Pneumonia

Question 1

Pneumonia is defined as ______________.

Answer 1

infection of the lung parenchyma from the alveoli

Question 2

About how many pneumonia deaths occur each year?

Answer 2

Roughly four million (mostly in children)

Question 3

Pneumonia kills more children than _______________.

Answer 3

AIDS, measles, and malaria combined

Question 4

What is normally respiratory rate?

Answer 4

12-20

Question 5

What are factors that strongly correlate with increased risk of pneumonia?

Answer 5

• COPD
• Age
• Hospitalization
• Asthma
• Steroid use

Question 6

The gold standard for pneumonia diagnosis is ______________.

Answer 6

x-ray

Question 7

What’s the sensitivity of sputum culture in diagnosing pneumonia?

Answer 7

About 60% in pooled meta-analyses (more sensitive than Gram staining)

Question 8

Describe the differences between typical and atypical pneumonia.

Answer 8

•Typical: extracellular

• Prominent sputum
• Lobar infiltrate
• S. pneumoniae, H. influenzae, M. catarrhalis, S. aureus

•Atypical: intracellular

• Sputum less prominent
• Patchy, diffuse infiltrate
• M. pneumoniae, C. pneumoniae, L. pneumophila, viral

Question 9

Which three pneumonia subtypes have the worst mortalities?

Answer 9

• Legionella: 15%
• Unknown etiology: 13%
• S. pneumoniae: 12%

Question 10

What complications of pneumonia are most common?

Answer 10

• Effusions/empyema (11%)
• Respiratory failure (8%)
• Pneumothorax (6%)

Question 11

Why does smoker’s cough occur in the morning?

Answer 11

The cilia reactivate in the night when the person is not smoking and push debris back to the lung regions that trigger coughing.

Question 12

Explain the CURB-65 mnemonic.

Answer 12

The presence of each of the following increases mortality with CAP:

• Confusion
• Uremia (BUN greater than 7)
• RR greater than 30
• BP systolic less than 90; diastolic less than 60
• 65 years or older

0 factors: mortality almost 0
1 factor: mortality ~2%
2 factors: mortality 10% 
3 factors: mortality 15%
4 factors: 40%
5 factors: 55%

Question 13

Why is the pneumococcal vaccine not effective for prevention of pneumonia?

Answer 13

Pneumonia is a mucosal infection and the vaccine primarily prevents accumulation of bacteria in the blood.

Note: the 13-valent vaccine has been shown to have some ability to prevent pneumonia, but the strains that it covers are increasingly less common.

Question 14

Which organisms are more often found in hospitalized patients?

Answer 14

• S. aureus
• H influenzae
• L. pneumophila
• P. aeruginosa

Question 15

Most pneumococcal pneumonia occurs during the __________.

Answer 15

summer

Question 16

What are the four main treatment suggestions for treating CAP by patient characteristics?

Answer 16

• Outpatient healthy: macrolides or doxycycline
• Outpatient with co-morbidities: fluoroquinolone or macrolides and augmentin
• Inpatient: fluoroquinolone or macrolide and cephalosporin
• ICU: 3rd generation cephalosporin and fluoroquinolone or macrolide