PAEA Internal Medicine EOR Pulmonology 15% Exam Study
Guide Questions And Answers Verified 100% Correct
CAP Dx - ANSWER CXR/CT: (remember cxr resolution lags behind clinical improvement for weeks).
A pleural effusion may be present
-1. Abcess formation in S. aureus
-2. Upper lobe (esp RUL) with bulging fissure, cavitations - think klebsiella
Sputum (stain/culture): rusty - strep, currant jelly - klebsiella, green sputum - h flu or pseudomonas, foul
smelling - anaerobes
CAP Tx - ANSWER • Empiric antibiotic options for outpatients with CAP who do not require
hospitalization: o Macrolides - Clarithromycin OR azithromycin o Doxycycline
• Treatment of inpatients with CAP - divided into medical ward vs. ICU o
General medical floor ward:
* Anti-pneumococcal beta-lactam - Ceftriaxone, cefotaxime, or ampicillin-sulbactam PLUS
* Macrolide - Azithromycin or clarithromycin
OR
* Monotherapy with a fluoroquinolone -
o ICU pts:
* beta lactam PLUS IV azithromycin
OR
* IV fluoroquinolone PLUS/ IV vancomycin (MRSA)
HAP Hospital Acquired Pneumonia info/pathogens - ANSWER • Pneumonia developing more than
48 hours after admission
,Pathogens:
• Most common organisms: Pseudomonas o Aerobic gram negative: Enterobacter, Klebsiella
pneumoniae o Aerobic gram positive S. aureus,
HAP Sx - ANSWER • Symptoms/Signs = nonspecific
• Fever, leukocytosis, purulent sputum
• New or progressive pulmonary infiltrate on CXR typically are present in most patients
HAP Dx - ANSWER LABS:
• Blood cultures (+) in 20%
• Arterial blood gas or pulse oximetry
• CBC and chemistry
• Thoracentesis
• Gram stains and cultures of sputum
• Endotracheal aspiration and fiberoptic bronchoscopy
IMAGING:
• Chest X-Ray
• Nonspecific
• Patchy airspace infiltrates OR lobar consolidation with air bronchograms OR diffuse alveolar or
interstitial infiltrates
• Can include pleural effusions and cavitation
HAP Tx - ANSWER Use two antipseudomonal agents o
One of the following:
* Cefepime or ceftazidime
* Imipenem or meropenem
* Piperacillin-tazobactam
, o PLUS another antipseudomonal agent *
Levofloxacin or ciprofloxacin
* Gentamicin, tobramycin, or amikacin
o PLUS vancomycin if MRSA is suspected
HIV DISEASE AND PNEUMOCYSTIC JIROVECI PNEUMONIA info - ANSWER • Pneumocystic jiroveci
pneumonia is the most common opportunistic infection in HIV. MC if CD4 count <200
HIV DISEASE AND PNEUMOCYSTIC JIROVECI PNEUMONIA Sx - ANSWER Fever, DOE, dry cough, O2
desaturation with ambulation*
HIV DISEASE AND PNEUMOCYSTIC JIROVECI PNEUMONIA Dx - ANSWER LABS:
• increased LDH (lactic dehydrogenase) (>200U/L)
IMAGING:
• CXR:
o Bilateral diffuse interstitial infiltration
HIV DISEASE AND PNEUMOCYSTIC JIROVECI PNEUMONIA Tx and prevention - ANSWER •
Trimethoprim-sulfamethoxazole (TMP-SMX)-->Bactrim
• +/- Prednisone (if O2 below 80%)
Prevention:
• Prophylaxis if CD4 counts <200
• Preferred regiment for prophylaxis: TMP-SMX
Idiopathic Fibrosing Interstitial Pneumonia
(Idiopathic Pulmonary Fibrosis) - ANSWER Chronic progressive interstitial scarring (fibrosis) from
persistent inflammation.
• Specific cause unknown
Guide Questions And Answers Verified 100% Correct
CAP Dx - ANSWER CXR/CT: (remember cxr resolution lags behind clinical improvement for weeks).
A pleural effusion may be present
-1. Abcess formation in S. aureus
-2. Upper lobe (esp RUL) with bulging fissure, cavitations - think klebsiella
Sputum (stain/culture): rusty - strep, currant jelly - klebsiella, green sputum - h flu or pseudomonas, foul
smelling - anaerobes
CAP Tx - ANSWER • Empiric antibiotic options for outpatients with CAP who do not require
hospitalization: o Macrolides - Clarithromycin OR azithromycin o Doxycycline
• Treatment of inpatients with CAP - divided into medical ward vs. ICU o
General medical floor ward:
* Anti-pneumococcal beta-lactam - Ceftriaxone, cefotaxime, or ampicillin-sulbactam PLUS
* Macrolide - Azithromycin or clarithromycin
OR
* Monotherapy with a fluoroquinolone -
o ICU pts:
* beta lactam PLUS IV azithromycin
OR
* IV fluoroquinolone PLUS/ IV vancomycin (MRSA)
HAP Hospital Acquired Pneumonia info/pathogens - ANSWER • Pneumonia developing more than
48 hours after admission
,Pathogens:
• Most common organisms: Pseudomonas o Aerobic gram negative: Enterobacter, Klebsiella
pneumoniae o Aerobic gram positive S. aureus,
HAP Sx - ANSWER • Symptoms/Signs = nonspecific
• Fever, leukocytosis, purulent sputum
• New or progressive pulmonary infiltrate on CXR typically are present in most patients
HAP Dx - ANSWER LABS:
• Blood cultures (+) in 20%
• Arterial blood gas or pulse oximetry
• CBC and chemistry
• Thoracentesis
• Gram stains and cultures of sputum
• Endotracheal aspiration and fiberoptic bronchoscopy
IMAGING:
• Chest X-Ray
• Nonspecific
• Patchy airspace infiltrates OR lobar consolidation with air bronchograms OR diffuse alveolar or
interstitial infiltrates
• Can include pleural effusions and cavitation
HAP Tx - ANSWER Use two antipseudomonal agents o
One of the following:
* Cefepime or ceftazidime
* Imipenem or meropenem
* Piperacillin-tazobactam
, o PLUS another antipseudomonal agent *
Levofloxacin or ciprofloxacin
* Gentamicin, tobramycin, or amikacin
o PLUS vancomycin if MRSA is suspected
HIV DISEASE AND PNEUMOCYSTIC JIROVECI PNEUMONIA info - ANSWER • Pneumocystic jiroveci
pneumonia is the most common opportunistic infection in HIV. MC if CD4 count <200
HIV DISEASE AND PNEUMOCYSTIC JIROVECI PNEUMONIA Sx - ANSWER Fever, DOE, dry cough, O2
desaturation with ambulation*
HIV DISEASE AND PNEUMOCYSTIC JIROVECI PNEUMONIA Dx - ANSWER LABS:
• increased LDH (lactic dehydrogenase) (>200U/L)
IMAGING:
• CXR:
o Bilateral diffuse interstitial infiltration
HIV DISEASE AND PNEUMOCYSTIC JIROVECI PNEUMONIA Tx and prevention - ANSWER •
Trimethoprim-sulfamethoxazole (TMP-SMX)-->Bactrim
• +/- Prednisone (if O2 below 80%)
Prevention:
• Prophylaxis if CD4 counts <200
• Preferred regiment for prophylaxis: TMP-SMX
Idiopathic Fibrosing Interstitial Pneumonia
(Idiopathic Pulmonary Fibrosis) - ANSWER Chronic progressive interstitial scarring (fibrosis) from
persistent inflammation.
• Specific cause unknown
