BCPS and PSAP ID Flashcards

According to the IDSA/ATS definition, within what timeframe must an infection occur to be classified as community-acquired pneumonia (CAP) if a patient was recently hospitalized?

Within 48 hours of hospitalization.

What pneumonia severity index (PSI) score threshold indicates that a patient with CAP requires inpatient management?

A score greater than 90.

Which two major criteria define severe community-acquired pneumonia according to the 2007 IDSA/ATS guidelines?

Septic shock requiring vasopressors and respiratory failure requiring mechanical ventilation.

The minor criterion for severe CAP regarding the PaO2/FiO2 ratio is a value less than or equal to _____.

250

What is the respiratory rate threshold used as a minor criterion for severe CAP?

Greater than 30 breaths/minute.

Which blood urea nitrogen (BUN) level is considered a minor criterion for severe CAP?

≥ 20 mg/dL

A platelet count less than _____ cells/mm³ is a minor criterion for severe CAP.

100,000

What white blood cell (WBC) count threshold defines leukopenia as a minor criterion for severe CAP?

Less than 4.0 × 10³ cells/mm³.

At what core temperature is hypothermia defined as a minor criterion for severe CAP?

Less than 36° C.

Hospital-acquired pneumonia (HAP) is defined as pneumonia occurring _____ hours or more after admission.

48

Ventilator-associated pneumonia (VAP) is defined as pneumonia arising more than _____ hours after endotracheal intubation.

48

Which organism is the most likely pathogen in CAP patients with a history of alcoholism?

Streptococcus pneumoniae (along with oral anaerobes and gram-negative bacilli like Klebsiella).

Patients with chronic obstructive pulmonary disease (COPD) are specifically predisposed to pneumonia caused by S. pneumoniae, H. influenzae, and _____.

Moraxella catarrhalis

Exposure to water sources is a specific risk factor for pneumonia caused by which organism?

Legionella pneumophila

What is the recommended first-line empiric treatment for an outpatient with CAP and no comorbidities or risk factors for MRSA/Pseudomonas?

Amoxicillin 1 g three times daily.

What is the alternative monotherapy for an outpatient with CAP and no comorbidities if penicillin is avoided?

Doxycycline.

When can a macrolide be used as monotherapy for an outpatient with CAP and no comorbidities?

Only if local pneumococcal resistance to macrolides is less than 25%.

List three chronic comorbidities that necessitate broader empiric therapy for outpatient CAP.

Diabetes, alcoholism, and congestive heart failure (or COPD, renal/liver failure, malignancy, asplenia, immunosuppression).

For outpatient CAP with comorbidities, what is the recommended dose for levofloxacin monotherapy?

750 mg once daily.

What β-lactam options are recommended in combination with a macrolide or doxycycline for outpatient CAP with comorbidities?

Amoxicillin/clavulanate, cefpodoxime, or cefuroxime.

What is the preferred empiric β-lactam/macrolide combination for hospitalized patients with non-severe CAP?

Ceftriaxone (or ampicillin/sulbactam or ceftaroline) plus a macrolide.

What is the standard minimum duration of antibiotic therapy for community-acquired pneumonia?

At least 5 days.

Under what condition should empiric MRSA coverage be added to a CAP regimen?

Prior respiratory isolation of MRSA or severe pneumonia with locally validated risk factors (e.g., recent parenteral antibiotics).

Which rapid diagnostic test can be used to de-escalate or discontinue MRSA coverage in pneumonia?

MRSA nasal PCR.

What are the options for single-agent empiric therapy in hospital-acquired pneumonia (HAP)?

Piperacillin/tazobactam, cefepime, levofloxacin, imipenem, or meropenem.

When should two antipseudomonal agents be used for HAP empiric therapy?

If the patient received antibiotics in the past 90 days, has a high risk of mortality (ventilator/shock), or has structural lung disease.

List two risk factors for multidrug-resistant (MDR) organisms specifically in ventilator-associated pneumonia (VAP).

Intravenous antibiotic therapy in the past 90 days and hospitalization for 5 days or more prior to VAP.

What is the recommended duration of antibiotic therapy for HAP and VAP?

7 days.

Which molecular class of β-lactamases includes the KPC carbapenemase?

Class A (Serine β-lactamases).

Molecular Class B β-lactamases are also known as _____ β-lactamases.

Metallo

Which β-lactamase inhibitor is uniquely effective against Class D (OXA family) CRE?

Avibactam.

Mutations in gyrA and parC genes lead to resistance against which antibiotic class?

Fluoroquinolones.

Resistance to vancomycin in Enterococcus is typically mediated by which two genes?

vanA and vanB.

What gene is responsible for altered penicillin-binding proteins in methicillin-resistant Staphylococcus?

mecA

How does the onset of influenza typically differ from that of COVID-19 or the common cold?

Influenza onset is sudden, whereas COVID-19 and the common cold are usually gradual.

What is the characteristic temperature range for influenza infection?

High (> 101° F or 38° C).

Which sign is commonly present in COVID-19 but never in influenza or the common cold?

Loss of taste/smell.

What is the difference between antigenic 'drift' and 'shift' in Influenza Type A?

Drift is a gradual change via mutations; shift is a dramatic change leading to pandemics.

By how many days do neuraminidase inhibitors typically reduce the duration of influenza symptoms?

1 to 1.5 days.

What is the standard treatment dose and duration for oseltamivir in adults with influenza?

75 mg orally twice daily for 5 days.

What is the adjusted oseltamivir dose for a patient with a CrCl of 11--30 mL/minute/1.73 m²?

30 mg once daily orally.

Which influenza medication is administered as a single intravenous dose?

Peramivir.

Why is zanamivir not recommended for patients with asthma or COPD?

Risk of bronchospasm.

What is the mechanism of action for baloxavir in the treatment of influenza?

Inhibits viral endonuclease, which is vital for initiating viral transcription.

What is the baloxavir dose for a patient weighing ≥ 80 kg?

80 mg orally once.

How long should influenza prophylaxis continue during an institutional outbreak?

At least 14 days and for 7 days after the last identified case.

What is the first-line preferred therapy for symptomatic, non-hospitalized COVID-19 patients?

Ritonavir-boosted nirmatrelvir (Paxlovid).

What is the treatment duration for Paxlovid in COVID-19?

5 days.

Which COVID-19 therapy is restricted to patients with an eGFR of ≥ 30 mL/minute?

Paxlovid (dosage reduction required if 30--59).

What is the recommended dose of dexamethasone for hospitalized COVID-19 patients receiving supplemental oxygen?

6 mg daily (oral or IV) for 10 days.

What percentage of sinusitis cases are caused by viruses?

More than 90%.

What is the clinical definition of 'double-sickening' in the context of bacterial sinusitis?

Symptoms that improve after a viral infection but then worsen on days 5 or 6.

What temperature threshold early in the course of illness suggests bacterial rather than viral sinusitis?

≥ 102.2° F (39° C).

What is the first-line empiric antibiotic therapy for bacterial sinusitis in adults?

Amoxicillin/clavulanate.

When is high-dose amoxicillin/clavulanate (2 g/125 mg BID) indicated for adult sinusitis?

In regions with high penicillin-nonsusceptible S. pneumoniae, severe infection (>102.2° F), or if the patient is over 65.

What is the recommended duration of antibiotic therapy for sinusitis in adults?

5 to 7 days.

What is the recommended duration of antibiotic therapy for sinusitis in children?

10 to 14 days.

Which antibiotic mechanism involves altered dihydropteroate synthase?

Sulfonamides.

In HAP, what is the threshold for MRSA incidence in a hospital unit that warrants empiric MRSA coverage?

Greater than 20%.

Which class of β-lactamases is characterized by not being inhibited by any currently available inhibitors?

Class B (Metallo β-lactamases).

The standard dose for amoxicillin in CAP for a patient without comorbidities is _____ TID.

1 g

Which COVID-19 treatment should only be continued after discharge if the patient still requires supplemental oxygen?

Dexamethasone.

What is the incubation period for SARS-CoV-2?

3 to 6 days.

Which molecular class of β-lactamases targets cephalosporins specifically and includes AmpC?

Class C.

In CAP treatment, what determines if a macrolide can be used as monotherapy?

Local pneumococcal resistance must be < 25%.

Name one immunomodulatory drug to consider for COVID-19 patients with rapidly increasing oxygen needs.

Baricitinib (or tofacitinib, tocilizumab, sarilumab).

Which RTI pathogen is transmitted via the hands of health care workers or contaminated respiratory equipment?

Pseudomonas aeruginosa

What is the second-line preferred therapy for non-hospitalized COVID-19 patients?

Remdesivir.

For outpatients with sinusitis who have a penicillin allergy, which second-line antibiotic is an option?

Doxycycline.

In the treatment of severe CAP in the ICU, a β-lactam must be combined with either a macrolide or a _____.

Respiratory fluoroquinolone

Which organism commonly causes pneumonia in patients following an influenza infection?

Staphylococcus aureus (or H. influenzae or S. pneumoniae).

What is the incidence of HAP among all hospitalized patients?

0.6% to 1.1%.

True or False: Pseudomonas aeruginosa has innate resistance to vancomycin.

True.

What is the recommended dose of peramivir for an adult with influenza and normal renal function?

600 mg intravenously once.

Which mechanism of resistance is specifically noted for aminoglycosides in Pseudomonas?

Decreased uptake (porins).

Name the two components of Paxlovid.

Nirmatrelvir and Ritonavir.

Which pneumonia type has the highest estimated mortality rate (20%--50%)?

Ventilator-associated pneumonia (VAP).

What duration of illness generally distinguishes bacterial from viral sinusitis?

Greater than 10 days.

Which molecular class includes SHV and TEM family β-lactamases?

Class A.

What is the age threshold over which influenza-related mortality is greatest (80% of deaths)?

65 years.

In patients aged 1 to 50 years, urinary tract infections (UTIs) occur predominantly in which biological sex?

Women

The increased incidence of UTIs in men after age 50 is primarily attributed to which physiological issue?

Prostate problems

Which organism is the most common cause of community-acquired UTIs, accounting for approximately 73% of cases?

Escherichia coli

Which gram-positive organism is a common cause of community-acquired UTIs in young women, accounting for 13% of cases?

Staphylococcus saprophyticus

While E. coli remains the most common nosocomial UTI pathogen, its incidence drops to what percentage in the hospital setting?

31%

Which two gram-negative bacilli, other than E. coli, each account for approximately 10% of nosocomial UTIs?

Pseudomonas aeruginosa and other gram-negative bacilli

UTI symptoms such as dysuria, frequency, and urgency are classic indicators of which localized infection?

Lower UTI (Cystitis)

In older adults, what are common nonspecific symptoms that may indicate a UTI instead of classic urinary signs?

Mental status changes, abdominal pain, and decreased eating/drinking

Which clinical sign involves pain upon palpation of the area over the kidneys and is characteristic of pyelonephritis?

Costovertebral angle (CVA) tenderness

A patient with systemic symptoms such as fever, chills, nausea, and vomiting along with flank pain likely has which condition?

Upper UTI (Pyelonephritis)

In the context of UTI diagnosis, what is the specific threshold for defining pyuria?

WBC > 10 cells/mm³

What is the minimum colony-forming units per milliliter (CFU/mL) required to diagnose bacteriuria in a symptomatic patient?

10² CFU/mL

Which three specific organisms are associated with a positive nitrite test in a urinalysis?

Escherichia coli, Proteus, and Klebsiella

The presence of _____ in a urinalysis is a strong diagnostic indicator of pyelonephritis.

Casts

Under what condition can a UTI diagnosis be made solely on the basis of urinalysis results?

A diagnosis cannot be made on urinalysis alone; the patient must also have symptoms.

Which three patient populations should be screened and treated for asymptomatic bacteriuria?

Pregnant women, patients undergoing endoscopic urologic procedures, and renal transplant recipients (first 30 days).

What is the recommended treatment duration for asymptomatic bacteriuria in a pregnant woman?

4 to 7 days

How many doses of antibiotics are typically required for patients undergoing endoscopic urologic procedures who have asymptomatic bacteriuria?

One or two doses

According to guidelines, should patients with functional or cognitive impairment be treated for asymptomatic bacteriuria based solely on mental status changes?

No, they must have local urinary symptoms or systemic signs of infection.

What is the recommended dosage and duration of Trimethoprim/sulfamethoxazole for uncomplicated cystitis?

160 mg/800 mg (double strength) twice daily for 3 days