Microbio - Pneumonia

Question 1

What is pneumonia?

Answer 1

An infection resulting in inflammation of lung alveoli

Question 2

Pneumonia Ix (8)

Answer 2

1. Observations
2. Bloods
3. FBC, CRP, U&E
4. CURB65
5. Cultures
6. Blood & sputum
7. ±Atypical screen
8. CXR

Question 3

Typical pneumonia syx

Answer 3

Fever, productive cough, SOB, pleuritic chest pain

Question 4

Pneumonia Initial Mx

Answer 4

ABCDE if unwell
Oxygen if needed
CURB-65 -> antibiotics

Question 5

Difference between typical and atypical pneumonia

Answer 5

Atypical - different presentation, CXR and do not respond to penicillins (due to lack of cell wall) -> treat w Macrolides

Question 6

When is pneumonia considered HAP?

Answer 6

after >48hrs of hospital admission

Question 7

Most common HAP (4)

Answer 7

S. aureus, Klebsiella, Pseudomonas, Haemophilus

Question 8

Most common typical pneumonia (5)

Answer 8

1. Strep pneumoniae (pneumococcus)
2. Haemophilus influenzae
3. Moraxella catarrhalis
4. Staph aureus
5. Klebsiella pneumoniae

Question 9

*What is the typical presentation of strep pneumoniae?

Answer 9

Rusty-coloured sputum
Lobar on CXR

Question 10

What is the typical presentation of haemophilus influenzae?

Answer 10

Smoking, COPD

Question 11

What is the typical presentation of moraxella catarrhalis?

Answer 11

Smoking

Question 12

What is the typical presentation of staph aureus?

Answer 12

Post-influenza infection
Cavitation on CXR

Question 13

*What is the typical presentation of klebsiella pneumoniae?

Answer 13

Alcoholism
Haemoptysis
Elderly

Ix: patchy consolidation + cavitating lesion

Question 14

Most common atypical pneumonia (3)

Answer 14

Legionella pneumophilia
Mycoplasma pneumonia
Chlamydia psittaci

Question 15

*What is the typical presentation of legionella pneumophila?

Answer 15

Travel / hotels, air conditioning, water
Hyponatraemia, hepatitis

Question 16

*What is the typical presentation of Mycoplasma pneumonia?

Answer 16

Flu-like symptoms: cough, arthralgia
Universities, boarding schools
AIHA: cold agglutinins +ve
Erythema multiforme

Question 17

What is the typical presentation of Chlamydia psittaci?

Answer 17

Birds

Question 18

What are the components of CURB65?

Answer 18

Confusion
Urea >7
Resp rate >30
BP <90systolic/ <60diastolic
>65 y/o

Question 19

What is the severity scoring for CURB65?

Answer 19

0-1 - Mild
2-3 Moderate
4-5 Severe

Question 20

*What is the management for mild pneumonia?

Answer 20

Amoxicillin PO 5d
Outpatient treatment
Pen allergy= macrolide

Question 21

What is the management for moderate pneumonia?

Answer 21

Amoxicillin PO 5-7d +
Clarithromycin PO 5-7d
Consider admission

Question 22

What is the management for severe pneumonia?

Answer 22

Co-amoxiclav IV 7d +
Clarithromycin IV 7d
Admit +/- ITU

Question 23

What is the management for HAP?

Answer 23

hospital guidelines (e.g. vanc, taz)

Question 24

What is used to treat Legionella?

Answer 24

Macrolides

Question 25

What Ix can be seen in Legionella?

Answer 25

Lobar consolidation, gram - rods

Question 26

*Which atypical pneumonia presents with bilateral ground glass opacities on CT?

Answer 26

Pneumocystis jiroveci

Question 27

*Transplant patient on immunosuppressives has pneumonia - halo sign (multiple)?

Answer 27

Aspergillosis

Question 28

*Which pneumonia cause is most common in HIV pts?

Answer 28

Pneumocystis jiroveci (PCP)

Question 29

*Urinary antigen tests are useful in the diagnosis of community acquired pneumonia. State one organism that the commonly available tests can detect.

Answer 29

Strep pneumonia