Pneumonia

Question 1

Whats associated with high fever, rapid onset and herpes liabilis

Answer 1

streptococcus pneumoniae

Question 2

what bacteria is common in COPD patients?

Answer 2

haemophilus influenza

Question 3

what is pneumonia?

Answer 3

an infection of the lower resp tract causing inflammation of the alvelar sacs

Question 4

symptoms?

Answer 4

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

Question 5

signs ?

Answer 5

• fever
• cyanosis
• tachypnoea
• tachycardia
• hypotension
• pleural rub
• signs of consolidation (dull percussion, diminished expansion)

Question 6

investigations?

Answer 6

• blood culture
• CXR
• ABGS
• sputum sample
• bloods

Question 7

Why is a blood culture done?

Answer 7

to determine what type of pneumonia it is

Question 8

what would be seen on CXR?

Answer 8

new shadowing

Question 9

Why are ABGS done?

Answer 9

to confirm type 1 or type 2 resp failure

Question 10

what type of pneumonia uses CURB 65 to determine the severity

Answer 10

community acquired pneumonia

Question 11

what does CURB 65 stand for

Answer 11

C- new onset of confusion
U- urea>7
R- rr>30
B-  bp systolic <90, diastolic <60
age >65

Question 12

Score 0-1 CURB 65

Answer 12

treat as outpatient

Question 13

Score 2 CURB 65

Answer 13

treat at hospital

Question 14

Score 3+ CURB 65

Answer 14

severe and often require ITU

Question 15

Complications of pneumonia?

Answer 15

• resp failure
• pleural effusions
• empyema
• death

Question 16

pathogens in community acquired pneumonia

Answer 16

• streptococcus pneumoniae
• haemophilus influenza
• mycoplasma pneumoniae

Question 17

bacteria most common in young people

Answer 17

mycoplasma pneumoniae

Question 18

bacteria most common in old

Answer 18

streptococcus pneumoniae

Question 19

bacteria most common in bird owners

Answer 19

chlamydia Psittaci

Question 20

bacteria most common in sheep workers

Answer 20

coxiella burnetti

Question 21

bacteria associated with red jelly sputum

Answer 21

klebsiella pneumonia

Question 22

bacteria associated with rusty sputum

Answer 22

pneumococcal pneumonia

Question 23

bacteria associated with COPD exacerbations

Answer 23

haemophilus influenza

Question 24

bacteria associated with returning travelers

Answer 24

legionella pneumophila

Question 25

Treatment for CURB 65 rating 0

Answer 25

``` amoxicillin (500mg x3 daily) OR clarithromycin (500mg x2 daily) OR if allergic to penicillin Doxycycline (200mg loading dose then x1 100mg) ALL ORAL ```

Question 26

Treatment for CURB 65 rating 1-2

Answer 26

Amoxicillin (500mg x3 daily) AND Clarithromycin (500mg x2 daily) OR if allergic to penicillin Doxycycline (200mg loading dose, 100mg x1 daily)

Question 27

Treatment for CURB 65 rating 3-5

Answer 27

``` Co-amoxiclav (IV 1.2g x3 daily) AND Clarithromycin (IV 500mg x2 daily) OR if allergic to penicillin Cephalosporin IV AND clarithromycin (500mg x2 daily) ```

Question 28

What should be added to treatment if suspected legionella pneumoniae?

Answer 28

fluoroquinolones

Question 29

What is hospital acquired pneumonia?

Answer 29

Patient contracts pneumonia atleast 48 hours after being admitted in hospital

Question 30

What organisms usually cause early onset hospital acquired pneumonia? (<4 days in hospital)

Answer 30

- streptococcus pneumonia - haemophilus influenzae - staph aureus

Question 31

What organisms usually cuase late onset hospital acquired pnuemonia>

Answer 31

- all of the early onset - Klebsiella Pneumonia - Legionella pneumoniophilia - Pseudomonas aeruginosa

Question 32

Treatment for early onset hospital acquired pneumonia

Answer 32

Narrow spectrum antibiotics - Co amoxiclav - Cefrtriaxone - Ciprofloxacin

Question 33

Treatment for late onset hospital acquired pneumonia

Answer 33

Broad spectrum antibiotics - gentamycin - vancomycin - antipseudomonal cephaloisporin

Question 34

Whats aspiration pneumonia?

Answer 34

Pneumonia caused by breathing vomit, a foreign object or a harmful substance

Question 35

Treatment for aspiration pneumonia?

Answer 35

Co amoxiclav will cover gram neg and anaerobic bacteria but would be better to check exactly what bacteria using culture

Question 36

according to NICE guidelines, how should the patient respond to treatment from week 1 - month 6

Answer 36

``` week 1- fever resolve week 4- chest pain and sputum reduced week 6- cough and sputum reduced month 3- most symptoms resolved, only tired month 6- back to normal ```