Pneumonia

Question 1

What are the typical findings on physical examination in pneumonia

Answer 1

Dull to percussion, bronchial breath sounds with crackles

Question 2

What is the most common organism to cause community pneumonia

Answer 2

Strep pneumoniae (gram positive)

Question 3

What are the other common organisms that causes pneumonia

Answer 3

Hemophilus influenzae (gram neg)
Mycoplasma or chlamydophilia (atypical, cannot use beta lactam)
Legionella (usually from poor sanitation, may use urine antigen to check)

Question 4

What are the initial tests to consider

Answer 4

1. Sputum and blood culture
2. CXR
3. Urine strep antigen
4. Procal (test for bacteria) or CRP

Question 5

How to determine whether to admit patient into the hospital

Answer 5

using CURB-65
1. Confusion
2. Urea >7
3. RR >30
4. Blood pressure SBP <90 or DBP <60

Question 6

What is the empirical antibiotics to give CAP

Answer 6

Co-amoxiclav (especially with co-morbidities, else amoxicillin)

Question 7

What are some risk factors that may cause a patient to have beta lactam resistant S.pneumoniae

Answer 7

1. Age <2 or >65 years
2. beta lactam therapy for previous 3 months
3. Alcoholism
4. Medical comorbidities
5. Immunosuppressive illness
6. Exposure to child in daycare

Question 8

What do we give if there is beta-lactam resistant S.pneumoniae

Answer 8

Respiratory fluroquinolones eg levofloxacin

Question 9

What is the first line therapy for community acquired pneumonia

Answer 9

Amoxicillin +/- Azithromycin

Question 10

What is the first line therapy for community acquired pneumonia that requires hospitalisation

Answer 10

IV ceftriaxone + PO azithromycin

Question 11

What is the first line therapy for severe community acquired pneumonia

Answer 11

IV Ceftazidime + IV levofloxacin

Question 12

What is the first line therapy for severe community acquired pneumonia that requires ventilation

Answer 12

IV meropenem + IV azithromycin

Question 13

What is the first line therapy for HAP

Answer 13

IV tazocin OR IV levo + IV vanco

Question 14

What is the first line therapy for HAP that requires ventilation

Answer 14

IV meropenem Or IV levo + IV vanco + IV amikacin

Question 15

What are some complications from pneumonia

Answer 15

1. Parapneumonic effusion
2. Empyema
3. Lung abscess
4. ARDS
5. Septicaemia

Question 16

What are some risk factors for pseudomonas aeruginosa pneumonia

Answer 16

1) Structural lung disease like bronchietasis
2) Corticosteroid therapy
3) Broad spectrum antibiotic therapy in the past month
4) Malnutrition
5) Leukopenic immune suppression