Clinical Study Day 1, Patient D

Question 1

What are the three main types of pneumonia?

Answer 1

Bacterial
Viral
Mycoplasma pneumonia

Question 2

What is the most common cause of bacterial pneumonia?

Answer 2

Strep. pneumoniae.

Question 3

What is the main cause of viral pneumonia?

Answer 3

The flu: influenzae.

Question 4

What does mycoplasma pneumonia present as?

Answer 4

Mild, widesread pneumonia that affects all age groups.

Somewhat different symptoms and physical signs .

Question 5

Who is most at risk for pneumonia?

Answer 5

Adults aged 65 and older.
Children younger than age 2.
People with certain medical conditions.
People that smoke.

Question 6

What are the symptoms of pneumonia?

Answer 6

Bluish colour to lipts and fingernails.

Confused mental state or delirium, especially in older people.

Cough that produces green, yellow, or bloody mucus.

Fever.

Heavy sweating.

Loss of appetite.

Low energy and extreme tiredness.

Rapid breathing.

Rapid pulse.

Shaking chills.

Sharp or stabbing chest pain that’s worse with deep breathing or coughing.

SoB that gets worse with activity.

Question 7

How is pneumonia usually diagnosed?

Answer 7

Chest Xray
Sputum culture.
Pulse oximetry.
Chest CT scan. 
Bronchoscopy. 
Plueral fluid culture.

Question 8

How is the severity of CAP assessed?

Answer 8

CRB65
Confusion
Raised respiratory rate (30 breaths per minute or more)
Low blood pressure (diastolic 60mmHg or less, or systolic less than 90mmHg)
Age 65 years or more.

Question 9

What does a CRB65 score of 1 or 2 indicate?

Answer 9

1 or 2; intermediate risk (1-10% mortality risk)

Question 10

What does a CRB65 score of 3 or 4 indicate?

Answer 10

High risk, more than 10% mortality.

Question 11

How does the assessment of CAP differ between community and hospital settings?

Answer 11

CRB65 = community. 
CURB65 = hospital.
U = raised blood urea nitrogen (over 7mmol/litre)

Question 12

When assessing CAP in hospital using the CURB65 tool, what does U represent?

Answer 12

Raised blood urea nitrogen of over 7mmol/litre

Question 13

When using the CURB65 tool in hospital to assess CAP severity, how are patients stratified according to their risk of death?

Answer 13

0 or 1: low risk (less than 3% mortality risk)
2: intermediate risk (3-15% mortality risk)
3 to 5: high risk (more than 15% mortality risk)

Question 14

When would microbiological tests be offered to patients with CAP?

Answer 14

Only for patients with moderate - or high-severity CAP: take blood and sputum cultures AND consider pneumococcal and legionella urinary antigen tests.

Question 15

What is the recomended treatment for low-severity CAP?

Answer 15

Offer a 5-day course of a single antibiotic to patients with low-severity CAP.

Consider amoxicillin in preference to a macrolide or tetracycline unless patients are allergic to penicillin.

Question 16

When would we consider extending the course of low-severity CAP treatment?

Answer 16

In patients with CAP whose symptoms do not improve as expected after 3 days.

Question 17

What is the recommended treatment for moderate and high severity CAP?

Answer 17

Consider a 7- to 10-day course of antibiotic therapy for patients with moderate- or high-severity community-acquired pneumonia.

With dual antibiotic therapyt such as amoxicillin and a macrolide for moderate severity.

With dual antibiotic therapy with a beta-lactamse stable beta-lactam and a macrolide for patients with high-severity CAP.

Question 18

What beta-lactamse stable beta-lactam options are there for high-severity CAP treatment in combination with a macrolide?

Answer 18

1. Co-amoxiclav (amoxicillin and clavuluanic acid)
2. Cefotaxime
3. Ceftaroline fosamil
4. Ceftriaxone
5. Cefuroxime
6. Piperacillin with tazobactam

Question 19

When would we consider measuring C-reactive protein concentration in patients with CAP?

Answer 19

On admission and then repeat the test if clinical progress is uncertain after 48-72 hours.

Question 20

What is confusion defined as in CRB65/CURB65?

Answer 20

Abbreviated Mental Test score 8 or less, or new disorentiation in person, place or time.

Question 21

When should we advise patients with CAP that their fever should be resolved by?

Answer 21

1 week: Fever resolved.
4 weeks: chest pain and sputum production should have substantially reduced.
6 weeks: cough and breathlessness should have substantially reduced.
3 months: most symptoms should have resolved but fatigue may still be present.
6 months: most people will feel back to normal.

Question 22

When should we advice patients with CAP that their chest pain and sputum production should be substantially reduced by?

Answer 22

1 week: Fever resolved.
4 weeks: chest pain and sputum production should have substantially reduced.
6 weeks: cough and breathlessness should have substantially reduced.
3 months: most symptoms should have resolved but fatigue may still be present.
6 months: most people will feel back to normal.

Question 23

By what point should most people who have had CAP feel back to normal?

Answer 23

1 week: Fever resolved.
4 weeks: chest pain and sputum production should have substantially reduced.
6 weeks: cough and breathlessness should have substantially reduced.
3 months: most symptoms should have resolved but fatigue may still be present.
6 months: most people will feel back to normal.

Question 24

Cholestatic jaundice can occur either during or shortly after the use of which beta-lactamase stable beta lactam antibiotic?

Answer 24

Co-amoxiclav: amoxicllin and clavulanic acid.

The duration of treatment should be appropriate to the indication and should not usually exceed 14 days.