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CAP Flashcards

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1
Q

What is Community-acquired pneumonia (CAP) typically defined by?

A
  • Cough (productive)
  • Shortness of breath
  • Fever
  • Dullness of percussion
  • Crackles on auscultation
  • New infiltrate on chest x-ray

CAP is a common and serious illness with various clinical signs and symptoms.

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2
Q

Who is at highest risk for Community-acquired pneumonia (CAP)?

A
  • Very young
  • Very old
  • Smokers
  • People with cardiopulmonary conditions
  • Alcohol dependence
  • Immunodeficiency

These groups are more susceptible to severe outcomes from CAP.

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3
Q

What is the mortality rate for those requiring hospitalization due to CAP?

A

8–10%

The mortality rate can rise to up to 40% for patients requiring treatment in an ICU.

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4
Q

Which microorganism accounts for about 50% of all cases of CAP that require hospital admission?

A

Streptococcus pneumoniae

This bacterium is a common cause of severe pneumonia.

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5
Q

In a CDC cohort study, what percentage of hospitalized CAP patients had a causative organism detected?

A

About 40%

Of those, viruses were detected in about 25% and bacteria in about 10%.

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6
Q

What are the most common pathogens detected in hospitalized CAP patients?

A
  • Human rhinovirus (9%)
  • Influenza virus (6%)
  • S. pneumoniae (5%)

These pathogens are frequently identified in cases of CAP.

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7
Q

True or false: Mycobacterium tuberculosis complex is a common cause of pneumonia.

A

FALSE

It is an uncommon and often forgotten cause of pneumonia, particularly in specific high-risk populations.

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8
Q

What are the goals of therapy for Community-acquired pneumonia (CAP)?

A
  • Assess severity of pneumonia
  • Relieve symptoms
  • Prevent morbidity
  • Prevent transmission
  • Prevent recurrence

These goals guide the management of CAP.

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9
Q

What symptoms should be particularly noted during the history and physical examination for CAP?

A
  • Cough
  • Shortness of breath
  • Pleuritic chest pain
  • Hemoptysis
  • Sputum production
  • Fever
  • Chills
  • Myalgia
  • Headache
  • Arthralgia
  • New-onset confusion

These symptoms help in diagnosing CAP.

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10
Q

What is the most sensitive and specific sign of severe pneumonia in adults?

A

Respiratory rate ≥30 breaths/minute

In patients under 50 years of age, a respiratory rate ≥25 may indicate severe pneumonia.

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11
Q

What should be measured in all patients with CAP presenting to the emergency department?

A

Oxygen saturation

If oxygen saturation is <92% in a COPD patient, arterial blood gas should be performed.

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12
Q

What is the Pneumonia Severity Index (PSI) used for?

A

To predict 30-day mortality rates among patients with CAP

It helps in deciding whether to treat patients as outpatients or in the hospital.

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13
Q

What does the CURB-65 score predict?

A

Risk of death

It assigns points based on specific clinical criteria to assess mortality risk.

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14
Q

What is the recommended initial therapy for penicillin-susceptible Streptococcus pneumoniae?

A
  • Penicillin G
  • Amoxicillin

Alternatives include macrolides and IV cephalosporins.

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15
Q

What should be used for severe pneumonia or patients at high risk for resistant pathogens?

A

Piperacillin/tazobactam

It is reserved for specific cases due to the risk of resistant pathogens.

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16
Q

What is the first choice antibiotic for outpatients with CAP?

A

Amoxicillin

Alternatives include amoxicillin/clavulanate or doxycycline.

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17
Q

What are the common laboratory tests for hospitalized patients with CAP?

A
  • Electrolytes
  • Glucose
  • Urea
  • Creatinine
  • CBC and differential WBC count

These tests help assess the patient’s overall health and guide treatment.

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18
Q

What are the first-line treatments for Legionnaires’ disease?

A
  • Fluoroquinolones
  • Azithromycin
  • Alternative: Doxycycline

Fluoroquinolones and azithromycin are preferred, with doxycycline as an alternative.

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19
Q

Which pathogens are associated with community-acquired pneumonia (CAP)?

A
  • Mycoplasma pneumoniae
  • Chlamydophila pneumoniae
  • Coxiella burnetii (Q fever)
  • Pseudomonas aeruginosa

These pathogens are common causes of CAP and require specific antibiotic treatments.

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20
Q

What is the recommended duration of antibiotic therapy for patients treated on an ambulatory basis?

A

Minimum of 5 days

Hospitalized patients may be treated for 5-7 days if they respond to treatment within 48 hours.

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21
Q

What are the two distinct clinical entities of aspiration pneumonia?

A
  • Aspiration pneumonitis
  • Aspiration pneumonia

Aspiration pneumonitis is due to gastric contents, while aspiration pneumonia results from bacterial infection.

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22
Q

True or false: Aspiration pneumonitis requires antibiotic therapy.

A

FALSE

Aspiration pneumonitis does not require antibiotic treatment.

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23
Q

What are the effective treatments for Methicillin-Resistant Staphylococcus aureus (MRSA) pneumonia?

A
  • Vancomycin
  • Linezolid

Linezolid should be used only in consultation with an infectious diseases specialist.

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24
Q

What are the benefits of corticosteroids in treating severe pneumonia?

A
  • Reduction in all-cause mortality
  • Less likelihood of requiring mechanical ventilation
  • Shorter time to clinical stability
  • Shorter hospital stay

Corticosteroids may have adverse effects but provide significant benefits in severe cases.

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25
What is the recommended treatment for **influenza pneumonia**?
* Neuraminidase inhibitors (oseltamivir, zanamivir) ## Footnote These treatments are recommended for influenza A or B virus infection.
26
What is the recommendation for **antibiotic use** in patients with **COVID-19 pneumonia**?
Antibiotics should not be routinely prescribed ## Footnote They should only be considered if bacterial co-infection is strongly suspected.
27
What is the recommended **influenza vaccination** strategy for individuals over 6 months of age?
Annual influenza vaccination ## Footnote This is especially important for those at high risk of complications.
28
What are the two types of **pneumococcal vaccines** available in Canada?
* Polysaccharide vaccine (Pneu-P-23) * Conjugate vaccines (e.g., Pneu-C-10, Pneu-C-13) ## Footnote Conjugate vaccines offer longer duration of immunogenicity.
29
What is the recommended interval between administering older and newer **pneumococcal vaccines**?
1-year gap ## Footnote An 8-week interval may be appropriate for some immunocompromised individuals.
30
What is the effect of **tobacco smoking** on the risk of invasive pneumococcal pneumonia?
2-fold increase in risk ## Footnote Smoking cessation is likely to reduce pneumonia rates.
31
What posture may help reduce the occurrence of **aspiration pneumonia**?
Chin down posture ## Footnote This posture protects the airway during swallowing.
32
What is the recommended treatment for **community-acquired pneumonia (CAP)** in pregnant patients?
* High-dose amoxicillin * Beta-lactam and macrolide (e.g., erythromycin or azithromycin) ## Footnote Treatment should be tailored based on local resistance rates.
33
What is the recommended duration of therapy for **uncomplicated CAP**?
Minimum of 5 days ## Footnote Clinical improvement is expected within 48-72 hours.
34
Treatment failures may be encountered in up to **15%** of cases; what should be chosen if the infecting agent is identified?
a broad-spectrum regimen or more specific treatment ## Footnote This highlights the importance of tailoring treatment based on the identified pathogen.
35
The antimicrobials recommended in pregnancy are considered compatible with **breastfeeding**. True or False?
TRUE ## Footnote This includes those for MRSA.
36
Pregnant patients should be immunized against **influenza** due to the high risk of complications. What other vaccination is recommended for those at higher risk of pneumococcal disease?
Pneumococcal vaccination ## Footnote Recommended for patients with conditions like immunosuppression, diabetes, and other chronic diseases.
37
The **COVID-19 vaccination** is safe in pregnancy and during breastfeeding. What should be offered to eligible pregnant or breastfeeding individuals?
vaccination against COVID-19 (primary series and/or booster doses) ## Footnote This can be administered at any time during pregnancy if no contraindications exist.
38
What are some **primary prevention strategies** to reduce the risk of respiratory infections?
* handwashing * limiting contact with sick individuals ## Footnote These strategies are particularly important for pregnant and breastfeeding patients.
39
For empiric therapy in CAP, what should be administered if the patient has received antibiotics within the **3 months** prior to diagnosis?
an agent from a different therapeutic class ## Footnote This helps to avoid resistance and ensure effective treatment.
40
Erythromycin monotherapy is not routinely recommended in patients with **COPD** due to its lowered activity against which pathogen?
H. influenzae ## Footnote This emphasizes the need for effective antibiotic selection in COPD patients.
41
What does evidence from 1 randomized controlled trial suggest about **early mobilization** during management of CAP?
can reduce length of stay ## Footnote Early mobilization is an important aspect of patient recovery.
42
True or False: Regimens that include **atypical coverage** result in better outcomes than those that do not.
FALSE ## Footnote There is no evidence supporting the superiority of atypical coverage in hospitalized patients.
43
What criteria should be met before switching from **parenteral therapy** to oral antibiotics?
* GI tract functioning normally * hemodynamically stable * 2 normal temperature readings * normalized white blood cell count * subjective improvement in cough and shortness of breath * able to consume oral medications ## Footnote These criteria ensure patient readiness for oral therapy.
44
What are the criteria for **discharging** a patient with pneumonia?
* absence of complications from pneumonia * absence of complications from comorbid illnesses * absence of complications from treatment * physiological stability ## Footnote Physiological stability includes oxygen saturation, pulse rate, and respiratory rate.
45
What should be reviewed and immunized if indicated for patients **≥65 years** of age or those suffering from recurrent pneumonia episodes?
pneumococcal and influenza vaccine status ## Footnote This is crucial for preventing recurrent pneumonia.
46
What is the **dosage** for cefazolin in the treatment of CAP?
1–2 g Q8H IV ## Footnote Cefazolin is a first-generation cephalosporin used for methicillin-sensitive S. aureus pneumonia.
47
What are the **adverse effects** of ciprofloxacin?
* GI upset * headache * dizziness * photosensitivity * QTc interval prolongation * hypoglycemia * C. difficile-associated diarrhea ## Footnote Ciprofloxacin should be avoided in children due to cartilage toxicity.
48
What is the **dosage** for azithromycin in treating mild to moderate CAP?
500 mg on first day then 250 mg daily for 4 days ## Footnote A 5-day course is adequate for treatment.
49
What is the **cost** of the pneumococcal 20-valent conjugate vaccine (Pneu-C-20)?
$120 ## Footnote This vaccine is administered as a single 0.5 mL dose IM.
50
What are the **local reactions** associated with the pneumococcal 15-valent conjugate vaccine?
* erythema * swelling * pain at the injection site * palpable nodule at the injection site ## Footnote These reactions may persist for several weeks.
51
What is the **cost** of **Prevnar 20**?
$120 ## Footnote Single 0.5 mL dose IM.
52
How many doses of **Prevnar 20** are recommended for **HSCT recipients**?
3 doses starting 3–9 months after transplant ## Footnote This vaccination schedule is crucial for immunocompromised individuals.
53
What are the **local reactions** associated with **Prevnar 20**?
* Erythema * Swelling * Pain at the injection site * Palpable nodule at the injection site ## Footnote Erythema appears red in light skin tones and violaceous in dark skin tones.
54
What are the **systemic reactions** associated with **Prevnar 20**?
* Fever * Irritability * Fussiness * Drowsiness * Decreased appetite * Increased or decreased sleep ## Footnote These reactions may vary in intensity among individuals.
55
Who does the **NACI** recommend to receive **Pneu-C-20** or **Pneu-C-21**?
* Adults ≥65 y * Adults 50–64 y with conditions increasing risk of IPD * Immunocompromised adults <50 y ## Footnote This recommendation applies regardless of prior pneumococcal vaccination if ≥1 y has elapsed since last vaccination.
56
What is the **cost** of **pneumococcal 21-valent conjugate vaccine (Pneu-C-21)**?
$140 ## Footnote Single 0.5 mL dose IM.
57
What is the **drug class** of **Pneu-C-21**?
Pneumococcal vaccines, polysaccharide ## Footnote This class includes various vaccines targeting pneumococcal disease.
58
What is the **cost** of the **pneumococcal 23-valent polysaccharide vaccine (Pneu-P-23)**?
$40 ## Footnote Single 0.5 mL dose IM/SC.
59
What is recommended for certain **immunocompromised individuals** regarding **Pneu-P-23**?
A booster dose ## Footnote Specific guidelines can be found in the CIG pneumococcal vaccines chapter.
60
Is **Pneu-P-23** recommended for routine use in adults in Canada?
Not recommended ## Footnote Use only when Pneu-C-20 and Pneu-C-21 are not suitable.
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