Deck 24: Pulmonary Infections

Question 1

Via what route is tuberculosis spread?

A) Direct contact
B) Fecal-oral route
C) Fomite
D) Inhaled particles

Answer 1

D
Explanation: Tuberculosis is acquired by inhalation of infectious particles is the basis for a policy whereby patients with suspected or proven tuberculosis who are coughing are placed in respiratory isolation, thereby minimizing the risk of disease transmission within the hospital setting.

Question 2

Which of the following represents an example of atypical community-acquired pneumonia?

A) Haemophilus influenzae
B) Legionella pneumophila
C) Staphylococcus aureus
D) Streptococcus pneumoniae

Answer 2

B
Explanation: Legionella species, Chlamydophilia pneumoniae, and Mycoplasma pneumoniae together account for 10% to 20% of cases. These latter organisms, called atypical pathogens, vary in frequency in recent reports, depending on the age of the patient population, the season of the year, and geographical locale.

Question 3

Which of the following types of pneumonia suggests that the patient acquired it through inhalation of infectious particles?

A) Cytomegalovirus
B) Haemophilus influenzae
C) Histoplasmosis
D) Staphylococcus

Answer 3

C
Explanation: Six pathogenetic mechanisms may contribute to the development of pneumonia Histoplasmosis is one of those caused by inhalation of infectious particles.

Question 4

Your patient has community-acquired bacterial pneumonia. Which of the following symptoms are common with this type of pneumonia?
1) Cough with purulent sputum
2) Diarrhea
3) Low fever
4) Shaking chills

A)1 and 3 only
B)2 and 4 only
C)3 only
D)1, 2, and 4 only

Question 5

Which of the following types of pneumonia suggests that the patient acquired it because of the reactivation of a latent infection, often in the setting of immunosuppression?

A) Cytomegalovirus
B) Haemophilus influenzae
C) Histoplasmosis
D) Staphylococcus

Question 6

In what type of pneumonia is diarrhea a common symptom?

A) Cytomegalovirus
B) Klebsiella
C) Pneumococcal
D) Staphylococcal

Question 7

In what percentage of patients with pneumonia has no microbial agent been isolated?

A) Up to 40%
B) Up to 50%
C) Up to 60%
D) Up to 70%

Question 8

Which group of patients is most likely to develop pneumonia subsequent to large-volume aspiration?

A) Acute respiratory distress syndrome
B) Alcohol toxicity
C) Diabetes mellitus
D) Obstructive sleep apnea

Question 9

What is the most common identified cause of community-acquired pneumonia?

A) Haemophilus influenzae
B) Legionella pneumophila
C) Staphylococcus aureus
D) Streptococcus pneumoniae

Question 10

What term is used to describe objects capable of transmitting infection through physical contact with them?

A) Consolidates
B) Contaminants
C) Fomites
D) Vectors

Question 11

What has been found to be a common cause of pneumonia in HIV-positive patients?

A) Klebsiella
B) Pneumocystis jiroveci
C) Staphylococcus
D) Streptococcus pneumoniae

Question 12

Which of the following mechanisms is an uncommon route for the spread of pneumonia?

A) Aspiration of infectious particles
B) Inhalation of infectious particles
C) Through the bloodstream
D) Direct contact

Question 13

What mechanism has been found to be useful in minimizing the development of pneumonia associated with intubated patients?

A) Elevation of the head of the bed
B) Frequent suctioning through the endotracheal tube
C) Maintaining the patient on severe fluid restriction
D) Use of tracheal gas insufflation

Question 14

Which of the following is true concerning pneumonia?

A) Patients with community-acquired pneumonia most often require hospitalization.
B) Community-acquired pneumonias are most often antibiotic-resistant strains.
C) Pneumonia is the number one cause of death in the United States.
D) Pneumonia is the sixth leading cause of death in the United States.

Question 15

A patient presents with pneumonia accompanied by foul-smelling breath, absent gag reflex, or recent loss of consciousness. What should be suspected?

A) Aspiration pneumonia
B) Chlamydia pneumonia
C) Pneumococcal pneumonia
D) Tuberculosis

Question 16

Which of the following symptoms is typical for pneumococcal pneumonia?

A) Foul-smelling sputum
B) Low-grade fever
C) Minimal sputum production
D) Pleuritic chest pain

Question 17

What organism is likely to be responsible for pneumonia that is community acquired and produces a hoarse voice in the patient?

A) Chlamydia pneumoniae
B) Haemophilus influenzae
C) Legionella
D) Mycoplasma

Question 18

A patient presents with high fever, teeth-chattering chills, pleuritic pain, and a cough producing rust-colored sputum. What pathogen should be suspected?

A) Chlamydia pneumoniae
B) Legionella pneumoniae
C) Mycoplasma pneumoniae
D) Pneumococcal pneumoniae

Question 19

A patient comes into the emergency department presenting with signs and symptoms of pneumonia. While taking the patient's history, it is determined that 2 months ago the patient spent 3 days in the hospital for acute angina. Since then the patient has been stable on medication. What type of pneumonia is this patient most likely to have?

A) CAP
B) HAP
C) HCAP
D) VAP

Question 20

Which of the following would be the more common route for nosocomial pathogens to be transmitted?

A) Directly patient to patient
B) Fecal-oral route
C) Aerosol route
D) Via the health care worker

Question 21

What organism is associated with the highest mortality rate for patients with pneumonia?

A) Klebsiella
B) Legionella
C) Pseudomonas aeruginosa
D) Staphylococcus aureus

Question 22

An intubated, mechanically ventilated patient is suspected of developing nosocomial pneumonia. The pulmonologist decides to perform a bronchoscopy. Which bronchoscopy findings would be consistent with pneumonia?
1) Alveolar collapse
2) Distal purulent secretions
3) Persistent secretions surging from distal bronchi during exhalation
4) P/F ratio less than 50

A)2, 3, and 4 only
B)1 and 3 only
C)2 only
D)3 and 4 only

Question 23

Which of the following would interfere with the collection of a good sputum sample for Gram stain?
1) Contamination of the sample with oral secretions
2) Lack of productive cough
3) Prior antibiotic therapy
4) Rinsing with mouthwash prior to sputum collection

A)1, 2, and 3 only
B)2 and 4 only
C)3 only
D)1 and 4 only

Question 24

Which of the following organisms have been found to colonize the oropharynx of healthy individuals?

A) Coccidioides immitis
B) Haemophilus influenzae
C) Histoplasma capsulatum
D) Mycobacterium

Question 25

What type of severe lung infection may result in the development of small lung cavities called pneumatoceles?

A) Community-acquired pneumonia
B) Legionella pneumoniae
C) Staphylococcus aureus
D) Viral pneumonia

Question 26

What finding is usually used to confirm the diagnosis of pneumonia?

A) Development of central cyanosis
B) New cough or new characteristic to the cough
C) New fever
D) New infiltrate on chest radiograph

Question 27

What percent of patients with community-acquired pneumonia have a parapneumonic pleural effusion?

A) 5% to 10%
B) 20% to 35%
C) 30% to 50%
D) 50% to 75%

Question 28

What clinical finding should raise your suspicion that a patient has developed hospital-acquired pneumonia?

A) A new fever
B) Digital clubbing
C) Diplopia
D) Pedal edema

Question 29

Which of the following organisms that cause pneumonia is most likely to result in a positive blood culture?

A) Chlamydia pneumoniae
B) Haemophilus influenzae
C) Mycoplasma pneumoniae
D) Pneumocystis jiroveci

Question 30

What type of lung infection is most commonly associated with cavitating lesions on the chest radiograph?

A) Community-acquired pneumonia
B) Reactivation tuberculosis
C) Staphylococcus aureus
D) Viral pneumonias

Question 31

In order to determine the presence of ventilator-associated pneumonia, what diagnostic procedure might be done by a respiratory therapist?

A) Bronchial biopsy
B) Mini bronchoalveolar lavage
C) Protected specimen brush
D) Transthoracic ultrathin needle aspiration

Question 32

Which of the following clinical conditions are often associated with a normal chest radiograph in the patient with pneumonia?
1) Dehydration
2) Early infection
3) Klebsiella pneumonia
4) Pneumocystis jiroveci infection

A)1, 2, and 4 only
B)2 and 3 only
C)1 only
D)3 and 4 only

Question 33

A 35-year-old man is admitted to the hospital and has been confirmed to have pneumococcal pneumonia. What test would it be wise to order at this time?

A) Bronchial biopsy
B) CBC and electrolytes
C) HIV
D) Sputum culture and sensitivity

Question 34

Which of the following would be associated with a fatal outcome in a patient with pneumonia who is mechanically ventilated?

A) Heart rate of 110 beats/min
B) Multisystem organ failure
C) Presence of purulent sputum
D) Respiratory alkalosis

Question 35

In the patient suspected of having tuberculosis, what finding on Gram stain would result in the initiation of antituberculosis medications?

A) Acid-fast bacilli
B) Gram-negative rods
C) Pleomorphic cocci
D) Presence of gram-negative cocci

Question 36

Rapidly spreading multilobar consolidation is typical for what type of pneumonia?

A) Klebsiella
B) Legionella
C) Pneumocystis jiroveci
D) Viral

Question 37

Which of the following clinical findings is not associated with an increased risk of death in the patient with pneumonia?

A) Kidney disease
B) Heart rate of 130 beats/min
C) Respiratory alkalosis
D) Systolic blood pressure of 85 mm Hg

Question 38

An elderly patient comes in with failure to thrive, shortness of breath, confusion, and worsening congestive heart failure. What is most likely the patient's primary problem?

A) An atypical pneumonia
B) Aspiration pneumonia
C) Community-acquired pneumonia
D) Tuberculosis

Question 39

What finding on the chest radiograph is typical for a viral pneumonia?

A) Interstitial infiltrates
B) Lobar consolidation
C) Patchy infiltrate surrounding one bronchus or several bronchi
D) Pleural effusion

Question 40

What would be important to perform in order to obtain a good sputum sample that is to be used to detect the pathogen causing community-acquired pneumonia?

A) Ensure that antibiotic treatment was instituted at least 24 hr earlier.
B) Have patient sit in the semirecumbent position to obtain sample.
C) Have patient spit into sample container.
D) Patient should rinse mouth prior to sample collection.

Question 41

Pneumococcal vaccines are indicated for which of the following individuals?
1) 65-year-old individual
2) Respiratory therapist
3) Individual with chronic heart disease
4) Individual with glaucoma

A)1, 2, and 3 only
B)2 and 4 only
C)1 and 2 only
D)3 and 4 only

Question 42

The chest radiograph is often of little help in the diagnosis of nosocomial pneumonia in mechanically ventilated patients in the ICU because these individuals often have other reasons for radiographic abnormalities.

Question 43

For a patient with pneumonia with coexisting cardiopulmonary disease, according to the ATS guidelines, what single antibiotic could be given as empiric treatment?

A) Intravenous beta-lactam
B) Intravenous doxycycline
C) Intravenous fluoroquinolone
D) Intravenous macrolide

Question 44

Which of the following organisms is associated with a poor prognosis in the patient with ventilator-related pneumonia despite optimal therapy?

A) C. pneumoniae
B) Klebsiella
C) P. aeruginosa
D) S. pneumoniae

Question 45

Which of the following individuals should be immunized against influenza?
1) 65-year-old individual
2) Respiratory therapist
3) Individual with chronic heart disease
4) Individual with glaucoma

A)1, 2, and 3 only
B)2 and 4 only
C)1 and 3 only
D)1, 2, 3, and 4

Question 46

What antibiotic is the drug of choice for the patient with nonresistant S. pneumoniae?

A) Ampicillin
B) Azithromycin
C) Penicillin
D) Vancomycin

Question 47

ATS guidelines suggest using which of the following antibiotics if methicillin-resistant S. aureus is a concern?

A) Cefazolin
B) Doxycycline
C) Penicillin
D) Vancomycin

Question 48

A 26 year-old seasonal worker from South America came to the ER with a history of a dry, hacking blood-tinged cough, fever, chills, and loss of appetite. The chest x-ray showed cavitary lesion in the right upper lobe. After a week in the hospital, the sputum culture shows the present of acid-fast stained organisms. Which of the following medications would you recommend for this patient at this time?
1) Ceftizoxime
2) Isoniazid
3) Rifampin
4) Ethambutol

A)1 only
B)2 and 4 only
C)1, 2, and 3 only
D)2, 3, and 4 only

Question 49

All of the following are extra-pulmonary manifestations for TB, except:

A) hectic fever.
B) hepatomegaly.
C) bronchioectasis.
D) weight loss.

Question 50

If an HIV-infected patient has an adverse reaction to the treatment of choice for Pneumocystis jiroveci pneumonia, what treatment should be instituted?

A) Amphotericin B
B) Pentamidine
C) Trimethoprim-sulfamethoxazole
D) Vancomycin

Question 51

Which of the following are common laboratory findings found in adults with suspected community-acquired pneumonia?
1) Acidemia
2) Proteinuria
3) Azotemia
4) Hyponatremia

A)1, 2, and 3 only
B)2 and 4 only
C)1 and 3 only
D)1, 3, and 4 only

Question 52

What is an often-neglected but very important component of preventing transmission of pathogens between patients, particularly those who are ventilated?

A) Adequate antibiotic therapy
B) Brushing of teeth
C) Handwashing
D) Use of negative-pressure rooms

Question 53

A 45-year-old patient diagnosed with pneumonia has received appropriate antibiotic therapy. Radiographic resolution is most often seen within what time period?

A) 1 week
B) 1 month
C) 6 months
D) 1 year

Question 54

What is the drug of choice for the patient with Pneumocystis jiroveci pneumonia?

A) Ampicillin
B) Doxycycline
C) Erythromycin
D) Trimethoprim-sulfamethoxazole

Question 55

What might be indicated by failure of the patient's temperature to normalize 4 or 5 days after the start of antibiotic therapy?
1) A closed-space infection
2) Drug fever
3) A missed pathogen

A)1 and 2 only
B)2 and 3 only
C)1 only
D)1, 2, and 3

Question 56

What time line has been established to initiate antibiotic treatment in patients with pneumonia who are admitted to the hospital that will result in improved survival?

A) 2 hr or less
B) 4 hr or less
C) 6 hr or less
D) 8 hr or less