1. Community Acquired Pneumonia Tutoring
By Alaina Darby

2. JD is a 75 yo WF who has COPD from years of cigarette smoking
JD is a 75 yo WF who has COPD from years of cigarette smoking. She is being treated for GERD and diabetes and currently lives in a nursing home. Which of the following increases the chances of pneumonia without increasing negative bacterial colonization?
Age
COPD
GERD therapy
Nursing home

3. JD is a 75 yo WF who has COPD from years of cigarette smoking
JD is a 75 yo WF who has COPD from years of cigarette smoking. She is being treated for GERD and diabetes and currently lives in a nursing home. Which of the following would be a symptom that would be most age-specific?
High fever
Chest pain
Severe chill
Lethargy

4. JD is a 75 yo WF who has COPD from years of cigarette smoking
JD is a 75 yo WF who has COPD from years of cigarette smoking. She is being treated for GERD and diabetes and currently lives in a nursing home. Which of the following lab values would you most expect to see for WBC’s?
Increased bands
Decreased segs
WBC 4,000
WBC 12,000

5. JD is a 75 yo WF who has COPD from years of cigarette smoking
JD is a 75 yo WF who has COPD from years of cigarette smoking. She is being treated for GERD and diabetes and currently lives in a nursing home. Which of the following lab values would be least likely to check?
CXR
PaO2
Blood culture
Sputum culture

6. FK is a college student who presents with an abrupt chill, chest pain, and a high fever. A sputum culture is taken, but nothing is cultured. What diagnosis is most likely?
Klebsiella pneumonia
Anaerobic pneumonia
Mycoplasma pneumonia
Probably not pneumonia… look for something else

7. JD is an alcoholic who presents with an abrupt chill, chest pain, and bloody sputum. A sputum culture is taken, and red rods are present. What diagnosis is most likely?
Klebsiella pneumonia
Anaerobic pneumonia
Mycoplasma pneumonia
Probably not pneumonia… look for something else

8. SO is a 55 yo WM who presents with pneumonia symptoms
SO is a 55 yo WM who presents with pneumonia symptoms. The following are his relevant lab values: BUN CrCl 75 RR BG 155 (fasting) BP 85/65 HR 105 Which value is not considered when determining severity?
BUN BP BG RR

9. SO is a 55 yo WM who presents with pneumonia symptoms
SO is a 55 yo WM who presents with pneumonia symptoms. The following are his relevant lab values: BUN CrCl 75 RR BG 155 (fasting) BP 85/65 HR 105 How should the patient be treated?
Watch and wait
Outpatient
Inpatient (general ward)
Inpatient (ICU)

10. SO is a 55 yo WM who presents with pneumonia symptoms
SO is a 55 yo WM who presents with pneumonia symptoms. The following are his relevant lab values: BUN CrCl 75 RR BG 155 (fasting) BP 85/65 HR 105 What if the patient was 75?
Watch and wait
Outpatient
Inpatient (general ward)
Inpatient (ICU)

11. Remember the abbreviations!!
CURB - 65
Confusion
Uremia
Respiratory Rate
Blood Pressure
65 years or older
Determines treatment... admit or no?
SMART-COP
Systolic BP
Multilobar infiltrates
Albumin
Respiratory Rate
Tachycardia
Confusion O2 pH
ICU admission?

12. Which of the following is the most frequent cause of CAP in outpatients?
S. pneumonia
H. influenza
C. pneumonia
Viruses

13. Which of the following conditions is least likely to lead to a foul smelling, polymicrobial pneumonia?
Alcoholism
Aspiration
COPD
IV drug use

14. Upper Respiratory Tract Infections Tutoring
Alaina Darby

15. CK is a 8 week old WM whose mother is worried about his risk of ear infections, since his older brother and sister have had many ear infections in the past. What would not be a step that would be beneficial in reducing his risk?
Proper immunizations
Pacifier use
Breastfeeding
Not smoking

16. When CK is 4 months old, he develops ear pain
When CK is 4 months old, he develops ear pain. The tympanic membrane is moderately bulging. How should he be diagnosed?
Definitively AOM
Possibly AOM
Not AOM

17. OME AOM! Fluid ONLY Fluid + Infection ROM 3 in 6 mo 4+ in 12 mo
Definite:
Moderate/severe bulging OR
New onset of fluid drainage
Maybe:
Mild bulging + 48 hours or less
ROM
3 in 6 mo
4+ in 12 mo

18. When CK is 4 months old (10 kg), he develops ear pain
When CK is 4 months old (10 kg), he develops ear pain. The tympanic membrane is moderately bulging. His ear pain is moderate and has lasted for almost 24 hours. It is present in one ears. His temperature is 102F. How would you treat him?
Watchful waiting
Augmentin 900/64 mg PO BID
Amoxcillin 450 mg PO BID
Ceftriaxone 500 mg IM Q day

19. If CK fails the amoxicillin after 48 hours, how should you treat him?
Augmentin 450/32 mg PO BID
Clindamycin 100 mg PO TID
Ceftriaxone 500 mg IM Q day
Clindamycin + Ceftriaxone

20. When is prophylaxis recommended?
Pneumovax for 4 mo and high risk
Pneumovax for 3 yo and high risk
Amoxcillin for 4 mo with 3 episodes in 6 months
Amoxcillin for 3 yo with 3 episodes in 6 months

21. BR (5 month old WM) starts having middle ear effusion 2 months after his last ear infection. What should be done?
Watchful waiting x 1 month
Watchful waiting x 3 months
Watchful waiting x 6 months
Treat ASAP

22. BR (18 month old WM) starts having middle ear effusion 2 months after his last ear infection. What should be done?
Watchful waiting x 1 month
Watchful waiting x 3 months
Watchful waiting x 6 months
Treat ASAP

23. PQ is a 2 YO WF with a sore throat, headache, and cough
PQ is a 2 YO WF with a sore throat, headache, and cough. What should be administered?
Penicillin V
Azithromycin
Amoxcillin
Nothing

24. ST is a 22 YO WF with a sore throat and headache. RADT is negative
ST is a 22 YO WF with a sore throat and headache. RADT is negative. What should be done?
Throat culture
Redo RADT
Nothing

25. FT is a 2 YO WM (25 kg). RADT comes back negative but his throat culture is positive for GABHS. How should he be treated?
Amoxcillin 1000 mg Q day
Amoxcillin 100 mg BID x 10 days
Penicillin V 500 mg BID x 10 days
Benzathine PCN IM 600,000 units x 1

26. FT is a 2 YO WM (25 kg). RADT comes back negative but his throat culture is positive for GABHS. How should he be treated if allergic to PCN?
Cetriaxone IM x 1
Azithromycin PO x 10 days
Clarithromycin PO x 5 days
Cephalexin PO x 10 days