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CHAPTER 18: MANAGING PNEUMONIA IN CHRONIC OBSTRUCTIVE LUNG DISEASE

Which laboratory test(s) help identify if a patient needs treatment for pneumonia?

A. Procalcitonin 1.9 ng/mL

B. WBC 23.1 × 103/mm3

C. Chest imaging

D. All of the above

Correct answer: D

Rationale: Empiric antibiotic therapy should be initiated in adults with clinically suspected and radiographically confirmed CAP. Although procalcitonin is not a required test, the high procalcitonin indicates a high likelihood of bacterial infection.1 Patients may also demonstrate leukopenia, and chest imaging helps confirm pneumonia.

Based on the GOLD guidelines, what cardinal symptom must you have to start empiric treatment of antibiotics?

A. Dyspnea

B. Sputum volume

C. Sputum purulence

D. Fever

Correct answer: C

Rationale: Cardinal symptoms of COPD include dyspnea, sputum volume, and sputum purulence. Typically, you need all three to start empiric therapy of antibiotics; however, if increased sputum purulence is one of the symptoms, you only need one other symptom. Mechanical ventilation (invasive and noninvasive) should receive empiric therapy.1

When choosing an antibiotic, what pathogens should be covered?

A. Streptococcus pneumoniae

B. Haemophilus influenzae

C. Atypical bacteria such as Mycoplasma pneumoniae

D. All of the above

Correct answer: D

Rationale: Streptococcus pneumoniae, Haemophilus influenzae, and atypical bacteria such as Mycoplasma pneumoniae are all the most commonly identified pathogens with pneumonia secondary to a COPD exacerbation. Some patients who have frequent exacerbations, severe airflow issues, or mechanical ventilation may suffer from other pathogens such as gram-negative bacteria (e.g., Pseudomonas).1

Which of the following classes of medication is preferred for acute exacerbations?

A. Short-acting bronchodilators

B. Inhaled corticosteroid

C. Long-acting inhaled beta2-agonist

D. Long-acting anticholinergic

Correct answer: A

Rationale: Regardless of exacerbation severity, the guidelines recommend all patients be on short-acting bronchodilators. Inhaled corticosteroids, long-acting inhaled beta2-agonists, and long-acting anticholinergics are utilized for long-term management but can be used during an exacerbation in combinations of a short-acting bronchodilator.1

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