Pneumonia

Question 1

What is definition of pneumonia

Answer 1

any inflammatory condition affecting alveoli of the lungs - usually secondary to a bacterial infection

Question 2

What are risk factors for pneumonia

Answer 2

<5 or >65
smoking
recent viral resp tract infection
Chronic respiratory disease
Immunosuppression
Patients at risk of aspiration
IV drug users
diabetes , CVD

Question 3

What is the most common organism that causes CAP

Answer 3

Streptococcus pneumoniae

Question 4

What other organisms cause CAP

Answer 4

Haemophilus influenzae
S.aureus

atypical pneumonias -Mycoplasma pneumoniae

viruses
Klebsiella pneumoniae - classically in alcoholics

Question 5

What is pneumococcal pneumonia and the characteristic features

Answer 5

caused by streptococcus pneumoniae

rapid onset
high fever
pleuritic chest pain
herpes labialis - cold sores

Question 6

How may someone with pneumonia present

Answer 6

cough with purulent sputum
dyspnoea
chest pain
fever
malaise
signs of systemic infection
tachypnoea
low oxygen sats
reduced breath sounds

Question 7

What is stepwise investigations for pneumonia

Answer 7

Chest X-ray
- may show consolidation/ effusion
REPEAT 6 WEEKS AFTER CLINICAL RESOLUTION

Bloods
FBC, U&Es,CRP and blood cultures

sputum sample

Test for urinary antigen for Legionella

Question 8

What investigations might be needed for atypical pneumonia

Answer 8

CT may be needed to detect abcess/empyema formation with bronchoscopy

Mycoplasma serology

Question 9

What is CURB-65

Answer 9

predicts 30 day mortality in CAP

Confusion
Urea >7
Respiratory rate >30
SBP <90 or DBP<60
65

Question 10

How do you interpret the scores of CURB-65

Answer 10

0-1- low risk home based care

2- intermediate risk , hospital care

3-5 high risk, intensive care

Question 11

How do you treat patient with CURB-65 score of 0-1

Answer 11

OUTPATIENT
first line - amoxicillin

if allergic then clarithromycin

5 day course

Question 12

How do you treat patient with CURB65 score of 2

Answer 12

Dual antibiotic therapy
amoxicillin and clarithromycin \

7-10 day course

Question 13

How do you treat patients with CURB-65 score >3

Answer 13

consider ITU
Co-amoxiclav AND clarithromycin
7 DAYS

Question 14

How do you manage hospital acquired pneumonia

Answer 14

Co-amoxiclav

Doxycycline if penicillin allergy

Question 15

How do you manage atypical pneumonia

Answer 15

Clarithromycin or Doxycycline

Question 16

What are some complications of pneumonia

Answer 16

Severe pneumonia can result in resp failure/septic shock

Empyema - should be suspected if patient not responding as expected to antibiotics

AF can be triggered

Bacterial pericarditis