Pneumonia

Question 1

Pneumonia RF

Answer 1

Age (young+old), lifestyle, preceding viral infections, respiratory diseases, immunosuppression, IVDU, hospitalisation, aspiration pneumonia, underlying predisposing disease

Question 2

CAP pathogens

Answer 2

S.pneumoniae, S.aureus, Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydophila pneumoniae, resp viruses, mixed in 25%

Question 3

Epidemiology of CAP

Answer 3

5-12% who present GP with LRTI are diagnosed with CAP. 22-42% admitted to hospital

Question 4

Diagnosis of pneumonia unlikely if

Answer 4

No focal chest signs, HR, RR and temp are normal

Question 5

Pneumonia presentation in elderly

Answer 5

Malaise, fatigue, anorexia and myalgia

Question 6

CRB-65?

Answer 6

• Confusion
• RR >30
• SBP <90 (or DBP <60)
• Age 65 or older

If above 0, consider admission

Question 7

Pneumonia management

Answer 7

Oxygen, fluids, analgesics, (NSAIDS or P for mild pleuritic pain) try avoid morphine (retention), nebulised saline

Question 8

When to seek further advice on pneumonia?

Answer 8

If no improvement after 72 hours

Question 9

Low severity pneumonia management

Answer 9

• Antibacterials recommended in all cases starting as soon as possible
• 5 day course amoxicillin, if allergic; clarithromycin, erythromycin or doxycycline
• Extend course if no improvement in 3 days
• Add flucloxacillin in staphylococcal infection suspected, or vancomycin for MRSA

Question 10

Moderate to severe pneumonia management

Answer 10

• Treat in hospital
• For moderate treat as per low severity
• For high severity; 5 day course of co-amoxiclav with clarithromycin or erythromycin (pregnancy)
• Managing for atypical shows no additional benefit

Question 11

Atypical pneumonia pathogens

Answer 11

M. pneumoniae, C. pneumoniae, Legionella pneumophila

Question 12

M. pneumoniae presentation

Answer 12

• Vague slow-onset

- Much like a viral illness but persistence and progression marks it out

Question 13

C. pneumoniae presentation

Answer 13

• Cough with scanty sputum

- Hoarseness

Question 14

L. pneumophila presentation

Answer 14

• Most severe atypical

- Mild headache and myalgia leading to pyrexia, chills, rigors

Question 15

Signs of atypical pneumonia

Answer 15

• Discordance between chest signs and illness of patient (patient looks better than symptoms suggest)
• Floridity of initial CXR appearance
• Extrapulmonary symptoms

Question 16

HAP in first four days causes

Answer 16

S. pneumoniae,

-often caused by multiple organisms

Question 17

HAP after first four days

Answer 17

H. influenzae, MRSA, Pseudomonas Aeruginosa

-often caused by multiple organisms

Question 18

Pneumonia differentials

Answer 18

Different organism, pulmonary oedema, pleural effusion, pneumothorax, PE, asthma, COPD, bronchiectasis, fibrosing alveolitis, neoplasm, sarcoidosis

Question 19

Pneumonia Ix

Answer 19

FBC, CRP, LFT, CXR, U/E, cultures, urinary antigen tests, sputum culture, obs, aspiration

Question 20

Pneumonia complications

Answer 20

Pleural effusion, empyema, lung abscess, pneumatocele, pneumothorax, DVT