15 Questions
What is the typical duration between exposure to the virus and the appearance of symptoms?
2-14 days
What is a common symptom of pneumonia that is NOT typically associated with COVID-19?
Pleuritic chest pain
What physical sign is often evident in patients with pneumonia?
All of the above
What is a common gastrointestinal symptom of COVID-19?
Nausea or vomiting
What is a common respiratory symptom of pneumonia?
Cough with purulent sputum
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
What is the threshold for PaO2/FiO2 ratio to classify as a minor criterion for severe CAP?
< 250
What is the type of ventilation required for a patient with severe CAP who meets the major criterion?
Invasive mechanical ventilation
What is the BUN level threshold to classify as a minor criterion for severe CAP?
> 20 mg/dL
What is the type of organism that would be treated with specific antibiotics?
MRSA or Pseudomonas aeruginosa
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
Which of the following is not a recommended treatment option for a non-severe inpatient pneumonia?
Amoxicillin/clavulanate plus doxycycline
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
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
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
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
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.
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