Pneumonia

Question 1

What defines an infection as Pneumonia?

Answer 1

Consolidation on CXR

Question 2

What are some of the common differentials for consolidation on CXR?

Answer 2

Pneumonia
TB (Usually upper lobe)
Lung cancer
Lobar collapse (Blockage of bronchi)
Haemorrhage
*Localised PE infarcts can look like consolidation*

Question 3

What is CURB-65?

Answer 3

The tool used to asses what treatment is needed for a Pneumonia

Question 4

What does the C in CURB-65 stand for?

Answer 4

New onset Confusion or a drop of 2 or more in the MMT score

Question 5

What does the U in CURB-65 stand for?

Answer 5

Urea above 7.0

Question 6

What does the R in CURB-65 stand for?

Answer 6

Resp rate above 30/min

Question 7

What does the B in CURB-65 stand for?

Answer 7

Blood pressure below 90 systolic or 60 diastolic

Question 8

What does the 65 in CURB-65 mean?

Answer 8

Aged above 65

Question 9

What investigations should be performed in a patient with suspected Pneumonia?

Answer 9

CXR
CURB-65 score
Bloods - FBC, U&Es, CRP
Sputum cultures
*Consider blood culture if febrile*

Question 10

What follow up tests need to be performed on a patient with Pneumonia?

Answer 10

HIV test
Immunoglobulins
Pneumococcal IgG serotypes
Haemophilus influenzae b IgG
Follow up appointment in clinic in 6 weeks with a repeat CXR to ensure resolution

Question 11

What are the causes of a non resolving Pneumonia?

Answer 11

C - Complication eg Lung abscess, empyema
H - Host eg Immunocompromised
A - Antibiotic eg Inadequate dose, poor absorption
O - Organism eg Resistent or unexpected
S - Second diagnosis eg PE, Ca, organising pneumonia

Question 12

What are the organisms that commonly cause CAP?

Answer 12

Streptococcus Pneumoniae
Haemophius Influenzae
Moraxella catarrhalis
Pneumocystitis Carinii (Immunocompromised)

Question 13

What are the organisms that commonly cause HAP?

Answer 13

Gram negative bacilli
Staphylococcus Aureus
Pseudomonas Aeruginosa

Question 14

What is the treatment for a patient with a CURB score of 0-1?

Answer 14

Oral Amoxicillin (500mg) for 5 days

Question 15

What is the treatment for a patient with a CURB score of 2?

Answer 15

Oral Amoxicillin (1g) for 5 days and oral Doxycycline (200mg) for 5 days

Question 16

What is the treatment for a patient with a CURB score of 3-5?

Answer 16

IV Co-Amoxiclav (1.2g tds) for 5 days and oral Doxycycline (200mg) for 7-10 days

Question 17

How does Pneumonia cause consolidation on CXR?

Answer 17

The Pneumonia causes an inflammed bronchiole and consolidation occurs due to excess mucus