Pneumonia

Question 1

CURB65 criteria

Answer 1

C Confusion
U Urea >7
R Respiration rate >= 30/min
B Blood pressure: systolic <= 90 mmHg and/or diastolic <= 60 mmHg
65 Aged >= 65 years

Question 2

Risk stratification based on CURB65 score

Answer 2

score 1-2 = intermediate risk (consider admission)
Score 3-4 = high risk (admission needed)

Question 3

What do NICE recommend with regards to antibiotics based on a point-of-care CRP test?

Answer 3

CRP < 20 - do not routinely offer antibiotic therapy

CRP 20 - 100 - consider a delayed antibiotic prescription

CRP > 100 - offer antibiotic therapy

Question 4

Investigations used to diagnose pneumonia

Answer 4

CXR
Bloods and CRP
blood cultures
sputum cultures
pneumococcal and legionella urinary antigen tests

Question 5

Antibiotic management of low severity CAP

Answer 5

1st Line: Amoxicillin
Penicillin allergic: Doxycycline or Clarithromycin

5 day course

Question 6

Antibiotic management of high severity CAP

Answer 6

1st line: Amoxicillin + CLarithromycin

7-10 day course is recommended

*can also use Co-amoxiclav/ceftriaxone/Tazocin and Clarithromycin

Question 7

What features in the past 24 hours would prehibit a patient from being discharged with CAP

Answer 7

Fever
RR>24
HR >100 beats per minute
systolic BP <90 mmHg
O2 sats <90% on room air
remains confused

Question 8

Following admission with CAP, when should the fever have resolved?

Answer 8

1 week later

Question 9

Following admission for CAP, when should Chest pain and sputum production have substantially reduced?

Answer 9

4 weeks

Question 10

Cough and breathlessness should have substantially reduced by how many weeks following CAP?

Answer 10

6 weeks

Question 11

3 months following admission for CAP, what symptom may continue to linger?

Answer 11

Fatigue

Question 12

6 months following CAP, patients should feel back to normal. TRUE/FALSE

Answer 12

TRUE

Question 13

Why must patients with pneumonia have a follow-up CXR at 6 weeks?

Answer 13

to ensure that the consolidation has resolved and there is no underlying malignancy