Assessing Severe Community-Acquired Pneumonia (CAP)
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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?

    <p>Nausea or vomiting</p> Signup and view all the answers

    What is a common respiratory symptom of pneumonia?

    <p>Cough with purulent sputum</p> Signup and view all the answers

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

    <p>Empiric treatment considering local epidemiology and drug-resistant organisms</p> Signup and view all the answers

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

    <p>&lt; 250</p> Signup and view all the answers

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

    <p>Invasive mechanical ventilation</p> Signup and view all the answers

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

    <p>&gt; 20 mg/dL</p> Signup and view all the answers

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

    <p>MRSA or Pseudomonas aeruginosa</p> 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?

    <p>Amoxicillin or doxycycline or macrolide</p> Signup and view all the answers

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

    <p>Amoxicillin/clavulanate plus doxycycline</p> 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?

    <p>Combination therapy with amoxicillin/clavulanate or cephalosporin plus a macrolide or doxycycline</p> 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?

    <p>A b-lactam plus a macrolide</p> 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?

    <p>A b-lactam plus a macrolide plus coverage for MRSA or Pseudomonas aeruginosa</p> 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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    Pneumonia D2 Part1 2022 PDF

    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.

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