Community Acquired Pneumonia Tutoring By Alaina Darby

JD is a 75 yo WF who has COPD from years of cigarette smoking JD is a 75 yo WF who has COPD from years of cigarette smoking. She is being treated for GERD and diabetes and currently lives in a nursing home. Which of the following increases the chances of pneumonia without increasing negative bacterial colonization? Age COPD GERD therapy Nursing home

JD is a 75 yo WF who has COPD from years of cigarette smoking JD is a 75 yo WF who has COPD from years of cigarette smoking. She is being treated for GERD and diabetes and currently lives in a nursing home. Which of the following would be a symptom that would be most age-specific? High fever Chest pain Severe chill Lethargy

JD is a 75 yo WF who has COPD from years of cigarette smoking JD is a 75 yo WF who has COPD from years of cigarette smoking. She is being treated for GERD and diabetes and currently lives in a nursing home. Which of the following lab values would you most expect to see for WBC’s? Increased bands Decreased segs WBC 4,000 WBC 12,000

JD is a 75 yo WF who has COPD from years of cigarette smoking JD is a 75 yo WF who has COPD from years of cigarette smoking. She is being treated for GERD and diabetes and currently lives in a nursing home. Which of the following lab values would be least likely to check? CXR PaO2 Blood culture Sputum culture

FK is a college student who presents with an abrupt chill, chest pain, and a high fever. A sputum culture is taken, but nothing is cultured. What diagnosis is most likely? Klebsiella pneumonia Anaerobic pneumonia Mycoplasma pneumonia Probably not pneumonia… look for something else

JD is an alcoholic who presents with an abrupt chill, chest pain, and bloody sputum. A sputum culture is taken, and red rods are present. What diagnosis is most likely? Klebsiella pneumonia Anaerobic pneumonia Mycoplasma pneumonia Probably not pneumonia… look for something else

SO is a 55 yo WM who presents with pneumonia symptoms SO is a 55 yo WM who presents with pneumonia symptoms. The following are his relevant lab values: BUN 15 CrCl 75 RR 22 BG 155 (fasting) BP 85/65 HR 105 Which value is not considered when determining severity? BUN BP BG RR

SO is a 55 yo WM who presents with pneumonia symptoms SO is a 55 yo WM who presents with pneumonia symptoms. The following are his relevant lab values: BUN 15 CrCl 75 RR 22 BG 155 (fasting) BP 85/65 HR 105 How should the patient be treated? Watch and wait Outpatient Inpatient (general ward) Inpatient (ICU)

SO is a 55 yo WM who presents with pneumonia symptoms SO is a 55 yo WM who presents with pneumonia symptoms. The following are his relevant lab values: BUN 15 CrCl 75 RR 22 BG 155 (fasting) BP 85/65 HR 105 What if the patient was 75? Watch and wait Outpatient Inpatient (general ward) Inpatient (ICU)

Remember the abbreviations!! CURB - 65 Confusion Uremia Respiratory Rate Blood Pressure 65 years or older Determines treatment... admit or no? SMART-COP Systolic BP Multilobar infiltrates Albumin Respiratory Rate Tachycardia Confusion O2 pH ICU admission?

Which of the following is the most frequent cause of CAP in outpatients? S. pneumonia H. influenza C. pneumonia Viruses

Which of the following conditions is least likely to lead to a foul smelling, polymicrobial pneumonia? Alcoholism Aspiration COPD IV drug use

Upper Respiratory Tract Infections Tutoring Alaina Darby

CK is a 8 week old WM whose mother is worried about his risk of ear infections, since his older brother and sister have had many ear infections in the past. What would not be a step that would be beneficial in reducing his risk? Proper immunizations Pacifier use Breastfeeding Not smoking

When CK is 4 months old, he develops ear pain When CK is 4 months old, he develops ear pain. The tympanic membrane is moderately bulging. How should he be diagnosed? Definitively AOM Possibly AOM Not AOM

OME AOM! Fluid ONLY Fluid + Infection ROM 3 in 6 mo 4+ in 12 mo Definite: Moderate/severe bulging OR New onset of fluid drainage Maybe: Mild bulging + 48 hours or less ROM 3 in 6 mo 4+ in 12 mo

When CK is 4 months old (10 kg), he develops ear pain When CK is 4 months old (10 kg), he develops ear pain. The tympanic membrane is moderately bulging. His ear pain is moderate and has lasted for almost 24 hours. It is present in one ears. His temperature is 102F. How would you treat him? Watchful waiting Augmentin 900/64 mg PO BID Amoxcillin 450 mg PO BID Ceftriaxone 500 mg IM Q day

If CK fails the amoxicillin after 48 hours, how should you treat him? Augmentin 450/32 mg PO BID Clindamycin 100 mg PO TID Ceftriaxone 500 mg IM Q day Clindamycin + Ceftriaxone

When is prophylaxis recommended? Pneumovax for 4 mo and high risk Pneumovax for 3 yo and high risk Amoxcillin for 4 mo with 3 episodes in 6 months Amoxcillin for 3 yo with 3 episodes in 6 months

BR (5 month old WM) starts having middle ear effusion 2 months after his last ear infection. What should be done? Watchful waiting x 1 month Watchful waiting x 3 months Watchful waiting x 6 months Treat ASAP

BR (18 month old WM) starts having middle ear effusion 2 months after his last ear infection. What should be done? Watchful waiting x 1 month Watchful waiting x 3 months Watchful waiting x 6 months Treat ASAP

PQ is a 2 YO WF with a sore throat, headache, and cough PQ is a 2 YO WF with a sore throat, headache, and cough. What should be administered? Penicillin V Azithromycin Amoxcillin Nothing

ST is a 22 YO WF with a sore throat and headache. RADT is negative ST is a 22 YO WF with a sore throat and headache. RADT is negative. What should be done? Throat culture Redo RADT Nothing

FT is a 2 YO WM (25 kg). RADT comes back negative but his throat culture is positive for GABHS. How should he be treated? Amoxcillin 1000 mg Q day Amoxcillin 100 mg BID x 10 days Penicillin V 500 mg BID x 10 days Benzathine PCN IM 600,000 units x 1

FT is a 2 YO WM (25 kg). RADT comes back negative but his throat culture is positive for GABHS. How should he be treated if allergic to PCN? Cetriaxone IM x 1 Azithromycin PO x 10 days Clarithromycin PO x 5 days Cephalexin PO x 10 days