Community Acquired Pneumonia (CAP)
A Grade Exam |Questions with Complete
Solutions
Urinary Antigen TEsting - Ans Available test: S. pneumoniae and Legionella pneumophila;
ONLY serotype I
- Antigen are still detected after initiation of antibiotics
A false positive Urinary Antigen testing is associated with ______________. - Ans Associated
with bacterial colonization and recent/chronic respiratory disease
Legionella PCR Testing - Ans Detects all serotypes of legionella in the sputum
Rapid Antigen Detection for Influenza - Ans Testing is highly specific and can lead to
reduced antibiotic utilizations
Acute Phase Serologic Testing - Ans -Standard for diagnosis of infection with most
atypical organism
- BAD SIDE: Testing has poor reproducibility and most therapy is completed prior to results
of the test.
CURB-65 - Ans C: Confusion (New onset disorientation to person, place, or time)
U: Uremia ( BUN > 20 mg/dL)
R: Respiratory rate ( ≥ 30 breaths/min)
B: Blood pressure
-Systolic < 90mmHg
-Diastolic ≤ 60 mmHg
,65: age ≥ 65 years
CURB-65 Scoring system - Ans Score 0-1: Can probably treated as outpatients
Score 2: Admit to hospital
Score ≥3: Assess for ICU care
What are some reasons to admit someone in the low risk group? - Ans 1) Complications
of pneumonia itself
2) Exacerbation of other underlying disease(s)
3) Inability to reliably take oral medications or receive outpatient care
4) Multiple risk factors falling just above or below score thresholds
What are the major ICU admission criteria for severe community acquired Pneumonia? - Ans 1)
Invasive mechanical ventillation
2) Septic shock requiring vasopressors
What are the minor ICU admission criteria for severe community acquired pneumonia? - Ans
1)Respiratory rate ≥ 30 breaths/min
2) Multilobar infiltrates
3) Uremia (BUN ≥ 20 mg/dL
4) Thrombocytopenia (PLT<100,000 cells/mm3)
5) Non-exposure hypothermia (Core temp < 30 C)
6) PaO2/FiO2 ratio ≤250
7) Leukopenia (WBW < 4,000 cells/mm3)
8) Hypotension requiring aggressive fluid resuscitation
, How do we assess for ICU admission for severe Community Acquired Pneumonia? - Ans - Either
of the two major criteria are absolute indications for ICU admission
-Presence of ≥ 3 minor criteria for ICU admission
Other criteria to consider when assessing for ICU admission - Ans 1) Hypoglycemia in a
nondiabetic patients
2) Acute alcoholism/Alcoholic withdrawal
3) Hyponatremia
4) Unexplained metabolic acidosis
5) Elevated Lactate level
6) Cirrhosis
7) Asplenia
8) Procalcitonin > 0.25 g/dL
9) other decompensated comorbid illness
What is the significant of measuring procalcitonin level? - Ans Procalcitonin is release
in response to bacterial toxin
What are the most commonly isolated pathogens in CAP ? - Ans 1) Streptococci pneumoniae *
2) Mycoplasma pneumoniae
3) Chlamydophila pneumoniae
4) Haemohilis influenzae
What pathogen commonly seen in outpatient setting? - Ans 1) Streptococcus pneumoniae
2) Mycoplasma pneumoniae
3) Haemophilus influenzae
4) Chlamydophila pneumoniae
A Grade Exam |Questions with Complete
Solutions
Urinary Antigen TEsting - Ans Available test: S. pneumoniae and Legionella pneumophila;
ONLY serotype I
- Antigen are still detected after initiation of antibiotics
A false positive Urinary Antigen testing is associated with ______________. - Ans Associated
with bacterial colonization and recent/chronic respiratory disease
Legionella PCR Testing - Ans Detects all serotypes of legionella in the sputum
Rapid Antigen Detection for Influenza - Ans Testing is highly specific and can lead to
reduced antibiotic utilizations
Acute Phase Serologic Testing - Ans -Standard for diagnosis of infection with most
atypical organism
- BAD SIDE: Testing has poor reproducibility and most therapy is completed prior to results
of the test.
CURB-65 - Ans C: Confusion (New onset disorientation to person, place, or time)
U: Uremia ( BUN > 20 mg/dL)
R: Respiratory rate ( ≥ 30 breaths/min)
B: Blood pressure
-Systolic < 90mmHg
-Diastolic ≤ 60 mmHg
,65: age ≥ 65 years
CURB-65 Scoring system - Ans Score 0-1: Can probably treated as outpatients
Score 2: Admit to hospital
Score ≥3: Assess for ICU care
What are some reasons to admit someone in the low risk group? - Ans 1) Complications
of pneumonia itself
2) Exacerbation of other underlying disease(s)
3) Inability to reliably take oral medications or receive outpatient care
4) Multiple risk factors falling just above or below score thresholds
What are the major ICU admission criteria for severe community acquired Pneumonia? - Ans 1)
Invasive mechanical ventillation
2) Septic shock requiring vasopressors
What are the minor ICU admission criteria for severe community acquired pneumonia? - Ans
1)Respiratory rate ≥ 30 breaths/min
2) Multilobar infiltrates
3) Uremia (BUN ≥ 20 mg/dL
4) Thrombocytopenia (PLT<100,000 cells/mm3)
5) Non-exposure hypothermia (Core temp < 30 C)
6) PaO2/FiO2 ratio ≤250
7) Leukopenia (WBW < 4,000 cells/mm3)
8) Hypotension requiring aggressive fluid resuscitation
, How do we assess for ICU admission for severe Community Acquired Pneumonia? - Ans - Either
of the two major criteria are absolute indications for ICU admission
-Presence of ≥ 3 minor criteria for ICU admission
Other criteria to consider when assessing for ICU admission - Ans 1) Hypoglycemia in a
nondiabetic patients
2) Acute alcoholism/Alcoholic withdrawal
3) Hyponatremia
4) Unexplained metabolic acidosis
5) Elevated Lactate level
6) Cirrhosis
7) Asplenia
8) Procalcitonin > 0.25 g/dL
9) other decompensated comorbid illness
What is the significant of measuring procalcitonin level? - Ans Procalcitonin is release
in response to bacterial toxin
What are the most commonly isolated pathogens in CAP ? - Ans 1) Streptococci pneumoniae *
2) Mycoplasma pneumoniae
3) Chlamydophila pneumoniae
4) Haemohilis influenzae
What pathogen commonly seen in outpatient setting? - Ans 1) Streptococcus pneumoniae
2) Mycoplasma pneumoniae
3) Haemophilus influenzae
4) Chlamydophila pneumoniae
