Pneumonia

Question 1

-AIDS+
-CD4 count low ( 200/mm3)
-productive cough
-RS distress
-BRONCHIAL BREATHING

Answer 1

Pneumococcal pneumonia
lobar pneumonia

Question 2

Scattered crackles unaltereted by coughing bc pus in interstitial space
-CD4 count low (< 200/mm3)

Answer 2

Pneumocystis jirovecii

Question 3

Young F
- breathlessness
-productive cough
-difficulty in speech
-fever
-CXR : circumscribed opacity in left upper zone

Answer 3

Round pneumonia
Pneumococcus Pneumonia

Question 4

Consolidation in right middle lobe
- SILHOUETTE SIGN : loss of cardiac border in CXR

Answer 4

Lobar Pneumonia - community acquired Pneumonia
Pneumococcus / Streptococcus

Question 5

Pneumococcus cause

Answer 5

Acute bacterial meningitis
Lobar pneumonia
Round pneumonia
pneumonia in AIDS + with bronchial breathing

Question 6

Pt on ventilator
-developed diffuse bilateral infiltrates

Answer 6

Ventilator associated pneumonia
- begins as respiratory bronchiolitis
-Organism : MDR Pseudomonas > Acinetobacter
-DOC : Piperacillin with Tazobactum
- infected tube non MDR - pneumococcus

Question 6

Phases of pneumonia

Answer 6

1. Phase of edema : Proteinaceous exudates
2. Red hepatization : RBC with Neutrophils
3. Grey Hepatization : infection
   - RBC lysis
   -PNM
   - Fibrin deposition in alveoli
4. Resolution : Alveolar macrophage present

Question 7

CAP pneumonia

Answer 7

Pneumococcus
Mycoplasma pneumoniae
H.Influenza

Question 7

pneumonia + GI symptoms

Answer 7

Mycoplasma pneumoniae
DOC : Azithromycin

Question 8

pneumonia + Hyponatremia + seizure
-URTI ( Pontiac fever )
-Legionaries’s disease ( spread by water droplets )

Answer 8

Legionella pneumophila

Question 9

pneumonia + contact with bird

Answer 9

Chlamydia pneumoniae

Question 10

Mx of Atypical pneumonia

Answer 10

Macrolides
Doxycycline

Question 11

pneumatocele then rupture cause pneumothorax caused by

Answer 11

Influenza A + Staph aureus

Question 12

20 y - m
- too much alcohol consumption
- slept 2 day
- while waking up- productive cough - fever-chills-purulent bronchorrhea
-CXR : air fluid level

Answer 12

Lung absence caused by Anaerobes
DOC : Clindamycin

Question 13

Aspiration pneumonia
Drug overdose
Alcohol overdose
GCS <8
Seizure

Answer 13

pneumonia caused by Anaerobes

Question 14

1’ Lung Abscess

Answer 14

Oral Anaerobes

Question 15

2’ Lung Abscess

Answer 15

Staph Aureus
Gram - bacteria

Question 16

Embolism to lungs

Answer 16

Infective endocarditis -Staph Aureus

Question 17

Alcoholic pt + Pneumonia

Answer 17

Pneumococcus Pneumonia

Question 18

Alcoholic pt + RED CURRANT JELLY SPUTUM

Answer 18

Klebsiella pneumonia / FRIEDLANDER pneumonia

Question 19

COPD + Smoker

Answer 19

H.Influenza

Question 20

Structure lung disease Eg. Cystic Fibrosis

Answer 20

Pseudomonas aeruginosa
Burkholderia cepacia

Question 21

Contact with Bats

Answer 21

Histoplasmosis

Question 22

Contact with Rabbit

Answer 22

Francisella tularensis

Question 23

Contact with Sheep/ Goat

Answer 23

Coxiella burnetti - Q fever

Question 24

Rusty sputum

Answer 24

Pneumococcal Pneumonia

Question 25

old man - pneumonia discharged from hospital - after 15 days came to hospital with MI

Answer 25

Bc of pneumolysin toxin releases by pneumococcus which activate platelets - Heparin should be given after discharge

Question 26

Examination of Pneumonia

Answer 26

- RR increase - Use of Respiratory muscle -ABG : Respiratory alkalosis - Type 2 RS failure - subcoastal recession - Tactile fremitus increased - percussion : dull - bronchial breathing - Egophony : EE heard AAA - Whispering Pectoriloquy

Question 27

Ix of Pneumonia

Answer 27

CBC : TLC INCREASED CXR : consolidation Sputum : Culture & gram stain Urine Antigen : Legionella Pneumophilia Pneumococcus Biomarker : CRP, Procalcitonin PCR of sputum/BAL adequacy of sputum sampled analyzed by -25 PMN - <10 squamous epithelium cells

Question 28

Curb 65 score

Answer 28

Parameter used to determine need for hospitalization Confusion : 1 BUN >= 7 mmol/L : 1 RR >30 /min : 1 BP < 90/60 mmHg : 1 Age > 65 y : 1 0 : OPD basis 1-2 : IPD basis >= 3 : ICU basis

Question 29

Tx of Pneumonia 0 or 1 (only age > 65 )

Answer 29

OPD Previously healthy / not received antibiotic in last 3 months - Macrolides ( clarithromycin / Azithromycin ) or Doxycycline Co-morbid condition / received antibiotic in last 3 months - Moxifloxacin or beta lactam + macrolides

Question 30

Tx of Pneumonia score 1- 2

Answer 30

Iv beta lactam + Iv Macrolides Pseudomonas : Meropenem / piperacillin - tazobctam with levofloxacin CA -MRSA : linezolid / vancomycin

Question 31

VAP Tx

Answer 31

MDR : Pseudomonas : piperacillin - tazobctam - add Amikacin for gram -ve bacteria non MDR : Pneumococcus : piperacillin - tazobctam