Pneumonia

Question 1

What are the 3 commonest causative bacterial organisms for community acquired pneumonia?

Answer 1

1st: Streptococcus pneumoniae
2nd: Haemophilus influenzae
3rd: Mycoplasma pneumoniae

Question 2

What percentage of pneumonias are caused by viruses and what virus is most commonly responsible?

Answer 2

13-15%, influenza virus

Question 3

What features might you see on a CXR for a community acquired influenza pneumonia complicated by staphylococcal infection, for example in an IV drug user?

Answer 3

Bilateral cavitating bronchopneumonia (where normal lung architecture is replaced with a cavity)

Question 4

What organism most commonly causes hospital acquired pneumonia?

Answer 4

Gram negative enterobacteria or Staph Aureus

Question 5

What rare causative organism of hospital acquired pneumonia causes cavitating pneumonia of the upper lobes?

Answer 5

Klebsiella pneumoniae

Question 6

Give 6 conditions that increase an individuals risk of contracting aspiration pneumonia by aspirating oropharyngeal anaerobes

Answer 6

Stroke
Myasthenia graves
Poor dental hygiene 
Bulbar palsy
Lower consciousness 
Oesophageal disease

Question 7

Give 7 common clinical symptoms of pneumonia

Answer 7

Any 7 from:
Fever
Rigors 
Malaise
Breathlessness
Pleuritic chest pain
Productive cough with purulent sputum
Anorexia

Question 8

What common sign may be the only sign of a pneumonia in the elderly?

Answer 8

Confusion

Question 9

Give 4 signs of consolidation you would find on examination

Answer 9

Reduced expansion
Dull percussion note
Bronchial breathing
Increased vocal resonance/fremitus

Question 10

Give the indications for performing an pneumonia

Answer 10

Oxygen sats lower than 92%

Severe pneumonia

Question 11

Why is urine tested in suspected pneumonia?

Answer 11

Pneumococcal antigen is detectable in urine

Question 12

Describe the CURB65 score for assessing pneumonia severity

Answer 12

Confusion = 1 point
Urea > 12 = 1 point
Respiratory rate > 30 = 1 point
Blood pressure <90/60 = 1 point
Age >65 = 1 point
Home based care for score 0
Consider admission for score 1+
IV antibiotics for score 3+

Question 13

Give 2 atypical organisms that require different antibiotics to treat pneumonia

Answer 13

Legionella pneumophilia

Mycoplasma pneumoniae

Question 14

If IV antibiotics are indicated, what is usually given?

Answer 14

Co-amoxiclav

Question 15

What oral antibiotics are typically given for typical pneumonia?

Answer 15

Amoxicillin or clarithromycin (for atypical)

Question 16

What dose of oral amoxicillin is given for community acquired pneumonia?

Answer 16

500mg to 1 gram/8hours

Question 17

In severe pneumonia, if Staphylococcus infection is suspected, what antibiotics should be added?

Answer 17

Flucloxacillin

Question 18

In severe community acquired pneumonia, if MRSA infection is suspected, which antibiotic should be added?

Answer 18

Vancomycin

Question 19

If legionella is suspected in community acquired pneumonia, what antibiotic should be considered?

Answer 19

Rifampicin

Question 20

If chlamydia infection is suspected for the cause of pneumonia, what antibiotic should be added?

Answer 20

Tetracycline

Question 21

If pneumocystis Jiroveci is suspected in community acquired pneumonia, what antibiotic should be added?

Answer 21

Co-trimoxazole

Question 22

In hospital acquired pneumonia with a gram negative bacilli causing it, what antibiotics should be used and by what route?

Answer 22

Aminoglycosides e.g. Streptomycin or gentamicin

IV route

Question 23

If pseudomonas is suspected in hospital acquired pneumonia what antibiotic should be given?

Answer 23

Antipseudomonal penicillin IV, or 3rd generation cephalosporin e.g. Cefotaxime

Question 24

Give 10 complications of pneumonia

2 respiratory, 4 infective, 3 cardiovascular, 1 liver

Answer 24

Pleural effusion
Empyema
Lung abscess
Brain abscess
Respiratory failure type 1
Septicaemia
Pericarditis
Myocarditis
Atrial fibrillation
Cholestatic jaundice

Question 25

Give 4 causes of a lung abscess

Answer 25

Untreated pneumonia
Foreign body obstruction (tumour, foreign body)
Aspiration
Septic emboli (endocarditis, IV drug use)

Question 26

Give the common symptoms of a lung abscess

Answer 26

Swinging fever
Pleuritic chest pain
Productive cough with purulent sputum
Haemoptysis
Weight loss

Question 27

Give the common signs of a lung abscess

Answer 27

Finger clubbing
Anaemia
Crepitations
Empyema in 20-30%

Question 28

What might you find on a Chest X-ray for a lung abscess?

Answer 28

Walled cavity often with a fluid level

Question 29

Besides a CXR, what diagnostic tests can confirm a lung abscess?

Answer 29

CT will exclude obstruction

Bronchoscopy will produce diagnostic specimens

Question 30

Atrial fibrillation is one complication of pneumonia especially in the elderly. It usually recovers with treatment of the pneumonia. If it wins troublesome in the short term how can it be treated?

Answer 30

Digoxin or a beta blocker

Question 31

What condition can a chronic or recurring pneumonia lead to?

Answer 31

Bronchiectasis