Bacterial Pneumonia

Question 1

What are the typical organisms which cause bacterial pneumoniae?

Answer 1

Streptococcus pneumoniae
Haemophilia influenzae
Moraxella catharralis 
Mycoplasma pneumoniae
Legionella pneumophila
Chlamydophila pneumonia
Chlamydophila psittaci

Question 2

What are the risk factors for s.pneumonia infection?

Answer 2

Alcohol
Smoking
Asthma
Cancer

Question 3

What are the clinical signs of s.pneumoniae infection?

Answer 3

Abrupt onset cough
Fever
Pleuritic chest pain

Question 4

What examination findings would be seen with s.pneumoniae infection?

Answer 4

Dull percussion
Coarse crepitations
Increased vocal resonance

Question 5

S.pneumoniae infection is treated with penicillin. What alternative agent is used if there is penicillin allergy?

Answer 5

Clarithromycin

Doxycycline

Question 6

H.influenzae is more common in those with underlying lung disease. T/F?

Answer 6

True

Question 7

H.influenzae is usually treated with amoxicillin. What is used as an alternative treatment when there is beta lactamases causing resistance?

Answer 7

Co amoxiclav
Macrolides
Tetracyclines

Question 8

Why can’t beta lactams be used to treat mycoplasma pneumoniae?

Answer 8

Because M.pneumoniae lacks a cell wall

Question 9

What is the presentation of M.pneumoniae infection?

Answer 9

Haemolysis (cold agglutinins)
Guillain-barre
Erythema multiform
Cardiac symptoms 
Arthritis

Question 10

M.pneumoniae is very difficult to culture so how is it diagnosed?

Answer 10

Serology

PCR

Question 11

What agents are used to treat m.pnuemoniae and/or legionella pneumophila infection?

Answer 11

Clarithromycin (macrolides)
Doxycycline (tetracyclines)
Ciprofluxacin (quinolones)

Question 12

Describe the CURB65 score for assessment of a patient with pneumonia?

Answer 12

C is for confusion
U is for urea >7
R is for respiratory rate >30
B is for blood pressure, diastolic <60mmHg or systolic <90mmHg
65 age >65 years
A score of 3 or more indicates severe pnemonia

Question 13

What changes to observations are seen in sepsis?

Answer 13

Systolic bp <100mmHg
Altered mental status
Respiratory rate >22 breaths/min

Question 14

Describe the presentation of atypical pneumonia?

Answer 14

General non-specifically unwell with influenza like symptoms (sore head, myalgia, fever, diarrhoea) and few chest symptoms. Diagnosis only becomes apparent on examination of the chest or radiology