Podcast
Questions and Answers
What is the typical duration between exposure to the virus and the appearance of symptoms?
What is the typical duration between exposure to the virus and the appearance of symptoms?
What is a common symptom of pneumonia that is NOT typically associated with COVID-19?
What is a common symptom of pneumonia that is NOT typically associated with COVID-19?
What physical sign is often evident in patients with pneumonia?
What physical sign is often evident in patients with pneumonia?
What is a common gastrointestinal symptom of COVID-19?
What is a common gastrointestinal symptom of COVID-19?
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What is a common respiratory symptom of pneumonia?
What is a common respiratory symptom of pneumonia?
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What is the treatment approach for a patient with Community-Acquired Pneumonia (CAP) when the etiology is unknown?
What is the treatment approach for a patient with Community-Acquired Pneumonia (CAP) when the etiology is unknown?
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What is the threshold for PaO2/FiO2 ratio to classify as a minor criterion for severe CAP?
What is the threshold for PaO2/FiO2 ratio to classify as a minor criterion for severe CAP?
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What is the type of ventilation required for a patient with severe CAP who meets the major criterion?
What is the type of ventilation required for a patient with severe CAP who meets the major criterion?
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What is the BUN level threshold to classify as a minor criterion for severe CAP?
What is the BUN level threshold to classify as a minor criterion for severe CAP?
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What is the type of organism that would be treated with specific antibiotics?
What is the type of organism that would be treated with specific antibiotics?
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What is the recommended treatment for a previously healthy outpatient with no comorbidities or risk factors for 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?
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Which of the following is not a recommended treatment option for a non-severe inpatient pneumonia?
Which of the following is not a recommended treatment option for a non-severe inpatient pneumonia?
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What is the recommended treatment for a patient with comorbidities, such as chronic heart disease, lung disease, or liver disease?
What is the recommended treatment for a patient with comorbidities, such as chronic heart disease, lung disease, or liver disease?
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What is the recommended treatment for a patient with severe inpatient pneumonia and no risk factors for MRSA or Pseudomonas aeruginosa?
What is the recommended treatment for a patient with severe inpatient pneumonia and no risk factors for MRSA or Pseudomonas aeruginosa?
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What is the recommended treatment for a patient with severe inpatient pneumonia and risk factors for MRSA or Pseudomonas aeruginosa?
What is the recommended treatment for a patient with severe inpatient pneumonia and risk factors for MRSA or Pseudomonas aeruginosa?
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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.