Maxi CBL - Pneumonia

Question 1

What are the features of a “typical” pneumonia? [2]

Answer 1

predominance of chest related symptoms in the presence of markers for sepsis

Question 2

What are the features of an “atypical” pneumonia? [3]

Answer 2

1. patients who non-specifically unwell, often with influenza-like symptoms and only a few chest symptoms
   
   • sore head,
   • myalgia,
   • fever,
   • diarrhoea
2. the diagnosis of pneumonia only becomes apparent on examination of the chest or radiology when signs of focal consolidation are noticed

Question 3

What are the most common organisms associated with typical and atypical pneumonia (CAP)? [5]

Answer 3

1. Most common = streptococcus pneumonia (if in doubt guess this)
2. Other organisms associated with a more typical presentation include:
   
   • Haemophilus influenza
   • Moraxella cattharalis (more common if underling chest disease e.g. COPD)
   • Staphylococcus aureus (severe necrotising pneumonia)
   • Group A streptococcus

Question 4

What are the typical chest symptoms associated with community acquired pneumonia (CAP)? [4]

Answer 4

1. cough
2. purulent sputum,
3. pleuritic chest pain
4. dyspnoea

Question 5

What are the atypical organisms that can cause community acquired pneumonia (CAP)? [4]

Answer 5

1. L. pneumophila
   
   • inhaled from aerosols containing bacteria
   • risk with use of showers or air conditioning units often in warmer climates
2. M. pneumonia
   
   • most prevalent in school children and young adults
   • most prevalent in autumn and winter
3. C. psittaci
   
   • close association with sick psittacine birds (parrots)
4. C. burnetti
   
   • close association with ruminant animals e.g. abattoir workers

Question 6

How do you assess the severity of a patient’s pneumonia? [6]

Answer 6

• CURB65 score:
  
  • C → confusion
  • U → blood urea >7mmol/L
  • R → respiratory rate >30 breaths/min
  • B → diastolic BP <60mmHg
  • 65 → age ≥65yrs

Question 7

What antibiotics are given for patients with…

1. non-severe CAP → CURB65 score: 0-1 [4]
2. non-severe CAP → CURB65 score = 2 and no sepsis [3]
3. severe CAP → CURB65 ≥3 or CAP + sepsis [5]

Answer 7

1. Non-severe community acquired pneumonia (non-severe CAP) → CURB65 score: 0-1
   
   • Amoxicillin
   • or Doxycycline (if penicillin allergy present)
   • or Co-trimoxazole
   • or Clarithromycin
2. CURB65 score = 2 and no sepsis:
   
   • Same as above
   • or Amoxicillin + Clari​thromycin
3. Severe CAP → CURB65 ≥3 or CAP + sepsis
   
   • Clarithromycin + Amoxicillin or Co-amoxiclav
   • or clarithromycin + vancomycin (if penicillin allergy present)