Intern Year: Tintinalli- Section 8-Ch 68-Cap, Aspiration Pneumonia, Nonifectious Pulmonary Infiltrates

Front 1

what two organisms cause the most severe CAP in adults?

Back 1

Strep pneumo

Legionella

Front 2

Given the following symptoms and sputum findings, give the bacterial pneumonia that causes it:

Sudden onset fever, rigors, pleuritic CP, productive cough dyspnea

rust colored; gram positive encapsulated diplocci

Back 2

Strep pneumo

CXR: lobar infiltrate, occasionally patchy, occasional pleural effeusion

Front 3

given the following sputum finding, give the causal agent:

rust colored; gram positive encapsulated diplocci

Back 3

Strep pneumo

CXR: lobar infiltrate, occasionally patchy, occasional pleural effeusion

Front 4

Given the following symptoms and sputum findings, give the bacterial pneumonia that causes it:

gradual onset of productive cough, fever, dyspnea, especially just after viral illness

purulent; gram positive cocci in clusters

Back 4

Staph Aureus

CXR: patchy, multilobar infiltrate; empyema, lung abscess

Front 5

given the following sputum finding, give the causal agent:

purulent; gram positive cocci in clusters

Back 5

Staph Aureus

CXR: patchy, multilobar infiltrate; empyema, lung abscess

Front 6

Given the following symptoms and sputum findings, give the bacterial pneumonia that causes it:

Sudden onset, rigors, dyspnea, CP, bloody sputum, especially in alcoholics or nursing home pts

brown currant jelly; thick short, plump, gram negative encapsulated paired coocobacili

Back 6

Klebsiella pneumoniae

CXR: upper lobe infiltrate, bulging fissure sign, abscess formation

Front 7

given the following sputum finding, give the causal agent:

brown currant jelly; thick short, plump, gram negative encapsulated paired coocobacili

Back 7

Klebsiella pneumoniae

CXR: upper lobe infiltrate, bulging fissure sign, abscess formation

Front 8

Given the following symptoms and sputum findings, give the bacterial pneumonia that causes it:

Recently hospitalized, debilitated, or immunocompromised pt with fever dyspnea, cough

gram neg coccobacilli

Back 8

Pseduomonas aeruginosa

CXR: patchy infiltrate wtih frequent abscess formation


i kinda remember this being an agent on ventilators

Front 9

Given the following symptoms and sputum findings, give the bacterial pneumonia that causes it:

gradual onset, fever, syspnea, pleuritic CP, especially in elderly and COPD

short tiny gram negative encapsulated coccobacilli

Back 9

Haemophilus influenzae

CXR: patchy, frequently basilar infiltrate, occasional pleural effusion

Front 10

Given the following symptoms and sputum findings, give the bacterial pneumonia that causes it:

Fever, chills, headache, malaise, dry cough, dyspnea, anorexia, diarrhea, nausea, vomiting


few neutrophils and no predominant bacterial species

Back 10

Legionella pneumophila (look for old folks)

CXR: multiple patchy nonsegmented infiltrates, progresses to consolidation, occasional cavitation and pleural effusion

Front 11

Given the following symptoms and sputum findings, give the bacterial pneumonia that causes it:

indolent course of cough, fever, sputum and chest pain; more common in COPD pts

gram negative diplocci

Back 11

Moraxella catarrhalis

CXR: diffuse infiltrates

Front 12

Given the following symptoms and sputum findings, give the bacterial pneumonia that causes it:

Gradual onset, fever, dry cough, wheezing, occasionally sinus sx

few neutrophils, organsims not visible

Back 12

Chlamydophila pnuemoniae

CXR: patchy subsegmental infiltrates

Front 13

Given the following symptoms and sputum findings, give the bacterial pneumonia that causes it:

upper and lower resp tract sx, non productive cough, bullous myringitis, HA, malaise, fever

few neutrophils, organisms not visible

Back 13

Mycoplasma pneumoniea

CXR: Interstitial infiltrates (reticulonodular pattern) patchy densities occasional consolidation

Front 14

Given the following symptoms and sputum findings, give the bacterial pneumonia that causes it:

gradual onset, putrid sputum, especially in alcoholics

purulent; multiple neutrophils and mixed organisms

Back 14

Anaerobic organisms

CXR: consolidation of dependent portion of lung, abscess formation

Front 15

________ pneumonia responds to a variety of abx, although there is an increased incidence of PCN, macrolide, and FQ resistant strains

Back 15

Pneumococcal

Front 16

the atypical pneumonias lack a cell wall and do not respond well to b-lactams. What are the atypicals and what do they respond to

Back 16

Legionella
Chlamydophila
Mycoplasma

Macrolides and FQs

Front 17

there is no seasonality to this type of pneumonia, making it a more prominent cause of pneumonia in the summer when other pathogens decline in frequency

Back 17

Legionella

Front 18

This type of pneumonia is commonly complicated by GI sx including abdominal pin, vomiting, and diarrhea

Back 18

Legionella

Front 19

T/F

Most pts do not require identification of a specific organsim through blood or sputum analysis to direct Abx tx

Back 19

TRUE

Front 20

most common pathogen causing pneumonia in alcoholics?

Back 20

still s. pneumo

but kleb and haemophilus are others to think about

Front 21

give pathogens that are more likely to be seen in diabetics with pneumonia

Back 21

S. Aureus
Gram neg bacteria
Mucor
Mycobacterium tuberculosis

Front 22

chest radiography is recommended for pregnant pts with sx of resp tract infection and ____ exposure

Back 22

varicella

look for smokers, and skin lesions

Front 23

most common cause of AIDS related death in pregnant women?

Back 23

PCP pneumonia

Front 24

_____ is the most common serious viral infection in the elderly

Back 24

Influenza

Front 25

Postinfluenza bacterial pneumonia, whether following H1N1 or other seasonal influenza is most commonly caused by what 3 bugs?

Back 25

s pneumo

s aureus

h influ

Front 26

most frequently reported pathogens among pts with nursing home acquired pneumonia are?

Back 26

S. Pneumo

gram neg bacilli

h influ

Front 27

most common cause of bacterial pnuemonia in pts with HIV

Back 27

s pneumo

Front 28

non-hodgkin lymphoma, kaposi sarcoma, and adenocarcinoma of the lung are the 3 leading causes of noninfectious pleural effusion in what group of pts?

Back 28

HIV

Front 29

T/F

bacterial pnuemonia is less common after renal transplantation, but more common in pts receiving liver, heart, or lung transplants during the first 3 mo after surgery

Back 29

TRUE

Front 30

outpatient CAP tx options?

Back 30

Macrolide

or

tetracycline

Front 31

outpatient CAP tx options for pts with significant comorbidities

Back 31

FQ

or B-lactamase inhibitor plus macrolide

Front 32

Inpt therapy for CAP (non-ICU pt)

Back 32

FQ

or

ceph + macrolide

Front 33

Emperic therapy for suspected HAP icludes coverage for what 3 things

Back 33

Pseudomonas (Cefempime/Ceftazidime/Imipenem/Meropenem/Piperacillin-tazobactam)

FQ tx (Cipro)

Anti MRSA (Vanc)

Front 34

Note that FQs should be saved for pts that have intolerance to other agents or who have known resistance to other agents

they also shouldn't be used in pts with what disease

Back 34

Myasthenia gravis

also reports of hepatic tox

Front 35

What is CURB-65 and what is it used for?

Back 35

it helps predict mortality for pts with pneumonia... score <2 is good (low mortality rate)

Confusion
Uremia>7mmol/L
RR>30
BP<60mmHg

Front 36

the general consensus is that aspiration of gastric contents with pH < ____ and an apsirated volume of 0.3-0.4mL/kg are required to develop aspiration pneumonitis

Back 36

2.5

Front 37

T/F

Prophylactic antibiotics are not recommneded and there is no evidence that corticosteroids prevent lung injury in aspiration pneumonitis

Back 37

TRUE