FN: Pneumonia

Question 1

Epi

Answer 1

1/1000

Question 2

Mortality

Answer 2

10% in hospital, 30% in ITU

Question 3

Anatomic classification

Answer 3

Bronchopneumonia - patchy consolidation of different lobes

Lobar pneumonia - fibrosupportive consolidation of a single lob. Congestion red grey resolution

Question 4

Classification

Answer 4

Community acquired Pneumonia
Hospital Acquired Pneumonia
Aspiration
Immunocomprimised

Question 5

Community acquired

Answer 5

1. Pneumococcus, mycoplasma, haemophilus
2. S. aureus, Moraxella, Chlamydia, Legionella
3. viruses (155)

Question 6

Hospital acquired pneumonia

Answer 6

> 48hrs after hospital admission

Gram ive enterobacteria, S. aureus

Question 7

Aspiration

Answer 7

increased risk with: stroke, bulbar palsy, reduced GCS, GORD, achalasia
Anaerobes

Question 8

Immunocomprimised

Answer 8

The usual suspects, plus

PCP, TB, fungi, CMV/HSV

Question 9

Symptoms

Answer 9

Fever, rigors
Malaise, anorexia
dyspnoea
Cough, purulent sputum, haemoptysis
Pleuritic pain

Question 10

Signs

Answer 10

Raised RR, Raised HR
Cyanosis
Confusion

Question 11

consolidation signs

Answer 11

Reduced expansion
Dull percussion
Bronchial breathing
Reduced air entry
Crackles
Pleural rub
Raised VR

Question 12

Investigations

Answer 12

Bloods: FBC, U+E, LFT, CRP, culture, ABG (if sats low)
Urine: Ag tests (Pneumococcal, legionella)
Sputum: MC&S
Imaging CXR

Question 13

Special tests

Answer 13

Paired sera Abs for atypicals - mycoplasma, Chlamydia, legionella
Immunofloerence (PCP)
BAL
Pleural tap

Question 14

Severity

Answer 14

CURB-65 (only if xray changes)
Confusion (AMT 7mm)
Reso rate >30/min
BP 65

Question 15

CURB 65 score related to treatment

Answer 15

0-1 - home treatment
2 - hospital Rx
>3 consider ITU

Question 16

Management

Answer 16

BX
Oxygen
Fluids
Analgesia
Chest physio
Consider ITU if shock hypercapnia, hypoxia
f/up @ 6wks with CXR - check for underlying Cancer

Question 17

CAP management mild

Answer 17

Amoxicillin 500mg TDS PO for 5d or clarithro 500mg BD PO for 7d

Question 18

CAP management moderate

Answer 18

Amoxicillin 500mg TDS and clarithro 500mg BP PO/IV (clarithro alone if penicillin allergy) for 7d

Question 19

Cap management severe

Answer 19

Co-amoxiclav 1.2g TDS IV/cefuroxime 1.5mg TDS IV and clarithro 500mg BD IV for 7-10d

Question 20

Cap management Atyp

Answer 20

Chlamydia: tetracycline
PCP: Co-trimazole
Legionella: Clarithro + rifampicin

Question 21

HAP management mild/

Answer 21

Co-amoxiclav 625mg PO TDS for 7d

Question 22

HAP maagement severe/>5d

Answer 22

Tazocin ± vanc ± gent for 7d

Question 23

Aspiration pneumoni amangement

Answer 23

Co-amoxiclav 625mg PO TDS for 7d

Question 24

Pneumovax (23 valent)

Answer 24

>65 years
Chronic HLKP failure or condition
DM
Immunosuppresion: hyposplenism, chemo, HIV
CI: P, B, Fever

Question 25

Vaccination

Answer 25

Revaccinate every 6years