Pneumonia

Question 1

Tool used to assess severity of pneumonia

Answer 1

CRB-65

Question 2

Components of CRB-65

Answer 2

Confusion
Raised resp rate
Low BP
Age 65 or more

Question 3

Definition of confusion in CRB-65

Answer 3

New disorientation in person, place, or time; or abbreviated mental test score 8 or less

Question 4

Definition of raised resp rate in CRB-65

Answer 4

30 breaths per min or more

Question 5

Definition of low BP in CRB-65

Answer 5

Diastolic 60 mmHg or less

Or systolic less than 90 mmHg

Question 6

Interpretation of CRB-65

Answer 6

0 - low risk of death
1-2 - intermediate risk
3-4 - high risk

Question 7

Clinical features indicative of severe community-acquired pneumonia

Answer 7

Difficulty breathing 
O2 sats less than 90% 
Raised heart rate 
Grunting; very severe chest indrawing 
Inability to drink 
Lethargy; reduced level of consciousness

Question 8

When should sputum culture be requested for CAP

Answer 8

Moderate severity community-acquired pneumonia for whom community management is appropriate

Do not routinely recommend microbiological tests for people with low-severity CAP

Question 9

Features of acute bronchitis

Answer 9

May or may not have sputum, wheeze, or breathlessness

Substernal or chest wall pain may be present with coughing

Sometimes mild constitutional symptoms

Cough

Question 10

Features of CAP

Answer 10

Dyspnoea
Sputum 
Pleural pain 
Sweating 
Fever 
Shivers, aches and pains 
Cough

Question 11

Which clinical features indicate atypical penumonia

Answer 11

Dry cough 
No fever 
Headache 
Confusion 
Diarrhoea 
Hyponatraemia in legionella 
Upper resp involvement

Question 12

Typical examination and investigation findings for acute bronchitis

Answer 12

Mildly ill
Wheeze often present
Rhonchi that improve with coughing may be present
CXR normal

Question 13

typical examination and ix findings for CAP

Answer 13

Focal chest signs such as decreased or asymmetric breath sounds 
Bronchial breath sounds 
Dullness to percussion 
Course crepitations 
Vocal fremitus 
Tachypnoea and tachycardia

CXR abnormal

Question 14

When should adults be with CAP be referred to hospital

Answer 14

Symptoms and signs suggest a more serious illness or condition(for example, cardioresp failure or sepsis)

Symptoms are not improving as expected with antibiotics

Question 15

Follow up for a person with CAP in primary care

Answer 15

CXR after 6 weeks for adults:

With symptoms and signs that persist despite treatment

Who are a higher risk of underlying malignancy(smokers and people aged above 50)

Question 16

Which immunisation can be considered for individuals after recovery from pneumonia

Answer 16

Pneumococcal or influenza immunisation

Question 17

Management of CAP

Answer 17

Analgesia - NSAIDs
Antibiotic - Amoxicillin 500mg
Doxycycline or clarithromycin if allergy

Question 18

Risk factors for mycoplasma and chlamydophila pneumonia

Answer 18

Spread by person-to-person contact and spread is most common in closed populations(schools, offices)

Question 19

Risk factor for legionellae pneumonia

Answer 19

Found most commonly in fresh water and man-made water systems

Question 20

What is HAP occurring less than 5 days after hospital admission usually caused by

Answer 20

S.pneumoniae

Question 21

What is HAP occurring more than 5 days after hospital admission usually caused by

Answer 21

H.influenzae
MRSA
Pseudomonas aeurginosa

Question 22

Management of atypical penumonia

Answer 22

Treated as for other CAP initially(little value in serological testing)

Doxycycline, clarithromycin and erythromycin

Question 23

Which antibiotic may be used in severe legionella infections

Answer 23

Rifampicin as well as a macrolide

Question 24

Complications of pneumonia

Answer 24

Pleural effusion(usually sterile)
Empyema
Lung abscess
Pneumothorax

Question 25

What are focal outbreaks of L.pneumophila often caused by

Answer 25

Poorly maintained air-conditioning or humidification systems

Question 26

Features of pneumonic/Legionnaires' disease

Answer 26

``` More likely to have a cough(90%) Severe Not self-limiting Often display a relative bradycardia Headache, confusion, impaired cognition GI symptoms ```

Question 27

Features of non-pneumonic(pontiac disease)

Answer 27

Influenza-like illness with myalgia, fever and headache | Self-limiting

Question 28

IX - Legionnaires' disease

Answer 28

Isolation and culture of legionella species(usually sputum) Seroconversion(in titre of indirect immunoflourescent antibody test) Confirmation of L.pneumophila urinary antigen

Question 29

Management of legionnaires' disease

Answer 29

Paracetamol Oxygen/assisted ventilation Erythromycin(although care has to be taken to avoid GI upset)

Question 30

Classification of pneumonia by CRB-65

Answer 30

0 - low severity 1 or 2 - moderate 3+ - severe

Question 31

Antibiotic choice for low severity CAP

Answer 31

amoxicillin 500mg TDS Oral Doxycycline 200mg if allergic or oral clarithrymocyin

Question 32

Antibiotic choice for moderate severity CAP

Answer 32

Oral amoxicillin 500mg three times a day + oral clarithromycin 500mg BDS Doxycycline if allergic to penicillin

Question 33

How does legionnaires' disease cause hyponatraemia

Answer 33

Causes SIADH

Question 34

Rash associated with mycoplasma pneumoniae

Answer 34

Erythema multiform - target lesions Can also cause neurological symptoms

Question 35

What is pneumonia caused by coxiella burnetti caused by

Answer 35

Linked to exposure to animals and their bodily fluids

Question 36

What is pneumonia caused by chalmydia psittaci associated with

Answer 36

Typically contracted from contact with infected birds

Question 37

What is bronchitis

Answer 37

It is a result of inflammation of the trachea and major bronchi and is therefore associated with oedematous large airways and the production of sputum. Self-limiting

Question 38

Presentation of bronchitis

Answer 38

Cough - may or may not be productive Sore throat Rhinorrhoea Wheeze Most have normal chest exam but can have wheeze/low-grade fever

Question 39

Differentiating acute bronchitis from pneumonia in the history

Answer 39

Sputum, wheeze, breathlessness may be absent in acute bronchitis whereas at least one tends to be present in pneumonia.

Question 40

Differentiating acute bronchitis from pneumonia in the examination

Answer 40

No other focal chest signs (dullness to percussion, crepitations, bronchial breathing) in acute bronchitis other than wheeze. Moreover, systemic features (malaise, myalgia, and fever) may be absent in acute bronchitis, whereas they tend to be present in pneumonia.

Question 41

Management of acute bronchitis

Answer 41

Analgesia Fluids Antibiotics if systemically unwell, CRP raised Doxycycline as first line for acute bronchitis