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Flashcards in Pneumonia Deck (25):
1

What is the most common bacterial cause of lobar pneumonia?

Streptococcus pneumonia
Other organisms - klebsiella and legionella

2

What is the definition of lobar pneumonia?

Confluent consolidation involving a complete lung lobe

3

What is the standard test for confirming suspicion of legionella infection?

Urine antigen testing

4

What is the most useful antibiotic for clearing legionella infection?

Macrolides - erythromycin, clarithromycin, azithromycin
These inhibit protein synthesis in bacteria by binding to ribosome and stopping formation of peptide bonds. They are useful in legionella as they can cross cell membranes easily - they are lipophilic.
Using CURB65/ SIGN guidelines - add levofloxacin to standard treatment in moderate - severe cases

5

Describe the inflammatory response involved.

Classical acute inflammatory response - exudation of fibrin rich fluid including neutrophil and macrophage infiltration.

6

Name some of the complications of pneumonia.

Fibrous scarring
Bronchiectasis
Abscess
Empyema
Pleural effusion
Respiratory failure
Death

7

Describe bronchopneumonia.

Infection starting in airways and spreading to adjacent alveolar tissue

8

What investigations should be done if a diagnosis of pneumonia is suspected?

Blood culture
Serology
FBC
U&Es
LFTs
CXR
Arterial gases

9

Describe the CURB65 scoring system.

C - confusion
U - urea >7
R - respiratory rate > 30
B - blood pressure 65
Score 1 point for each of these.

10

Using the CURB65 system, how many points does each level of severity merit?

0 = low severity.
1/2 = moderate severity
3/4 = high severity. This requires urgent hospital admission.

11

What is the standard treatment for low severity pneumonia?

Amoxicillin 500mg
OR
Doxycycline 200mg & clarithromycin 500mg

12

What is the standard treatment for high severity pneumonia?

Co-amoxiclav & clarithromycin
Add levofloxacin for legionella
OR
Benzylpenicillin & ciprofloxin

13

Which organism should be considered in an immunosuppressed patient?

Pneumocystis carinii is a fungus which causes pneumocystis pneumonia (PCP) in immunosuppressed patients. This tends to present with dry cough, SOB and pulmonary infiltrates on CXR.

14

Which is the most common cause of community acquired pneumonia?

Pneumococcus/strep. pneumoniae
Other organisms -
Haemophilus influenza
Klebsiella pneumonia (think alcoholics)
Group A streptococcus

15

What type of organisms tend to cause hospital acquired pneumonia?

Gram negative
Also - staph. aureus

16

Which organism can cause additional respiratory tract infection in those with influenza?

Staph. aureus

17

Which antibiotic can be given initially to cover the possibility of atypical organisms such as mycoplasma pneumoniae?

Erythromycin

18

Which is the best antibiotic for pneumococcal pneumoniae?

Penecillin i.e. amoxicillin

19

What does a persistent swinging fever indicate?

May indicate that empyema has developed. This should prompt further examination and repeat CXR.

20

Other than those indicated on the CURB65 score, what are other indicators of severe pneumonia?

Temperature - 40
Cyanosis - PaO2 30

21

Describe strep. pneumoniae.

Gram-positive cocci in pairs or short chains
Alpha haemolytic

22

How should severe nosocomial pneumonia be treated?

IV amoxicillin & gentamicin & metronidazole

23

What are the main risk factors for developing community acquired pneumonia?

Winter months
The very young and the very old
Chronic lung, heart, renal and liver disease
Diabetes mellitus
Immunosuppression

24

In which patients in bronchopneumonia most common?

In patients with pre-existing disease

25

What bacteria should be considered the cause of pneumonia in alcoholics?

Klebsiella