LRTI adults (inc pneumonia)

Question 1

What are the CURB 65 parameters?

Answer 1

C confusion
U blood urea > 7mmol/L
R respiratory rate ≥ 30/min
B systolic BP < 90 mmHg, diastolic blood pressure < 60mmHg
65 age ≥ 65

0-1 low risk - could be treated in community < 3%
2 moderate risk - hospital treatment usually required 9%
3-5 high risk of death and need for ITU

Question 2

What pathogens cause community acquired pneumonia?

Answer 2

Strep pneumonia
H. flu
Mycoplasma pneumonia

Legionella pneumophilia
Chlamydia pneumoniae
Chlamydia psittaci
Coxiella burnetti
Moraxella catarrhalis
Viruses

Question 3

What pathogens cause hospital acquired pneumonia?

Answer 3

Enterobacteria
Staphylococcus aureus
Pseudomonas aerigunosa
Klebsiella pneumoniae

Question 4

What investigations are appropriate for hospital acquired pneumonia?

Answer 4

Bloods – serum biochemistry, FBC, CRP
Blood cultures
CXR
Sputum culture, viral throat swab
Legionella urinary antigen

Question 5

What does rusty brown sputum suggest?

Answer 5

Strep pneumoniae infection

Question 6

Signs and symptoms of pneumonia?

Answer 6

Symptoms:
-Fever, rigors, myalgia
-Cough and sputum
-Chest pain (pleuritic)
-Dyspnoea
-Haemoptysis

Signs:
-Tachypnoea
-Tachycardia
-Reduced expansion
-Dull percussion
-Bronchial breathing
-Crepitations
-Increased vocal resonance

Question 7

How is pneumonia treated?

Answer 7

CURB 0-1 Amoxicillin (pennicilin allergy: Clarithromycin) 5 days
2 Amoxicillin + clarithromycin (levofloxacin) 5-7 days
3-5 Co-Amoxiclav + Clarithromycin (levofloxacin and co-trimoxazole) 7-10 days

MRSA, use vancomycin

Aspiration pneumonia, use amoxicillin + metronidazole

Question 8

Acute bronchitis?

Answer 8

Inflammation of bronchi
Temporary <3 weeks
Cough and sputum
Usually viral
Supportive management

Question 9

Bronchiectasis?

Answer 9

Chronic productive cough
Breathlessness
Recurrent LRTI
Haemoptysis

Finger clubbing
Crepitations (coarse)
Wheeze
Obstructive spirometry