Co-Morbid Illness in Low-Risk CAP Patients
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Questions and Answers

What is the expected time frame to assess the response to initial therapy for CAP?

  • 12-24 hours
  • 24-48 hours
  • 72-96 hours
  • 48-72 hours (correct)

    • Which medication should be added if MRSA pneumonia is suspected?

  • Ciprofloxacin
  • Amikacin
  • Vancomycin (correct)
  • Gentamicin

    • What parameter indicates a need to repeat the chest radiograph after treatment for CAP?

  • Blood pressure improvement
  • Lack of improvement after 72 hours (correct)
  • Improvement in oxygen saturation
  • Temperature below 38°C

    • Which vaccination is recommended for the prevention of CAP?

    <p>Influenza vaccination</p> Signup and view all the answers

    What is advised for all persons with CAP who smoke?

    <p>Smoking cessation</p> Signup and view all the answers

    Which antibiotic is recommended for MSSA community-acquired pneumonia?

    <p>Clarithromycin 500 mg BID</p> Signup and view all the answers

    What is the appropriate duration of treatment for non-bacteremic MRSA community-acquired pneumonia?

    <p>7-21 days</p> Signup and view all the answers

    In a patient with high-risk CAP and no risk for P.aeruginosa, which β-lactam antibiotic can be used?

    <p>Ceftriaxone</p> Signup and view all the answers

    Which pathogen is associated with a duration of treatment of 14-21 days for non-bacteremic cases?

    <p>Pseudomonas aeruginosa</p> Signup and view all the answers

    What is the correct antibiotic choice for treating anaerobes in patients at risk of aspiration?

    <p>Cefotaxime 1-2g q8h IV</p> Signup and view all the answers

    What is the recommended duration of treatment for patients with bacteremic Mycoplasma pneumoniae?

    <p>28 days</p> Signup and view all the answers

    What is one of the first-line treatments for Gram-negative bacilli infections?

    <p>Ceftriaxone 2 gm OD</p> Signup and view all the answers

    Which of the following therapies is indicated for patients at high risk of Pseudomonas aeruginosa?

    <p>Piperacillin-tazobactam 4.5 gm q6h</p> Signup and view all the answers

    What is the typical duration recommended for treating Legionella pneumophila?

    <p>14-21 days</p> Signup and view all the answers

    Which combination of therapies would be appropriate for high-risk patients requiring antipseudomonal coverage?

    <p>IV extended macrolides + high-dose levofloxacin</p> Signup and view all the answers

    Which of the following criteria is NOT part of the hospital discharge recommendations?

    <p>Blood pressure &gt; 120 systolic</p> Signup and view all the answers

    Which antibiotic combination may be used for treating Staphylococcus aureus infections?

    <p>Vancomycin + Moxifloxacin</p> Signup and view all the answers

    Which of the following is a recommended antibiotic for treating anaerobes in patients with aspiration risk?

    <p>Azithromycin dihydrate</p> Signup and view all the answers

    What is the appropriate management for low-risk CAP patients without contraindications?

    <p>Outpatient care</p> Signup and view all the answers

    What is the recommended antibiotic duration for most bacterial pneumonias except enteric Gram-negative pathogens?

    <p>5-7 days</p> Signup and view all the answers

    Under which circumstance would a patient with moderate- or high-risk CAP be treated?

    <p>Hospitalized for closer monitoring</p> Signup and view all the answers

    Which antibiotic is a β-lactam/β-lactamase inhibitor combination?

    <p>Amoxicillin-Clavulanate</p> Signup and view all the answers

    For which of the following etiologic agents is an extended macrolide recommended in combination with a β-lactam?

    <p>Chlamydophila pneumoniae</p> Signup and view all the answers

    What is the preferred oral treatment for patients with enteric Gram-negative bacilli?

    <p>Ampicillin-Sulbactam</p> Signup and view all the answers

    What is the initial treatment recommendation for stable patients with co-morbid illness and low-risk CAP?

    <p>Outpatient care without special considerations</p> Signup and view all the answers

    Which of the following antibiotics is NOT typically used in the treatment of moderate-risk CAP?

    <p>Tetracycline</p> Signup and view all the answers

    Which of the following best describes bronchiectasis?

    <p>It is associated with increased sputum production.</p> Signup and view all the answers

    What physical findings may be commonly observed in bronchiectasis patients?

    <p>Clubbing of the digits.</p> Signup and view all the answers

    Which type of imaging is most specific for diagnosing bronchiectasis?

    <p>Chest CT scan.</p> Signup and view all the answers

    What does diffuse bronchiectasis indicate?

    <p>Widespread bronchiectatic changes throughout the lung.</p> Signup and view all the answers

    What is a common cause of secondary lung abscesses?

    <p>HIV infection.</p> Signup and view all the answers

    What is the primary complication associated with untreated lung abscesses?

    <p>Pneumonia.</p> Signup and view all the answers

    In bronchiectasis, what is often a possible underlying cause?

    <p>Cystic fibrosis.</p> Signup and view all the answers

    What is a typical finding on X-ray imaging for bronchiectasis?

    <p>Tram tracks indicating dilated airways.</p> Signup and view all the answers

    What is one of the main goals in treating infectious bronchiectasis?

    <p>Control active infection.</p> Signup and view all the answers

    Which organism is most commonly associated with primary lung abscesses?

    <p>Anaerobic bacteria.</p> Signup and view all the answers

    What is a potential prevention strategy for patients with chronic bronchiectasis?

    <p>Gamma globulin administration for immunoglobulin deficiencies.</p> Signup and view all the answers

    Which of the following describes acute exacerbations of bronchiectasis?

    <p>They can arise from both infectious and noninfectious causes.</p> Signup and view all the answers

    What is a characteristic of cylindrical bronchiectasis?

    <p>It presents as a series of dilated airways resembling a tube.</p> Signup and view all the answers

    Which finding is typically associated with lung abscesses on imaging?

    <p>Air-fluid level.</p> Signup and view all the answers

    Study Notes

    Community-Acquired Pneumonia (CAP) Management

    • Low-risk CAP patients can be treated as outpatients if no contraindications exist.
    • Moderate- and high-risk CAP patients require hospitalization for monitoring or parenteral therapy.
    • Antibiotic options for moderate-risk CAP include β-lactam/β-lactamase inhibitor combinations, second-generation oral cephalosporins, and extended macrolides.

    Duration of Antibiotic Therapy

    • Most bacterial pneumonias treatable with antibiotics for 5-7 days.
    • MSSA community-acquired pneumonia: non-bacteremic treated for 7-14 days, bacteremic longer (up to 21 days).
    • MRSA community-acquired pneumonia: non-bacteremic treated for 7-21 days, bacteremic longer (up to 28 days).
    • Pseudomonas aeruginosa infections: 14-21 days for non-bacteremic, longer for bacteremic pneumonia.

    Hospital Discharge Criteria

    • Patient must have stable vital signs: temperature (36-37.5°C), pulse <100/min, respiratory rate (16-24/min), systolic BP >90 mmHg, and blood oxygen saturation >90%.
    • Patient should also demonstrate functioning gastrointestinal tract.

    Prevention Strategies for CAP

    • Influenza vaccination is recommended to reduce CAP incidence.
    • Pneumococcal vaccination is essential to prevent invasive pneumococcal disease in adults.
    • Smoking cessation advised for all CAP patients.

    Bronchiectasis Overview

    • Irreversible airway dilation possibly caused by infectious or non-infectious factors.
    • Characterized by physical findings such as crackles, wheezing, and sometimes clubbing of digits.
    • Categories include cylindrical, varicose, or cystic bronchiectasis, with focal and diffuse patterns.

    Diagnosis of Bronchiectasis

    • X-ray may show tram track signs, indicating dilated airways, though low sensitivity.
    • Chest CT scan is the definitive modality for confirming bronchiectasis, demonstrating bronchial wall thickening and inspissated secretions.

    Treatment Response and Management

    • Treatment of infectious bronchiectasis focuses on controlling active infection, enhancing secretion clearance, and improving bronchial hygiene.
    • Reversal of immunodeficient states and vaccination can help decrease the risk of recurrent infections.

    Lung Abscess Characteristics

    • Pus-containing necrotic lung lesions often arise from aspiration involving anaerobic bacteria.
    • Secondary lung abscesses relate to underlying conditions, such as postobstructive processes or systemic conditions like HIV.
    • Prolonged antibiotic treatment is often necessary for secondary lung abscesses based on identified pathogens and resolution documentation.

    Summary of Pneumonia

    • Pneumonia remains the leading cause of death worldwide, characterized by infection of the pulmonary parenchyma.

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    Related Documents

    Community Acquired Pneumonia, Bronchiectasis and Lung Abscess PDF

    Description

    This quiz focuses on the management of patients with community-acquired pneumonia (CAP) who also have co-morbid illnesses. It explores the criteria for outpatient care suitability and discusses specific treatment combinations for low-risk cases. Test your understanding of clinical guidelines and treatment protocols!

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