Deck 22: Pulmonary Infections

Question 1

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

Answer 1

D

Question 2

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

Answer 2

A

Question 3

In what type of pneumonia is diarrhea a common symptom?

A)cytomegalovirus
B)Klebsiella
C)pneumococcal
D)staphylococcal

Answer 3

C

Question 4

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

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

Question 5

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 $\frac { 1 } { 2 }$ 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 6

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 7

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

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

Question 8

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

Question 9

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 10

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 11

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 12

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 13

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

A)consolidates
B)contaminants
C)fomites
D)nanospecs

Question 14

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

A)aspiration pneumonia
B)Chlamydia pneumonia
C)pneumococcal pneumonia
D)tuberculosis

Question 15

Your patient has community-acquired bacterial pneumonia. Which of the following symptoms are common with this type of pneumonia?
I)cough with purulent sputum
II)diarrhea
III)high fever
IV)shaking chills

A)I, II, and III
B)II and IV
C)III only
D)I, II, III, and IV

Question 16

Via what route is tuberculosis spread?

A)direct contact
B)fecal-oral route
C)fomite
D)inhaled particles

Question 17

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 18

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

Question 19

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 20

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 21

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 22

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 hours 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 23

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 24

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 25

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 26

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

A)bronchial biopsy
B)CBC and electrolytes
C)HIV
D)sputum culture and sensitivity

Question 27

An elderly patient presents 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 28

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 29

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 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

Which of the following clinical conditions are often associated with a normal chest radiograph in the patient with pneumonia?
I)dehydration
II)early infection
III)Klebsiella pneumonia
IV)Pneumocystis jiroveci infection

A)I, II, and IV
B)II and III
C)I only
D)I, II, III, and IV

Question 32

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?
I)alveolar collapse
II)distal purulent secretions
III)persistent secretions surging from distal bronchi during exhalation
IV)P/F ratio less than 50

A)II, III, and IV
B)I and III
C)II only
D)I, II, III, and IV

Question 33

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

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

Question 34

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 35

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 36

Which of the following would interfere with the collection of a good sputum sample for Gram stain?
I)contamination of the sample with oral secretions
II)lack of productive cough
III)prior antibiotic therapy
IV)rinsing with mouthwash prior to sputum collection

A)I, II, and III
B)II and IV
C)III only
D)I, II, III, and IV

Question 37

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 38

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 39

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

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

Question 40

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 41

What timeline 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 hours or less
B)4 hours or less
C)6 hours or less
D)8 hours or less

Question 42

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 43

What might be indicated by failure of the patient's temperature to normalize 4 or 5 days after the start of antibiotic therapy?
I)closed-space infection
II)drug fever
III)missed pathogen

A)I and II
B)II and III
C)I only
D)I, II, and III

Question 44

Would a patient being fed through a jejunostomy tube be more likely to develop nosocomial pneumonia than if he were fed totally via the parenteral route?

A)no, less likely
B)risks are almost the same
C)yes, more likely

Question 45

Pneumococcal vaccines are indicated for which of the following individuals?
I)65-year-old individual
II)respiratory therapist
III)individual with chronic heart disease
IV)individual with glaucoma

A)I, II, and III
B)II and IV
C)I and III
D)I, II, III, and IV

Question 46

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 47

Which of the following individuals should be immunized against influenza?
I)65-year-old individual
II)respiratory therapist
III)individual with chronic heart disease
IV)individual with glaucoma

A)I, II, and III
B)II and IV
C)I and III
D)I, II, III, and IV

Question 48

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

A)ampicillin
B)azithromycin
C)penicillin
D)vancomycin

Question 49

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)hand washing
D)use of negative-pressure rooms

Question 50

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 51

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

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

Question 52

What diagnostic procedure might be done by a lone respiratory therapist in order to determine the presence of ventilator-associated pneumonia?

A)bronchial biopsy
B)mini bronchoalveolar lavage
C)protected specimen brush
D)transthoracic ultrathin needle aspiration

Question 53

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 54

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

A)ampicillin
B)doxycycline
C)erythromycin
D)trimethoprim-sulfamethoxazole