Community Acquired Pneumonia Exam Questions And
Answers Graded A+
Community Acquired Pneumonia (CAP)
an acute infection of the pulmonary parenchyma acquired in the outpatient setting
Predisposing conditions for CAP
1) Alterations in level of consciousness
2) Alcohol consumption
3) Acidosis
4) Pulmonary edema
5) Malnutrition
6) Mechanical obstruction of a bronchus
7) Cystic fibrosis
8) COPD
9) Smoking tobacco
10) hypoxemia
11) Toxic inhalations
12) Uremia
13) Administration of immunosupressants
14) Elderly ( >=65 yrs)
15) Bronchiectasis
16) Previous pneumonia or chronic bronchitis
Symptoms occurs in CAP patients
1) Fever/Chills
2) Cough
3) Purulent sputum production
4) Dyspnea
5) Pleuritic chest pain
What is the MOST common classic symptoms of CAP?
Cough
How is the CAP symptoms different in elderly?
Elderly patients may not have classical symptom presentation mainly mental status
change.
What kind of organism should we worry about in asplenia ( functional or
anatomical) patients?
Encapsulated organism
Risk factors for Antimicrobial Resistance
1) Presence of comorbidities
2) Asplenia
3) Immunosuppressing drugs or conditions
4) Antimicrobial use within the previous 3 months
5) Regional rate of infection with high-level (MIC >=16 mcg/mL) macrolide resistant
S. pneumonia exceeds 25 %
Examples of comorbidities that put patients at risk for CAP
1) Chronic heart, lung, liver, or renal disease
2) Diabetes
, 3) Alcoholism
4) Malignancies
Example of Asplenia conditions that put patients at risk for CAP
1) Functional: Sickle cell disease
2) Anatomic: s/p splenectomy
What type of cultures are used in microbiological testing for CAP?
1) Respiratory tract specimens
2) Blood
3) Thoracentesis specimen
Name the three type of Respiratory tract specimens
1) Sputum
2) Tracheal aspirate
3) Bronchoscopic aspirate/bronchoaveolar lavage (BAL)
What is consider to be adequate for gram stain culture in a sputum sample?
1) > 25 neutrophils/fields
2) <10 squamous epithelial cells/fields
How is a gram stain from a sputum culture be useful?
1) Can broaden initial empirical coverage for less common etiologies
2) Cn validate subsequent sputum culture results
What type of test is a true respiratory sputum?
Trachela Aspirate/Bronchoalveolar lavage (BAL)
Trachela Aspirate
Lower respiratory tract sample
Bronchoalveolar lavage (BAL)
Similar to tracheal aspirate but more invasive, requires sedation and patient consent
BEST YEILD
When does Bronchoalveolar lavage (BAL) frequently used?
HCAP/VAP
What is the most common isolate organism in a blood culture?
S. pneumonae
False positive blood cultures are associated with ______________.
-Prolong hospital stay
-Coagulase negative staphylococci (EPI)
Thoracentesis specimen cultures
- Used in patients w/ pleural effusion > 5 cm in height on lateral upright chest
radiograph
-Yield w/ pleural fluid cultures is LOW, but impact on management decisions is
substantial
When is sputum culture recommended?
- ONLY be performed if a good quality specimen can obtained
- Properly transported prior to antibiotic therapy
When should tracheal aspirate culturing recommended?
For patients intubated with severe CAP
When should a blood culture be recommended?
1) optional for hospitalized patients but should be performed selectively
Answers Graded A+
Community Acquired Pneumonia (CAP)
an acute infection of the pulmonary parenchyma acquired in the outpatient setting
Predisposing conditions for CAP
1) Alterations in level of consciousness
2) Alcohol consumption
3) Acidosis
4) Pulmonary edema
5) Malnutrition
6) Mechanical obstruction of a bronchus
7) Cystic fibrosis
8) COPD
9) Smoking tobacco
10) hypoxemia
11) Toxic inhalations
12) Uremia
13) Administration of immunosupressants
14) Elderly ( >=65 yrs)
15) Bronchiectasis
16) Previous pneumonia or chronic bronchitis
Symptoms occurs in CAP patients
1) Fever/Chills
2) Cough
3) Purulent sputum production
4) Dyspnea
5) Pleuritic chest pain
What is the MOST common classic symptoms of CAP?
Cough
How is the CAP symptoms different in elderly?
Elderly patients may not have classical symptom presentation mainly mental status
change.
What kind of organism should we worry about in asplenia ( functional or
anatomical) patients?
Encapsulated organism
Risk factors for Antimicrobial Resistance
1) Presence of comorbidities
2) Asplenia
3) Immunosuppressing drugs or conditions
4) Antimicrobial use within the previous 3 months
5) Regional rate of infection with high-level (MIC >=16 mcg/mL) macrolide resistant
S. pneumonia exceeds 25 %
Examples of comorbidities that put patients at risk for CAP
1) Chronic heart, lung, liver, or renal disease
2) Diabetes
, 3) Alcoholism
4) Malignancies
Example of Asplenia conditions that put patients at risk for CAP
1) Functional: Sickle cell disease
2) Anatomic: s/p splenectomy
What type of cultures are used in microbiological testing for CAP?
1) Respiratory tract specimens
2) Blood
3) Thoracentesis specimen
Name the three type of Respiratory tract specimens
1) Sputum
2) Tracheal aspirate
3) Bronchoscopic aspirate/bronchoaveolar lavage (BAL)
What is consider to be adequate for gram stain culture in a sputum sample?
1) > 25 neutrophils/fields
2) <10 squamous epithelial cells/fields
How is a gram stain from a sputum culture be useful?
1) Can broaden initial empirical coverage for less common etiologies
2) Cn validate subsequent sputum culture results
What type of test is a true respiratory sputum?
Trachela Aspirate/Bronchoalveolar lavage (BAL)
Trachela Aspirate
Lower respiratory tract sample
Bronchoalveolar lavage (BAL)
Similar to tracheal aspirate but more invasive, requires sedation and patient consent
BEST YEILD
When does Bronchoalveolar lavage (BAL) frequently used?
HCAP/VAP
What is the most common isolate organism in a blood culture?
S. pneumonae
False positive blood cultures are associated with ______________.
-Prolong hospital stay
-Coagulase negative staphylococci (EPI)
Thoracentesis specimen cultures
- Used in patients w/ pleural effusion > 5 cm in height on lateral upright chest
radiograph
-Yield w/ pleural fluid cultures is LOW, but impact on management decisions is
substantial
When is sputum culture recommended?
- ONLY be performed if a good quality specimen can obtained
- Properly transported prior to antibiotic therapy
When should tracheal aspirate culturing recommended?
For patients intubated with severe CAP
When should a blood culture be recommended?
1) optional for hospitalized patients but should be performed selectively
