4. Pneumonia

Question 1

What is pneumonia?

Answer 1

Acute lower respiratory tract infection associated with fever, chest symptoms and abnormalities on CXR

Question 2

What are the symptoms of pneumonia?

Answer 2

Fever, rigors, anorexia
Dyspnoea, cough w/ purulent sputum, heamoptysis
Pleuretic pain

Question 3

What are the clinical signs of pneumonia?

Answer 3

Pyrexia, cyanosis, confusion, tachypnoea, tachycardia, hypotension, 
reduced expansion,
dull percussion, 
bronchial breathing,
increased vocal resonance

Question 4

What tests can be done for pneumonia?

Answer 4

Oxyegn sats (ABG if under 92%)
BP and obs
FBC, U&E’s, LFT, CRP,

Question 5

What diagnostic investigations can be carried out when pneumonia is suspected?

Answer 5

CXR,
urine- legionella, pneumococcal antigens
pleural fluid can be aspirated for culture

Question 6

What diagnostic investigations may be carried out in at risk groups?

Answer 6

Atypical organsim- PCR sputum, serology

Bronchoscopy./brocheolavage if immunocompromised/ITU

Question 7

What scoring system is used to assess pneumonia severity?

Answer 7

Confusion
Urea>7 mmol/L
Respiratory rate >30/min
Blood pressure (<90 systolic, <60 diastolic)
65

0-1 treat at home (unless por clinical prognosis featres e.g. SaO2<92, worrying x-ray changes
2- hospital
3- ITU (also consider ITU if shock, hypercapnea, hypoxic)

Question 8

What are the different types of pneumonia?

Answer 8

Community aquired
Atypical
Hospital acquired
Aspiration
Immunocompromised patient

Question 9

Describe the management of pneumonia?

Answer 9

Antibiotics based on CURB scoring system or class of disease
Oxygen- aim for sats>94
Iv fludis if vomiting, dehydrated, shock
Analgesia (if pleurisy)
VTE prophalaxis
Follow up at 6 months with CXR

Question 10

For a community acquired pneumonia, describe the grampian policy as of 2018 (to be reviewed 2021) for a curb score of 0-1

Answer 10

Curb 0-1- 1g oral amox 8 hrly 5 day course

or oral dox (pen allergy) 200mg then 100mg daily. 5 day course

Question 11

For a community acquired pneumonia, describe the grampian policy as of 2018 (to be reviewed 2021) for a curb score of 2

Answer 11

Curb 2- Oral/IV amox 1g, 8hrly+oral clarithromycin 500mg

True penicllin allergy oral dox 100mg 12 hrly. If IV then assume CURB 3

Question 12

For a community acquired pneumonia, describe the grampian policy as of 2018 (to be reviewed 2021) for a curb score of 3 or more and no previous antibiotic

Answer 12

IV amox and oral clarthromycin 500mg 12hrly (until atypical excluded) then oral doxycyline monotherpay 100mg 12 hrly

Question 13

For a community acquired pneumonia, describe the grampian policy as of 2018 (to be reviewed 2021) for a curb score of 3 or more and previous antibiotic

Answer 13

Co amoxiclav 1.2g 8hrly IV and clarithromycin 500mg oral/IV (until atypical excluded). Switch to oral doxcycyline monotherapy 100mg 12 hrly.

Question 14

For a community acquired pneumonia, describe the grampian policy as of 2018 (to be reviewed 2021) for a curb score of 3 or more and no previous antibiotic and penicillin allergy

Answer 14

Co-trimoxazole 960mg 12 hrly IV

Question 15

What are the most common organisms for a community acquired pneumonia

Answer 15

Streptococcus pneumoniae, heamophillus influenzae, morexella catarrhalis

Question 16

What are the most common organsisms for a community acquired pneumonia

Answer 16

typically Staph aureus or gram negative enterobacteria (e.g. e.coli)

may also be pseudemonas, kleibsiella

Question 17

What are the most common organisms that an immunocomprimised patient will get?

Answer 17

Pneumocystis jirovecii, fungi, mycobacteria

Question 18

For a hospital acquired pneumonia, describe the grampian policy as of 2018 (to be reviewed November 2021)

Answer 18

Non severe- Amoxicillin 1g 8hrly
or Doxycycline 100mg 12 hrly

Severe- co-amoxiclav 1.2g 8hrly and gentamicin IV

Add vancomycin IV if MRSA indicated

Question 19

For an aspiration pneumonia describe the grampian policy as of 2018 (to be reviewed 2021)

Answer 19

Oral amoxicillin 1g 8hrly
Oral metronidazole 400mg 8hrly

or if pen allergy clarithromycin 500mg 12 hrly
metronidazole 400mg 8 hrly