WorksheetsPulmonary Infections
Total questions: 30
Worksheet time: 30mins
Define pulmonary infections and identify two anatomical sites involved. Include one consequence of inflammation on respiratory function.
Which statement best describes the typical etiologic agents of pulmonary infections?
They are exclusively bacterial pathogens.
They are commonly caused by bacteria, viruses, or fungi.
They primarily result from autoimmune reactions without microbes.
They are limited to parasites in the lower respiratory tract.
A patient develops pneumonia 60 hours after hospital admission. Based on the classification provided, what type of pneumonia is this?
Community-acquired pneumonia (CAP)
Hospital-acquired pneumonia (HAP)
Ventilator-associated pneumonia (VAP)
Aspiration pneumonia
Match each pneumonia category to its defining context.
Community-acquired (CAP)
Occurs outside healthcare facilities
Hospital-acquired (HAP)
≥48 hours after hospital admission
Ventilator-associated (VAP)
In patients receiving mechanical ventilation
Aspiration pneumonia
Due to inhalation of oropharyngeal/gastric contents
Which pathogen is most commonly associated with community-acquired pneumonia according to the patterns to remember?
Pseudomonas aeruginosa
Streptococcus pneumoniae
Mycoplasma pneumoniae
Mycobacterium tuberculosis
Identify the pathogen frequently linked to COPD exacerbations.
Haemophilus influenzae
Streptococcus pneumoniae
Mycoplasma pneumoniae
Mycobacterium tuberculosis
Which pairing of pathogen and typical clinical context is correct?
Pseudomonas aeruginosa — walking pneumonia with dry cough
Mycoplasma pneumoniae — chronic disease requiring airborne isolation
Mycobacterium tuberculosis — chronic disease requiring airborne isolation
Streptococcus pneumoniae — primarily affects ventilated patients
Explain how inflammation in pulmonary infections leads to impaired gas exchange.
Based on the depicted sequence of events in pulmonary infection, which change directly contributes to hypoxemia by disrupting ventilation–perfusion (V/Q) matching?
Innate immune activation increases surfactant production
Alveolar exudate fills airspaces
Bronchial smooth muscle hypertrophy improves airflow
Enhanced lung compliance reduces work of breathing
Place the following pathophysiologic steps of pneumonia in the correct order from initial event to outcome: (a) ↓ compliance, ↑ work of breathing; (b) pathogen entry → innate immune response; (c) V/Q mismatch → hypoxemia; (d) alveolar exudate fills airspaces.
Initial event
Pathogen entry → innate immune response
Second step
Alveolar exudate fills airspaces
Third step
↓ Compliance, ↑ work of breathing
Final outcome
V/Q mismatch → hypoxemia
Which clinical finding most specifically localizes consolidation in pneumonia rather than diffuse airway disease?
Wheezing that improves with bronchodilator
Bronchial breath sounds over the affected area
Hyperresonant percussion throughout both lungs
Decreased tactile fremitus diffusely
A 65-year-old with fever, chills, productive cough, and pleuritic chest pain has increased tactile fremitus and dullness to percussion. Explain how alveolar exudate leads to these exam findings and the expected arterial blood gas (ABG) pattern early in the course.
Which diagnostic test both identifies the causative organism and provides antibiotic sensitivity information in pneumonia?
Chest X‑ray
Sputum Gram stain and culture
Complete blood count
Arterial blood gases
Match each diagnostic tool to its primary purpose in evaluating pneumonia.
Chest X‑ray
Differentiate lobar consolidation vs interstitial/patchy infiltrates
Sputum Gram stain & culture
Identify organism and sensitivities
CBC
Leukocytosis suggests bacterial infection
ABGs
Quantify gas exchange impairment
Which scenario best justifies bronchoscopy in suspected pneumonia according to the provided guidance?
Typical lobar consolidation responding to empiric antibiotics
Unclear etiology or poor response to therapy
Mild cough with normal chest X‑ray
Routine confirmation of bacterial leukocytosis
A patient with pneumonia is hyperventilating early in the illness. What ABG pattern is most consistent with this stage, and what pathophysiology has triggered it?
Respiratory acidosis due to CO₂ retention from airway obstruction
Metabolic acidosis from lactic acid accumulation
Respiratory alkalosis from tachypnea in response to hypoxemia
Metabolic alkalosis from vomiting and diuretic use
A 62-year-old male presents with fever, chills, and a productive cough. Chest radiograph shows right lower lobe consolidation, and sputum culture identifies Streptococcus pneumoniae. Which arterial blood gas (ABG) pattern is most consistent with this presentation?
Respiratory alkalosis with hypoxemia due to increased ventilation and shunt
Primary metabolic alkalosis with normal PaO2
Respiratory acidosis with severe hyperoxemia from shunt
Mixed metabolic acidosis and alkalosis with normal oxygenation
For the 62-year-old patient with community-acquired pneumonia and right lower lobe consolidation due to Streptococcus pneumoniae, propose two respiratory therapy (RT) interventions and justify how each addresses the pathophysiology.
A 48-year-old ICU patient on mechanical ventilation develops fever, increased secretions, and worsening oxygenation. CXR shows diffuse infiltrates, and cultures grow Pseudomonas aeruginosa. Which RT practice best helps prevent ventilator-associated pneumonia (VAP) in this scenario?
Maintaining semi-recumbent positioning and performing regular oral care with antiseptic
Routinely instilling saline into the ETT to thin secretions
Avoiding suctioning to minimize airway trauma
Keeping the patient fully supine to reduce aspiration risk
Match each intervention or monitoring focus to its most relevant clinical goal in ventilator-associated pneumonia (VAP).
Semi-recumbent positioning
Reduce aspiration of oropharyngeal contents
Regular oral care with antiseptic
Decrease oral bacterial load and colonization
Closed suction system and appropriate suctioning
Limit circuit contamination while removing secretions
Continuous pulse oximetry and ABG trending
Track oxygenation and ventilation status
Recall the causative agent of tuberculosis. Which organism is responsible for TB?
Streptococcus pneumoniae
Mycobacterium tuberculosis
Haemophilus influenzae
Staphylococcus aureus
A patient with suspected TB requires airborne precautions. Which combination best aligns with recommended respiratory isolation?
Surgical mask and standard room
N95 respirator and negative-pressure room
Face shield and positive-pressure room
N95 respirator only without room controls
Match each clinical feature or finding with the TB-related category it best represents.
Weight loss
Chronic symptom
Hemoptysis
Chronic symptom
Apical cavitation on chest imaging
Characteristic imaging pattern; confirm with microbiology
Night sweats
Chronic symptom
Given RT-focused treatment principles for pulmonary infections, select the most appropriate initial RT intervention for hypoxemia in a patient with active TB.
Immediate bronchodilator therapy PRN
Oxygen therapy to correct hypoxemia
Begin antimicrobial therapy before cultures
Oscillatory PEP only without other measures
A patient with TB presents with cough and obstruction due to secretions. Outline an RT plan that integrates bronchial hygiene and pharmacologic support, and explain how you would use clinical data to adjust therapy over time.
According to the infection control guidance, which precaution is specifically indicated for tuberculosis (TB)?
Contact precautions with gown and gloves
Droplet precautions with surgical mask
Airborne precautions with N95 or higher-level respirator
Standard precautions only for routine care
A patient with pneumonia deteriorates with rising oxygen requirements and worsening respiratory distress. Based on the outlined RT role and complications, explain the immediate actions a respiratory therapist should take and justify how these steps mitigate the risk of serious complications such as ARDS or sepsis.
A patient with community-acquired pneumonia has a PaO2 of 58 mmHg on room air. Which intervention is most appropriate?
Increase tidal volume
Start supplemental oxygen
Suction the airway
Initiate CPAP
Which finding best differentiates bacterial from viral pneumonia?
Dry cough and low-grade fever
Sudden onset and purulent sputum
Diffuse interstitial infiltrates
Normal WBC count
During suctioning, a patient's heart rate drops from 90 to 50 bpm. What should the RT do first?
Stop suctioning and provide oxygen
Continue and shorten suction time
Increase suction pressure
Switch to oral suction
