Community Acquired Pneumonia - no specific types

Question 1

Describe pneumonia

Answer 1

Inflammation of the lung parenchyma

Question 2

In pneumonia, the airspaces fill with ___, leading to localised ___ and therefore ___

Answer 2

In pneumonia, the airspaces fill with EXUDATE, leading to localised OEDEMA and therefore CONSOLIDATION

Question 3

What are the 3 ways in which pneumonia can be classified?

Answer 3

Clinical setting
Causative organism
Morphology

Question 4

What 2 things must a patient NOT have to be diagnosed with CAP?

Answer 4

Immunosuppression or malignancy

Question 5

What 2 ages is CAP particularly apperent in?

Answer 5

The extremes of life

<16 and >65 y/o

Question 6

What gender are 2x more likely to get CAP?

Answer 6

Men

Question 7

State the 5 major risk factors for CAP

Answer 7

Age
Co-morbidities
Resp conditions
Smoking
Immunosuppression

Question 8

What kind of comorbidities increase the risk of CAP?

Answer 8

HIV, Liver disease, diabetes, heart failure, malnutrition, low BMI

Question 9

What are the 4 main resp conditions that can increase the risk of CAP?

Answer 9

COPD
Asthma
CF
Obstruction

Question 10

What 3 lifestyle components increase the risk of CAP?

Answer 10

Smoking
Alcohol
IV drugs

Question 11

What 3 medications are known to increase the risk of CAP?

Answer 11

ICS
Oral steroids
PPIs

Question 12

What 2 things is the presentation of CAP dependant on?

Answer 12

The causative organisms

Age/health of the patient

Question 13

Why does a patient become breathless in CAP?

Answer 13

The pus and debris impairs gas exchange

Question 14

What are the 3 clinical examination findings in CAP that are due to consolidation?

Answer 14

Coarse crackles
Dull to percussion
Bronchial breathing

Question 15

What does a swinging fever indicate?

Answer 15

Empyema

Question 16

Why does pleuritic pain occur in CAP?

Answer 16

Pleural inflammation

Question 17

What can sometimes be heard early in CAP?

Answer 17

Pleural rub

Question 18

What population gets very generalised/non-specific symptoms in CAP?

Answer 18

Elderly

Question 19

What is a common skin manifestation of CAP and why does it occur?

Answer 19

Herpes lablialis

Reactivation of the virus due to the altered immune system

Question 20

What 2 conditions should always be considered when a patient has a possible pneumonia?

Answer 20

TB

Lung cancer

Question 21

What is the severity assessment of CAP?

Answer 21

CURB 65

Question 22

What are the components of the CURB 65 score?

Answer 22

C - new onset confusion
U - urea >7 mmol/L
R - RR >30/min
B - BP (systolic <90, diastolic <60)
65 - >65 y/o

Question 23

What are the 3 tiers of treatment based on the CURB65 score?

Answer 23

O-1 = outpatient treatment
2 - admission
3+ = ICU required

Question 24

What are the 2 antibiotics used in the treatment of mild, outpatient CAP?

Answer 24

Amoxicillin

Clarithromycin if penicillin allergic

Question 25

What should be done if a CAP outpatient patient fails to improve within 48 hrs?

Answer 25

CXR

Question 26

What should be measured in bloods taken from a CAP patient? (5)

Answer 26

``` FBC U&Es Biochemistry Serology LFTs ```

Question 27

What 2 cultures should be taken in a CAP patient?

Answer 27

Sputum | Blood

Question 28

Ideally, when should blood cultures be taken in CAP?

Answer 28

In all patients with moderate-severe, before antibiotics | treatment should not be delayed to do this

Question 29

What test should be offered to all CAP patients?

Answer 29

HIV

Question 30

What are the 6 other severity markers in CAP?

Answer 30

``` Multi-lobar involvement PaO2 <8 kPa Low albumin <35 g/l WCC <4 or >30 Positive blood culture Fever <35 or >40 ```

Question 31

What are the 3 times at which a CXR should be performed in pneumonia?

Answer 31

on admission 2-3 days post-admission 6 weeks post admission

Question 32

Why is a CXR done 6 weeks after a pneumonia?

Answer 32

To look for underlying malignancy

Question 33

What are the 5 general principles of pneumonia management?

Answer 33

``` Oxygen Fluids Antibiotics Thromboprophylaxis (if admitted for >12 hrs) Analgesia ```

Question 34

If a patient has a CURB score of 0-2, what antibiotic treatment should they get?

Answer 34

Amoxicillin for 5 days

Question 35

If a 0-2 CURB patient is penicillin allergic, what are the 2 options for antibiotics?

Answer 35

Doxycycline or clarithromycin

Question 36

If a patient has a CURB score of 3-5, what antibiotics should they be on?

Answer 36

Co-amoxiclav IV + Doxycyline oral

Question 37

What should be given to pencillin allergic 3-5 CURB patients?

Answer 37

IV levofloxacin

Question 38

If a CAP patient is in ICU/HDU, what 2 antibiotics should they be on?

Answer 38

Co-amoxiclav IV + Clarithromycin IV

Question 39

What should all ICU/HDU patients be stepped down to? (antibiotics)

Answer 39

Doxycyline

Question 40

What are the 2 components of thromboprophylaxis?

Answer 40

Subcutaneous, low molecular weight heparin | Compression stockings

Question 41

Why should CAP patients be given analgesia?

Answer 41

For the pleuritic pain - reduces

Question 42

What are the 2 general complications of CAP?

Answer 42

Resp failure/ARDS | Sepsis - multi-organ failure

Question 43

What are the 4 resp complications of CAP?

Answer 43

Pleural effusion Empyema Lung abscesses Organising pneumonia

Question 44

What kind of therapy is needed in hospital acquired pneumonia?

Answer 44

Extensive gram negative cover

Question 45

What kind of therapy is needed in aspiration pneumonia?

Answer 45

Anaerobic cover

Question 46

What 4 groups of people should be offered both the flu jab and the pneumococcal vaccination?

Answer 46

Over 65 y/o Chronic chest/cardio conditions Diabetes Immunocompromised

Question 47

Define lobar pneumonia

Answer 47

Confluent consolidation involving a complete lung lobe

Question 48

What organism normally causes lobar pneumonia?

Answer 48

Strep. pneumoniae

Question 49

What are the 2 rarer organisms that can cause lobar pneumonia?

Answer 49

Legionella | Klebsiella

Question 50

In what 2 ways is a lobar pneumonia a classic picture of acute inflammation?

Answer 50

Exudation of fibrin-rich fluid | Neutrophil and macrophage inflitration

Question 51

Describe bronchopneumonia

Answer 51

Starting in the airways and spreading to the adjacent alveolar lung

Question 52

What context is bronchopneumonia normally seen in?

Answer 52

With underlying/pre-existing conditions