Assessing Severe Community-Acquired Pneumonia (CAP)

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Questions and Answers

What is the typical duration between exposure to the virus and the appearance of symptoms?

1-7 days

1-3 days

5-21 days

2-14 days (correct)

What is a common symptom of pneumonia that is NOT typically associated with COVID-19?

Shortness of breath

Fatigue

Nausea or vomiting

Pleuritic chest pain (correct)

What physical sign is often evident in patients with pneumonia?

Egophony

Whispering pectoriloquy

Dullness to percussion

All of the above (correct)

What is a common gastrointestinal symptom of COVID-19?

Nausea or vomiting Signup and view all the answers

What is a common respiratory symptom of pneumonia?

Cough with purulent sputum Signup and view all the answers

What is the treatment approach for a patient with Community-Acquired Pneumonia (CAP) when the etiology is unknown?

Empiric treatment considering local epidemiology and drug-resistant organisms Signup and view all the answers

What is the threshold for PaO2/FiO2 ratio to classify as a minor criterion for severe CAP?

< 250 Signup and view all the answers

What is the type of ventilation required for a patient with severe CAP who meets the major criterion?

Invasive mechanical ventilation Signup and view all the answers

What is the BUN level threshold to classify as a minor criterion for severe CAP?

> 20 mg/dL Signup and view all the answers

What is the type of organism that would be treated with specific antibiotics?

MRSA or Pseudomonas aeruginosa Signup and view all the answers

What is the recommended treatment for a previously healthy outpatient with no comorbidities or risk factors for MRSA or Pseudomonas aeruginosa?

Amoxicillin or doxycycline or macrolide Signup and view all the answers

Which of the following is not a recommended treatment option for a non-severe inpatient pneumonia?

Amoxicillin/clavulanate plus doxycycline Signup and view all the answers

What is the recommended treatment for a patient with comorbidities, such as chronic heart disease, lung disease, or liver disease?

Combination therapy with amoxicillin/clavulanate or cephalosporin plus a macrolide or doxycycline Signup and view all the answers

What is the recommended treatment for a patient with severe inpatient pneumonia and no risk factors for MRSA or Pseudomonas aeruginosa?

A b-lactam plus a macrolide Signup and view all the answers

What is the recommended treatment for a patient with severe inpatient pneumonia and risk factors for MRSA or Pseudomonas aeruginosa?

A b-lactam plus a macrolide plus coverage for MRSA or Pseudomonas aeruginosa Signup and view all the answers

Study Notes

Pneumonia Severity Criteria

30-day mortality rates: 0.7%, 2.1%, 9.2%, 14.5%, 40%, 57% corresponding to 0, 1, 2, 3, 4, and 5 severity scores respectively
Low blood pressure (< 90/60) and age 65 years or greater are also important factors to consider
Reliability, oral intake, and outpatient support are other key considerations

Severe CAP – ICU Admission Criteria

Minor criteria: respiratory rate > 30 breaths/min, PaO2/FiO2 ratio < 250, multilobar infiltrates, confusion/disorientation, uremia, leukopenia, thrombocytopenia, hypothermia, and hypotension
Major criteria: invasive mechanical ventilation, septic shock requiring vasopressors
Any major criterion or 3 minor criteria warrant direct admission to the ICU

Treatment

Empiric treatment is directed at the most likely pathogens based on severity of illness, local epidemiology, and risk factors for infection with drug-resistant organisms
Outpatient treatment for previously healthy individuals without comorbidities: amoxicillin, doxycycline, or macrolide (if local pneumococcal resistance is < 25%)
Outpatient treatment for individuals with comorbidities: combination therapy with amoxicillin/clavulanate or cephalosporin and a macrolide, or monotherapy with respiratory fluoroquinolone
Inpatient treatment for non-severe pneumonia: beta-lactam plus a macrolide or a respiratory quinolone
Inpatient treatment for severe pneumonia: beta-lactam plus macrolide or fluoroquinolone, with additional coverage for MRSA or Pseudomonas aeruginosa if risk factors are present

Typical Manifestations of Pneumonia

Fever, cough (nonproductive or productive of purulent sputum), pleuritic chest pain, chills or rigors, and shortness of breath
Other symptoms: headache, nausea, vomiting, diarrhea, myalgia, arthralgia, and/or fatigue

Physical Signs of Pneumonia

Tachypnea
Dullness to percussion
Increased tactile and vocal fremitus
Egophony
Whispering pectoriloquy
Rales/crackles and rhonchi
Pleural friction rub

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Description

Determine the severity of community-acquired pneumonia (CAP) based on various criteria, including vital signs, lab results, and patient characteristics. This quiz helps healthcare professionals identify patients who require more intensive treatment and ICU admission.