Pneumonia

Question 1

Top 3 commonest pathogens causing CAP

Answer 1

1) strep pneumoniae
2) haemophilus influenzae
3) mycoplasma pneumoniae

Question 2

Other common CAP pathogens x4

Answer 2

Staph aureus
Chlamydia
Legionella
Moraxella catarrhalis

Question 3

What is HAP

Answer 3

Pneumonia acquired > 48hours after admission to hospital

Question 4

Common HAP pathogens x2

Answer 4

Staph a or gram negative enterobacteria (salmonella, e.coli, shigella, y.pestis, klebsiella)

Question 5

Other HAP pathogens

Answer 5

Pseudomonas
Bacteriodes
Clostridia

Question 6

Symptoms of pneumonia

Answer 6

Fever, malaise, rigours, anorexia
Dyspnoea, cough, purulent (yellow/green/rust) sputum
Haemoptysis
Pleuritic pain

Question 7

Signs of pneumonia

Answer 7

Pyrexia 
Cyanosis 
Confusion
Tachycardia and tachypnoea
Hypotension
Reduced expansion
dull percussion
Bronchial breathing
Increased tactile vocal fremitus 
Pleural rub 
Coarse creps

Question 8

Severity score for pneumonia

Answer 8

CURB 65 
Confusion (amts) 
Urea - serum - >7mmol/L
Resp rate >30
Blood pressure systolic below 90 or diastolic below 60 
Age over 65

Question 9

Consequences of curb 65 score

Answer 9

0-1 - go home for treatment
2 - hospital therapy
>/= 3 - severe - may need ITU

Question 10

General non-antibiotic management of Pneumonia

Answer 10

Fluids
VTE prophylaxis
Analgesia

Question 11

Antibiotic management of mild CAP pneumonia (not previously treated)
(What are pathogens)

Answer 11

Strep p and haem.i

Amoxicillin
Or
Clarithromycin
Or doxi

Question 12

Treatment of moderate CAP pneumonia and pathogens

Answer 12

Strep p, haem.i, mycoplasma.pn

Amoxicillin + clarithromycin
Or doxi

Question 13

Treatment of severe CAP by the top 3 pathogens

Answer 13

Co-amoxiclav (augmentin)
Or cephalosporin
AND clarithromycin

Question 14

Antibiotic if staph a

Answer 14

Flucoxacillin + rifampicin

Question 15

Antibiotic if MRSA

Answer 15

Vancomycin

Question 16

Legionella antibiotic

Answer 16

Fluoroquinolone

With clarithromycin or rifampicin if severe

Question 17

Chlamydia antibiotic

Answer 17

Doxycycline

Question 18

Pnemocystis jiroveci

Answer 18

Co-trimoxazole

Question 19

HAP treatment

Answer 19

Gentamicin
Penicillin
Cephalosporin

Question 20

Aspiration pneumonia treatment

Answer 20

Cephalosporin + metronidazole

Question 21

Which pneumonia pathogen do you herpes labialis with?

Answer 21

Strep pneumoniae

Question 22

What does klebsiella pneumonia cause?

Answer 22

Upper lobe cavitating pneumonia

Question 23

How does mycoplasma pneumoniae occur?

Answer 23

In epidemics every 4years
Flu like symptoms (myalgia, arthralgia and headache)
Followed by dry cough
Shadowing or patchy consolidation of lower lobe (usually one)

Question 24

How does chlamydia pneumoniae present?

Answer 24

Biphasal
Pharyngitis, hoarseness, otitis
Followed by pneumonia

Question 25

Who in and how does pneumocystis pneumonia present?

Answer 25

In immunocompromised patient Dry cough, exertional dyspnoea, fever Bilateral creps Bilateral perihilar shadowing

Question 26

What is SARS?

Answer 26

Severe acute respiratory distress syndrome caused by SARS virus

Question 27

How does SARS present?

Answer 27

``` Fever, chills, rigours Myalgia Dry cough and dyspnoea Headache Diarrhoea ```

Question 28

Tests in SARS

Answer 28

Decreased WCC and abnormal CXR

Question 29

Major complication of SARS

Answer 29

Respiratory failure

Question 30

Management of SARS

Answer 30

Supportive No druc dg been shown to be effective Early isolation

Question 31

Main complications of pneumonia x9

Answer 31

``` Respiratory failure Hypotension AF Pleural effusion Abscess Empyema Septicaemia Jaundice Pericarditis and myocarditis ```

Question 32

Why does hypotension occur as a complication of pneumonia? | Management

Answer 32

Dehydration and vasodilation due to sepsis | Give fluid challenge if systolic

Question 33

Presence of AF with pneumonia

Answer 33

Common especially in elderly Usually resolves with pneumonia May need to give beta blocker or digoxin to slow ventricular contraction in mean time

Question 34

What is empyema, presentation and management

Answer 34

Infected pleural effusion meaning pus in pleural space Resolving pneumonia but recurrent fever Drain (yellow fluid)

Question 35

Lung abcess in pneumonia, presentation and treatment

Answer 35

Cavitating area of localised suppurative infection Swinging fever, cough with purulent foul smelling sputum, chest pain, haemoptysis and malaise and weight loss Antibiotics and postural drainage, aspiration

Question 36

Incidence of pneumonia

Answer 36

5-11/1000 - higher in elderly and very young

Question 37

When do you give pneumococcal vaccine

Answer 37

Over 65 Diabetes Chronic renal, liver, heart or lung disease Immunosuppression