Pneumonia

Question 1

What is a pneumonia?

Answer 1

any inflammatory condition affecting the alveoli of the lungs

(but vast majority secondary to bacterial infection)

Question 2

State clinical features of the following possible causes of pneumonia:

1. Strep. pneumoniae
2. haemophilus influenzae
3. Staph. aureus
4. mycoplasma pneumoniae
5. legionella pneumophilia
6. klebsiella pneumoniae
7. pneumocystis jiroveci
   (this is a fungi!)
8. chlamydia psittaci

Answer 2

1. high fever, rapid onset, herpes labialis

(80% of cases)

2. particularly common in COPD
3. often follows on from influenza infection
4. atypical: dry cough + atypical XR
   +/- autoimmune haemolytic anaemia + erythema multiforme
5. atypical: “classically” associated with infected air conditioning units
   +/- hyponatraemia, lymphopenia
6. associated with alcoholics
7. • typically associated with HIV patients
   • atypical: dry cough + absence of chest signs
8. • history of bird contact
   • resistant to penicillin based antibiotics

Question 3

What pneumonia can occur as a result of RA or amiodarone therapy?

Answer 3

cryptogenic organising pneumonia

a type of idiopathic interstitial pneumonia I.e. pneumonias with no infective cause

Question 4

What clinical features can be seen with pneumonia?

Answer 4

symptoms:
- cough (productive with sputum)
- dyspnoea
- chest pain (can be pleuritic)

signs

• SIRS: fever + tachycardia
• reduced sats
• auscultation: reduced breath sounds + bronchial breathing

Question 5

What is seen on investigation in pneumonia?

Answer 5

CXR: consolidation

Bloods

• FBC: neutrophilia if bacterial cause
• U+E: urea assesses dehydration
• CRP: raised (continuous monitoring if in hospital to monitor response to treatment)

carry out ABG if:

• reduced sats
• pre-existing resp. disease (e.g. COPD)

if CURB65 2 or more:

• blood + sputum cultures
• pneumococcal + legionella urinary antigen tests

Question 6

CURB65

1. State the parts of this score?
2. When would a patient be indicated for home-based care?

NOTE: in GP will not have urea result so likely to be working with CRB65

Answer 6

1. • confusion
   • urea >7
   • RR >30
   • BP: systolic <90 or diastolic <60
   • age >65
2. if CRB65 score is 0 or if CURB65 is 1 or 0

Question 7

What should be done 6 weeks after resolution of pneumonia?

Answer 7

CXR

-> to check no underlying abnormalities e.g. cancer

Question 8

Management

State the treatment for

1. community acquired pneumonia
   a) CURB65 2 or less
   b) 3 or more
2. hospital acquired pneumonia
   a) CURB65 2 or less
   b) 3 or more
3. aspiration pneumonia
   a) CURB65 2 or less
   b) 3 or more

Answer 8

1

a) amoxicillin (doxy if pen allergic) for 5 days
b) co-amoxiclav + doxy (levofloxacin only if pen allergic) for 5 days

2. a) amoxicillin (doxy if pen allergic) for 5 days
   b) amoxicillin + gentamicin
   (co-trimoxazole + gentamicin if pen allergic) for 7 days
3. a) amoxicillin + metronidazole for 5 days
   b) amoxicillin, metronidazole, gentamicin for 7 days

Question 9

Resolution of symptoms

State the guidance which should be given to patients regarding their symptoms at:

1. 1 week
2. 4 weeks
3. 6 weeks
4. 3 months
5. 6 months

Answer 9

1. fever should have resolved
2. chest pain + sputum production should have been substantially reduced
3. cough + breathlessness should have been substantially reduced
4. most symptoms should have resolved with exception of lethargy
5. should feel back to normal