliary transport.
smoking
COPD
CF
viral infection
elderly
List factors that decrease host immune response.
ethanol abuse viral infection
elderly hypoxemia
DM, AIDS, cancer pulmonary edema
malnutrition bacterial endotoxin
immunosuppressants
List factors that increase G- colonization.
malnutrition
chronic ilness
elderly/nursing home resident
surgery or prolonged hospitalization
smoking
antacids, H2 blockers, PPIs
List factors that decrease cough reflex and thereby increase aspiration risk.
ethanol intoxication
stroke
general anesthesia
drugs that impair mental status
Explain the classic presentation of pneumococcal pneumonia.
follows respiratory viral illness
abrupt onset of severe chill
high fever
chest pain
productive cough
T/F: the classic presentation of CAP is seen in all age groups.
False
young or middle aged
[elderly have mental status changes instead]
List lab test findings for CAP.
increased WBC w/ left shift (15-40,000)
, CXR inflitrates
decreased PO2 on ABG
blood cultures of pneumonia causing bacteria
+- sputum culture and gram stain
Why is a sputum culture not always helpful in diagnosis of CAP?
often contaminated by natural flora of the mouth
List some bacteria that commonly cause CAP.
strep pneumo (pneumococcal pneumonia) - G+ diplococci
staph - G+ cocci in clusters
h. flu - small G- coccobacilli
klebsiella - short plump G- bacilli
mycoplasma - unremarkable
anaerobic - foul smelling, polymicrobial
How would mycoplasma CAP present?
"walking pneumonia"
low grade fever, non-productive cough
Anaerobic pneumonia is often secondary to ________.
Anaerobic pneumonia is often secondary to peridontal disease.
How are patients evaluated for seriousness of pneumonia?
CURB-65 scale
Confusion
Uremia (BUN>20)
Respiratory rate (>=30)
low Blood pressure (SBP<90 or DBP=<60)
65 y/o or greater
Using the CURB-65 scale, determine where a patient should be treated.
1 point for each letter/number
0-1: outpatient
2: inpatient, general ward
>=3: inpatient, ICU
How should a CAP be treated if outpatient and previously healthy, no ABx in past 3mos?
macrolide
doxycyline
How should a CAP patient be treated if outpatient with comorbidities or ABx in past 3mos?
respiratory FQ
B-lactam + macrolide
How should a CAP patient be treated if inpatient but non-ICU?
respiratory FQ
B-lactam + macrolide
Questions And Answers Graded A+
What general categories can increase the likelihood of CAP?
decreased mucociliary transport
decreased host immune response
decreased cough reflex (aspiration risk)
List factors that decrease mucociliary transport.
smoking
COPD
CF
viral infection
elderly
List factors that decrease host immune response.
ethanol abuse viral infection
elderly hypoxemia
DM, AIDS, cancer pulmonary edema
malnutrition bacterial endotoxin
immunosuppressants
List factors that increase G- colonization.
malnutrition
chronic ilness
elderly/nursing home resident
surgery or prolonged hospitalization
smoking
antacids, H2 blockers, PPIs
List factors that decrease cough reflex and thereby increase aspiration risk.
ethanol intoxication
stroke
general anesthesia
drugs that impair mental status
Explain the classic presentation of pneumococcal pneumonia.
follows respiratory viral illness
abrupt onset of severe chill
high fever
chest pain
productive cough
T/F: the classic presentation of CAP is seen in all age groups.
False
young or middle aged
[elderly have mental status changes instead]
List lab test findings for CAP.
increased WBC w/ left shift (15-40,000)
, CXR inflitrates
decreased PO2 on ABG
blood cultures of pneumonia causing bacteria
+- sputum culture and gram stain
Why is a sputum culture not always helpful in diagnosis of CAP?
often contaminated by natural flora of the mouth
List some bacteria that commonly cause CAP.
strep pneumo (pneumococcal pneumonia) - G+ diplococci
staph - G+ cocci in clusters
h. flu - small G- coccobacilli
klebsiella - short plump G- bacilli
mycoplasma - unremarkable
anaerobic - foul smelling, polymicrobial
How would mycoplasma CAP present?
"walking pneumonia"
low grade fever, non-productive cough
Anaerobic pneumonia is often secondary to ________.
Anaerobic pneumonia is often secondary to peridontal disease.
How are patients evaluated for seriousness of pneumonia?
CURB-65 scale
Confusion
Uremia (BUN>20)
Respiratory rate (>=30)
low Blood pressure (SBP<90 or DBP=<60)
65 y/o or greater
Using the CURB-65 scale, determine where a patient should be treated.
1 point for each letter/number
0-1: outpatient
2: inpatient, general ward
>=3: inpatient, ICU
How should a CAP be treated if outpatient and previously healthy, no ABx in past 3mos?
macrolide
doxycyline
How should a CAP patient be treated if outpatient with comorbidities or ABx in past 3mos?
respiratory FQ
B-lactam + macrolide
How should a CAP patient be treated if inpatient but non-ICU?
respiratory FQ
B-lactam + macrolide
