PCT exam 2 CAP

The most common infectious cause of death in the US is

community acquired pneumonia

What are the two top identified organisms that cause CAP

1. strep pneumoniae

2. H. flu

What are risk factors for CAP

1. age over 65

2. DM

3. asplenia

4. chronic CV, pulmonary, renal, and/or liver disease

5. smoking and/or alcohol abuse

Pneumonia is considered a

lower respiratory tract infection

Exposure to pathogens that cause CAP occurs by

1. direct inhalation

2. aspiration of oropharyngeal contents

3. hematogenous spread from another infection site

What is the pathogenesis of pneumonia

1. impairment of host defenses

2. colonization of upper respiratory tract

3. aspiration of oropharyngeal secretions

4. pulmonary infections

What are the signs of sepsis

1. tachypnea

2. hypotension

3. hypothermia

4. leukopenia

Which atypical pathogens can cause CAP

1. mycoplasma pneumoniae

2. chlamydophila pneumoniae

3. legionella pneumophila

What type of patient may get CAP from PJP or mycobacterium

HIV positive

Which patients are at risk for pseudomonas CAP

1. cystic fibrosis

2. prior use of b-lactams within 30 days

3. prior colonization

4. severe immunocompromise

t/f: in CAP, bacterial/viral co-infections are common

true

2 multiple choice options

What are the most common signs and symptoms of CAP

1. fever

2. chills

3. dyspnea

How can CAP be diagnosed

1. physical exam/history

2. chest x-ray

3. vitals

4. respiratory gram stain

5. urinary antigens

When should a patient with CAP receive a sputum culture as per the 2019 guidelines

1. patients with severe disease

2. inpatients empirically treated for MRSA or Pseudomonas or with risk factors for these organisms

When is legionella urinary antigen testing recommended

1. cases indicated by epidemiological factors

2. adults with severe CAP

When is pneumococcal urinary antigen testing recommended

adults with severe CAP

What classifies CAP as severe

1 major risk factor or 3 or more minor risk factors

What are the major criteria for severe CAP

1. septic shock needing vasopressors

2. respiration failure requiring mechanical ventiltion

What is the minor criteria for severe CAP

1. RR over or equal to 30 breaths/min

2. PaO2/FlO2 < 250

3. multi lobar infiltrates

4. confusion/disorientation

5. BUN > 20

6. WBC < 4000

7. temp over 36 C

8. hypotension requiring fluid resuscitation

What are the risk factors for MRSA or Pseudomonas CAP

1. previous MRSA or PSA infection

2. hospitalized and received IV antibiotics

What is the recommendation regarding procalcitonin use

not recommended to determine need for initial antibiotics

Which one has more factors in its calculation

PSI

1 multiple choice option

What is the use of a CURB-65 or PSI score

determine need for hospitalization

A patient that has 90 or less PSI points is considered _______ and should be managed _______

low risk, outpatient

A patient with a PSI 91-130 is considered __________ and should be managed ________

moderate risk, inpatient

A patient with a PSI score over 130 is considered ________ and should be treated _________

high, inpatient

the PSI score is more accurate at

identifying patients as low risk

What are the limitations of the PSI score

1. overemphasis on age

2. does not account for continuing patient evaluation and improvement

What are the benefits of the CURB-65 score

1. simple

2. easier

PSI may ________ among younger patients

underestimate illness severity

Which score is now recommended

PSI

1 multiple choice option

The PSI and CURB-65 are not designed to

select the level of care

What is the recommendation for treating CAP in healthy adults without comorbidities or risk factors for antibiotic resistant pathogens

1. amoxicillin 1g TID

2. doxycycline 100mg BID

Patients with CAP who have comorbidities such as chronic heart, lung, liver, or renal disease, or DM, alcoholism, malignancy, or asplenia, should be treated with

1. augmentin plus a macrolide or doxycyline

2. levo 750mg qd

3. moxi 400mg qd

The empiric antibiotic recommendation for CAP in nonsevere inpatients without risk factors for MRSA or PSA are

1. b-lactam plus a macrolide

2. levo or moxi

3. B lactam plus doxycycline

The empiric antibiotic recommendation for CAP in severe inpatients without risk factors for MRSA or PSA are

1. B-lactam + macrolide

2. B-lactam + levo or moxi

When should you switch a patient from IV to PO

1. stable

2. able to ingest orally

3. able to high highly bioavailable agents

DO NOT routinely add ___________ for suspected aspiration pneumonia UNLESS __________ or __________ is suspected

1. anaerobic coverage

2. lung abscess

3. empyema

what are the empiric choices for MRSA

1. Linezolid

2. vancomycin

What are the empiric choices for Psuedomonas

1. pip-tazo

2. cefepime

3. carbapenem

Treatment of CAP with corticosteroids is

not recommended

Antibiotic for the treatment of CAP should be

continued until the patient achieves stability AND for 5 or more days

CAP due to MRSA or PSA should be treated for at least

7 days

What is the recommendation for routine follow up chest X-rays for patients with CAP

not needed when symptoms resolve within 5-7 days