120 - Pneumonia

Question 1

What is pneumonia?

Answer 1

LRTI

Inflammation and consolidation of the lung tissue due to an infectious agent

Question 2

What is CAP?

Answer 2

Community acquired pneumonia

Question 3

What puts you at risk of pneumonia?

Answer 3

Institutions
Low nutrition
Smoking
Alcoholism
specific drugs - mucociliary drugs (atropine), sedatives - reduce cough, steroids - reduce phagocytosis

Question 4

What investigations might you do in pneumonia? What is the acronym?

Answer 4

SUBEX

Sputum - Acid fast bacilli, general culture, gram stain, legionella antigen
Urine
Blood - Cultures, WBC, urea, serology
ECG
Xray

Question 5

What is the prognosis of pneumonia?

Answer 5

6th leading cause of death

Most common cause of death due to infectious disease

Question 6

What is the ‘risk screening’ acronym used in pneumonia to see if you should admit the patient?

Answer 6

CURB65

Confusion
High urea (>7)
High rest rate (>30)
Low BP (90/60)
Age 65+

If they have 2 points, admit

Question 7

What are the historical types of pneumonia?

Answer 7

Typical - abupt onset, high fever, purulent sputum, focal consolidation

Atypical - Gradual onset, dry cough, myalgias, headaches

Question 8

What is lobar and bronchopneumonia?

Answer 8

Lobar - continuous area affected, eg. a lobe

Bronchopneumonia - affects brochioles, so mulitple lobe foci

Question 9

How could you treat uncomplicated pneumonia?

Answer 9

oral amoxycillin + clarithromycin

or

oral cephlasporin

Question 10

How could you treat complicated pneumonia?

Answer 10

IV cefuroxime + oral clarithromycin

or

IV augmentin + oral clarythromycin

Question 11

How could you treat atypical pneumonia?

Answer 11

IV Rifampicin + tetracycline

Question 12

How could you treat cavitation or aspiration in pneumonia?

Answer 12

IV CEF + MET

Cefuroxime + metronidazole

or

Flucloxacillin

Question 13

If someone with pneumonia has rust coloured sputum, what infectious cause would you suspect?

Answer 13

Streptococcus Pneumonia

Question 14

If someone had a viral infection, then developed pneumonia, that had sepsis, cavitation, empyema and absesses, what would you think is the cause?

Answer 14

Staphylococcus Aureus

Question 15

If someone had an URTI, develops a pneumonia that grumbles along, they feel weak, what might be the cause?

Answer 15

Haemiohilus influzena

Question 16

A patient with COPD develops a pneumonia, that is distributed as a bronchopneumonia, what may be the cause?

Answer 16

Haemophilus Influenza

Question 17

An alcoholic presents with redcurrent jelly like sputum, what might be the cause?

Answer 17

Klebsiella

Question 18

Someone who has many comorbidities and often chokes on food and regurgetates food develops pneumonia, what might be the cause?

Answer 18

E-coli

Question 19

Someone is chronically ill with a pneumonia that never fully clears, they have green sputum, what may cause this?

Answer 19

Pseudomonas Aerinonsa

Question 20

After travelling abroad, someone develops gradual shortness of breath, weight loss, and has a bright green sputum - what may cause this?

Answer 20

TB - Mycobacterium Turberculosis

Question 21

Someone develops pneumonia after staying in an apartment with old air con, they also stop passing urine and start developing hepatosplenomegaly - what is the cause?

Answer 21

Legionella Pneumophilia

Question 22

In a nursing home there is an outbreak of an URTI followed by pneumonia. People thought it might be glandular fever at first. What might cause this?

Answer 22

Mycoplasma Pneumoniae

Question 23

A pigeon fancier develops pneumonia, and starts to feel depressed. What might cause this?

Answer 23

Chlamydia Psittacci

Question 24

An immunocompromised patient develops pneumonia, what 3 causes may you suspect?

Answer 24

PCP - pneumocystis Carinii
Aspergillus
Cryptococcus