Pneumonia

Question 1

List pathogens causing “typical” CAP

Answer 1

Strep pneumoniae
Haemophilus influenzae (COPD, gram neg)
Moraxella (COPD, gram neg)

Question 2

Name 2 severity assessment scores for CAP

Answer 2

PSI

CURB-65

Question 3

What’s in CURB 65?

Answer 3

C - confusion
U - urea >7
R - RR >30
B- systolic BP <90, diastolic BP <60
65 - age >65

Each worth 1 point
0-1 = home
2 = likely admit
3-5 = admit, treat as severe

Question 4

List clinical features that help distinguish between typical and atypical pneumonia

Answer 4

Typical

• Abrupt onset
• Fever, rigors, SOB, productive cough, pleuritic chest pain
• CXR: lobar consolidation
• High inflammatory markers

Atypical

• Longer prodrome, late onset
• Minimal respiratory sx, constituitional sx
• CXR: NAD or bilateral interstitial infiltrates
• Normal or mildly raised inflammatory markers

Question 5

Any role for steroids in pneumonia?

Answer 5

No

Question 6

What investigations to do for CAP?

Answer 6

CXR
Urinary pneumococcal antigen
Urinary legionella antigen
Bloods atypical serology 
Sputum MCS (poor test)

Question 7

Which pathogen commonly causes rapid 1 day onset CAP?

Answer 7

Strep pneumoniae

Question 8

List pathogens causing “atypical” CAP

Answer 8

Mycoplasma pneumoniae
Legionella (water, soil, air conditioner) 
- Abnormal LFTs and GI symptoms
Chlamydia psittacosis (birds)
Brusilosis (QLD, cattle farm)
Ross-rover
Coxiella burnetti (Q fever) (cattle)

Question 9

Pathogens in HAP

Answer 9

Pseudomonas (gram neg) - get it from ICU
Klebsiella (gram neg)
Staph aureus/MSSA/MRSA (gram positive)
Ecoli (gram neg)
Proteus (gram neg)
Serratia (gram neg)
Strep pneumoniae (gram pos)

Question 10

Rx HAP with pseudomonas

Answer 10

Tazocin + gent/ceftazadine/cipro (careful with using cipro as its the only PO agent)

Question 11

Commonest pathogen in pneumonia from nursing homes

Answer 11

Strep pneumoniae

Question 12

Pathogens in aspiration pneumonia

Answer 12

Peptostreptococcus (oral), fusobacterium, prevotella, bacterioides, gram neg (often a mix)

Question 13

What kind of pneumonia is most prone to abscesses?

Answer 13

Aspiration pneumonia