Pneumonia

Question 1

what is the commonest cause of CAP

Answer 1

streptococcus pneumoniae

Question 2

organisms of CAP

Answer 2

strep pneumonia, haemophilus influenza, mycoplasma pneumonia. staph aureus, Legionella, Moraxella catarrhalis, chlymadia.

Question 3

what are rarer in CAP gram positive or negative

Answer 3

gram negative bailli are rarer. caxiella burntii and anaerobes rare

Question 4

what % are made up by viruses CAP

Answer 4

15%

Question 5

what may flu be complicated by

Answer 5

community acquired MRSA pneumonia

Question 6

how many hours after admission is pneumonia hospital acquired

Answer 6

> 48 hours after (nosocomial)

Question 7

what are the most common organisms Hospital acquired

Answer 7

gram negative enterobacteria or staph aureus. also pseudomonas, klebsiella, bacteroides, clostridia

Question 8

who are at risk of aspirating oropharyngeal anaerobes

Answer 8

those with stroke, myasthenia, bulbar palsies, decr consciousness, oesophageal disease, poor dental hygiene

Question 9

symptoms

Answer 9

fever, malaise, rigors, anorexia, dyspnoea, cough, purulent sputum, haemoptysis, pleuritic pain

Question 10

signs

Answer 10

pyrexia, cyanosis, confusion, tachypnoea, tachycardia, hypotension, signs of consolidation, pleural rub

Question 11

tests

Answer 11

CXR- lobar/multi lobar infiltrates, cavitation or pleural effusion. assess oxygenation- sats, bp. bloods- FBC, U&E, LFT, CRP, cultures. sputum MC&S. in severe cases check for legionella (urine antigen). pneumococcal antigen in urine. pleural fluid aspiration.

Question 12

if immunocompromised what tests can be done

Answer 12

bronchoscopy, and bronchoalveolar lavage

Question 13

what score is used to assess severity

Answer 13

CURB65 confusion, urea >7, RR >30, BP 65.

Question 14

what score indicates severe and to consider ITU

Answer 14

score 3 or above

Question 15

management

Answer 15

antibiotics. oxygen keep O2>8 and sats >94. IV fluids and VTE prophylaxis. analgesia if pleurisy eg paracetemol 1g/6h. follow up at 6 weeks

Question 16

complications

Answer 16

pleural effusion, empyema, lung abscess, resp failure, septicaemia, brain abscess, pericarditis, myocarditis, cholestatic jaundice

Question 17

what vaccine and who to give it to

Answer 17

pneumococcal. at risk groups- >65, chronic heart/liver, renal, lung conditions, DM, immunosuppression, AIDS, on chemo.

Question 18

antibiotics in CAP mild not previously acquired

Answer 18

strep and haem- amoxicillin or clarithromycin or doxycycline

Question 19

antibiotics in CAP moderate

Answer 19

strep, haem, myco- oral amoxicillin, clarithromycin, doxycycline. if IV required- amoxicillin or clarithromycin

Question 20

antibiotics in CAP severe

Answer 20

co amoxiclav or cephalosporin IV and clarithromycin. add flucloxacillin and rifampicin if staph, vancomycin if MRSA.

Question 21

atypical CAP antibiotics

Answer 21

legionella- fluoroquinolone, combined with clarithromycin or rifampicin. chlamydophila- tetracycline.

Question 22

hospital acquired antibiotics

Answer 22

gram negative, pseudomonas, anaerobes- aminoglycosides and antipseudomonal penicillin. cephalosporin

Question 23

aspiration pneumonia antibiotics

Answer 23

cephalosporin, metronidazole

Question 24

neutropenic pts

Answer 24

aminoglycoside, penicillin, cephalosporin

Question 25

what does CXR show in pneumococcal

Answer 25

lobar consolidation

Question 26

features pneumococcal

Answer 26

fever, pleurisy, herpes labialis

Question 27

what occurs with staph infection

Answer 27

may complicate influenza infection, young, elerly, IVDU, or patients with underlying disease

Question 28

when does klebsiella ccur

Answer 28

elderly, diabetics, alcoholics

Question 29

what does CXR show with staph

Answer 29

bilateral cavitating bronchopneumonia

Question 30

what does CXR show klebsiella

Answer 30

cavitating pneumonia, particularly of the upper lobes, often drug resistant

Question 31

treatment klebsiella

Answer 31

cefotaxime, imipenem

Question 32

what organism is common in bronchiectasis and CF

Answer 32

pseudomonas. also causes HAP

Question 33

how does infection with mycoplasma present

Answer 33

flu like symptoms- followed by a dry cough

Question 34

what does the CXR show in mycoplasma

Answer 34

reticular nodular shadowing or patchy consolidation often of 1 lower lobe

Question 35

diagnosis mycoplasma

Answer 35

PCR sputum or serology

Question 36

complications mycoplasma

Answer 36

skin rash, steven johnsons syndrome, meningoencephalitis, myelitis, GBS

Question 37

when is legionella common

Answer 37

colonises water tanks kept at

Question 38

symptoms legionella

Answer 38

flu like sx, dry cough, dyspnoea, anorexia, d+v, hepatitis, renal failure, confusion, coma

Question 39

what does the CXR show legionella

Answer 39

bi basal consolidation.

Question 40

diagnosis legionalla

Answer 40

urine antigen/serology

Question 41

complications of pneumonia

Answer 41

resp failure, hypotension, AF, pleural effusion, empyema, lung abscess, septicaemia, pericarditis and myocarditis, jaundice

Question 42

what is an empyema

Answer 42

pus in the pleural space

Question 43

features empyema

Answer 43

CXR indicates pleural effusion, aspirated pleural effusion is typically yellow and turbid with low ph, low glucose, high LDH.

Question 44

how to treat empyema

Answer 44

chest drain.

Question 45

what is a lung abscess

Answer 45

cavitating area of localised suppurative infection within the lung

Question 46

causes lung abscess

Answer 46

inadequately treated pneumonia, aspiration, bronchial obstruction, pulmonary infarction, septic emboli, subphrenic or hepatic abscess

Question 47

clinical features lung abscess

Answer 47

swinging fever, cough, purulent foul smelling sputum, pleuritic chest pain, haemoptysis, malaise, weight loss

Question 48

signs lung abscess

Answer 48

finger clubbing, anaemia, creps. empyema in 20-30%

Question 49

tests lung abscess

Answer 49

FBC- anaemia, neutrophilia, ESR, CRP, cultures. sputum microscopy, culture, cytology. CXR- walled cavity often with a fluid lvevel. CT, bronchoscopy

Question 50

treatment lung abscess

Answer 50

antibiotics indicated by sensitivities, postural drainage, repeated aspiration, surgical excision