L 47 & 48

Question 1

Pneumonia definition?

Answer 1

Lung inflammation caused by infection in which the air sacs fill with pus and may become solid.

Question 2

Will inflammation affect both or just one lung in pneumonia?

Answer 2

It can affect both or just one (double, or single pneumonia)

Question 3

Pneumonia symptoms: x7

Answer 3

High fever, chills, painful/productive cough, shortness of breath, dyspnoea, tachypnoea, fatigue.

Question 4

Danger symptoms for urgent referral of pneumonia (7 total, 2 main)

Answer 4

Temperature >38
Shortness of breath accompanied by a cough.
Respiratory rate >30 (at rest)
Oxygen saturation <92%
Chest pain (when not coughing)
Haemoptysis (coughing up blood)
Cough persisting longer than 21 days.

Question 5

4 types of pneumonia

Answer 5

CAP
HAP
VAP (ventilation acquired)
Aspiration pneumonia

Question 6

Diagnosis of pneumonia by….

Answer 6

Chest x-ray
Pulse oximetry (oxygen level in blood via finger test)
Full blood count, white cell count, CRP, U+E (urea + electrolytes)
Culture of LRT sample (if pss)
Consider

Question 7

High pH causes blood …

What does this mean?

Answer 7

High pH = blood alkalosis

High metabolic PaCO2 and low respiratory PaCO2

Question 8

Low pH causes blood …

What does this mean?

Answer 8

Low pH = blood acidosis

High respiratory PaCO2 and low metabolic PaCO2

Question 9

Define CAP

Community acquired pneumonia (CAP)

Answer 9

Pneumonia acquired outside of hospital or health care facilities

Question 10

Common causes of CAP (typical and atypical bacteria)

Answer 10

Typical bacteria: S. pneumoniae, Haemophilus influenzae, Staphylococcus aureus

Atypical bacteria: Legionella spp (soil), mycoplasma pneumoniae, chlamydophilia pneumoniae

Question 11

What could suggest that a patient has mycoplasma pneumoniae?

Answer 11

The patient will often have a rash

Question 12

Are the following gram -ve or +ve?

Answer 12

S. pneumoniae
Haemophilus influenzae
Staphylococcus aureus
S. pneumoniae: G+ve
Haemophilus influenzae: G-ve
Staphylococcus aureus: G+ve

Question 13

CAP common viral (x4) and fungal causes (x1)

Answer 13

Viral: RSV, Influenza A or B, COVID-19
Fungal: pneumocystitis pneumonia caused by the pneumocystis jirovecii

Question 14

What antibiotics would be first line for Streptococcus pneumoniae?

Answer 14

Drugs that work against gram +ve bacteria
Macrolides (azithromycin, clarithromycin)
Penicillins: Penicillin, amoxicillin
Augmentin, tazocin, doxycycline, cephalosporins

Question 15

What antibiotics would cover haemophilus influenzae?

Answer 15

Drugs that work against gram -ve bacteria
Amoxicillin
Augmentin
Broad spectrum cephalosporins
Tazocin

Question 16

What antibiotics would cover staph aureus?

Answer 16

Drugs that work against gram +ve bacteria
Cephazolin, cephalexin
Augmentin
Doxycycline

Question 17

Would you use flucloxacillin to treat pneumonia?

Answer 17

No, it isn’t really used in respiratory infections as it is not broad enough for what we are trying to treat.

Question 18

What antibiotics would cover legionella?

Answer 18

Any drugs that work against gram negative bacteria
Azithromycin
Clarithromycin
Doxycycline

Question 19

Is legionella gram positive or gram negative?

Answer 19

Gram -ve

Question 20

What covers mycoplasma pneumoniae?

Answer 20

Any drugs that work against gram -ve bacteria
Macrolides (clarithromycin, azithromycin)
Doxycycline

Question 21

What covers chlamydiphilia pneumoniae?

Answer 21

Anything that targets gram -ve

Doxycycline, azithromycin, clarithromycin

Question 22

How do we decide how severe someones CAP is?

Answer 22

Work out their CURB-65 score

Question 23

What does CURB65 stand for? How do you get points?

Answer 23

C: Confusion
U: Urea = 7+ mmol/L
R: Respiratory rate = 30+
B: Low BP (<90 SBP or <60 DBP)
65: Aged 65+
You get points by meeting this criteria. Higher score = worse potential outcome

Question 24

What does a CURB score of 3-5 mean?

Answer 24

22% chance of 30 day mortality. Admission to hospital and manage as severe.

Question 25

What is the issue with CURB65 score in clinical settings?

What would the adjustment be?

Answer 25

Communities don’t have access to quick urea results like hospitals do.
0 = low severity
1-2 = moderate severity
3-4 = high severity

Question 26

What is the CRB-65 score of Mr B?
32 y/o man and we don’t have his past medical history
He smokes 20 cigarettes a day
He returned from Spain with a dry cough which has lasted for several days
He is febrile, with a respiratory rate of 32/min which appears laboured.

Answer 26

C = not mentioned = 0
R = 1 point (is over 30)
B = unknown = 0
65 = 0, he is only 32 y/o
Therefore his CRB65 score is 1.

Question 27

Define HAP

Answer 27

Hospital acquired pneumonia
Acute pneumonia that is acquired at least 48 hours after admission to hospital and was not incubating at time of admission (didn’t have it before)

Question 28

Common pathogens that cause HAP x4 + class

Answer 28

Normally gram -v bacilli e.g
Pseudomonas aeruginosa
Escheria coli
Klebsiella pneumonia
Acinetobacter species

Question 29

Define VAP

What is it caused by?

Answer 29

Ventilator associated pneumonia.
A subset of HAP
Pneumonia occurring more than 48 hours after endotracheal intubation.
Caused by a biofilm on the endotracheal tube

Question 30

Common pathogens that cause VAP

Answer 30

Normally G+ve bacilli e.g s.aureus

Normally G-ve bacilli e.g Pseudomonas aeruginosa, E.coli, Klebsiella pneumonia

Question 31

Define aspiration pneumonia

Answer 31

Pneumonia that occurs when food, saliva, liquid, or vomit is breathed (aspirated) into the lungs instead of the stomach.

Question 32

How do we assess the patient’s treatment efficacy?

Answer 32

How long/what do we look at
An improvement trend is expected to be seen 48-72 hours within initiating antimicrobial treatment.

Look at:
Symptoms, FBC, urea, CRP, chest x-ray, temperature, respiratory rate, mental status.

Question 33

What non-antibiotic treatments do we give for pneumonia patients?

Answer 33

Fluids, oxygen, supportive care (e.g paracetamol), try to keep patients moving = helps cough up sputum.