Pneumonia

Question 1

Classification of pneumonia

Answer 1

Developed outside of hospital - “community acquired pneumonia”

Develops more than 48h after hospital admission - “hospital acquired pneumonia”

Develops as a result of aspiration - “aspiration pneumonia”

Question 2

Presentation of pneumonia

Answer 2

Shortness of breath

Cough productive of sputum

Fever

Haemoptysis

Pleuritic chest pain

Delirium

Sepsis

Question 3

Signs in pneumonia

Answer 3

Tachypnoea

Tachycardia

Hypoxia

Hypotension

Fever

Confusion

Question 4

Chest signs in pneumonia

Answer 4

Bronchial breath sounds (harsh breath sounds equally loud on inspiration and expiration)

Focal coarse crackles

Dullness to percussion due to lung tissue collapse and/or consolidation

Question 5

How do we score pneumonia severity?

Answer 5

CURB-65

C – Confusion (new disorientation in person, place or time)
U – Urea > 7
R – Respiratory rate ≥ 30
B – Blood pressure < 90 systolic or ≤ 60 diastolic.
65 – Age ≥ 65

Question 6

How do we used CURB-65 to decide whether to admit patients?

Answer 6

Score 0/1: Consider treatment at home

Score ≥ 2: Consider hospital admission

Score ≥ 3: Consider intensive care assessment

Question 7

Most common causes of pneumonia

Answer 7

Streptococcus pneumoniae (50%)

Haemophilus influenzae (20%)

Question 8

Cause of pneumonia in immunocompromised patients or those with chronic pulmonary disease

Answer 8

Moraxella catarrhalis

Question 9

Causes of pneumonia in patients with cystic fibrosis or bronchiectasis

Answer 9

Pseudomonas aeruginosa

Staphylococcus aureus

Question 10

What is ‘atypical pneumonia’?

Answer 10

Pneumonia caused by an organism that cannot be cultured in the normal way or detected using a gram stain

Question 11

How do we treat atypical pneumonias?

Answer 11

Macrolides (e.g. clarithomycin)

Fluoroquinolones (e.g. levofloxacin)

Tetracyclines (e.g. doxycycline)

Question 12

List the 5 causes of atypical pneumonia

Answer 12

Legions of psittaci MCQs

Legionella pneumophila

Chlamydia psittaci

Mycoplasma pneumoniae

Chlaymdophila pneumoniae

Q fever (coxiella burnetii)

Question 13

Legionella pneumonia (Legionnaire’s disease)

Answer 13

Typically caused by infected water supplies or air conditioning units

Can cause hyponatraemia) by causing SIADH

Typical patient has recently had a cheap hotel holiday and presents with hyponatraemia

Question 14

Mycoplasma pneumoniae

Answer 14

Milder pneumonia

Can cause erythema multiforme (target lesions)

Can cause neurological symptoms in young patient

Question 15

Chlamydophila pneumoniae

Answer 15

School aged child

Midl to moderate chronic pneumonia + wheeze

Question 16

Coxiella burnetii (“Q fever”)

Answer 16

Exposure to animals and their bodily fluids

Typical patient is a farmer with a flu-like illness

Question 17

Chlamydia psittaci

Answer 17

Contact with infected birds

Typical patient is parrot owner

Question 18

Which patients does fungal pneumonia occur in?

What organism is it cause by?

Answer 18

Immunocompromised e.g. new HIV or low CD4 count

Pneumocystis jiroveci (PCP)

Question 19

Fungal pneumonia (pneumocystic jiroveci) presentation

Answer 19

Dry cough without sputum

SOBOE

Night sweats

Question 20

Fungal pneumonia (pneumocystic jiroveci) management

Answer 20

Co-trimoxazole (Septrin)

Low CD4 count patients are prescribed prophylactic co-trimoxazole

Question 21

Investigations for pneumonia

Answer 21

CXR
FBC (raised white cells)
U&Es (for urea)
CRP (raised in inflammation and infection)

If moderate-severe:
Sputum cultures
Blood cultures
Legionella and pneumococcal urinary antigens (send a urine sample for antigen testing)

Question 22

Antibiotics for pneumonia

Answer 22

Mild CAP: 5 day course of oral antibiotics (amoxicillin or macrolide)

Moderate to severe CAP: 7-10 day course of dual antibiotics (amoxicillin and macrolide)

Question 23

Complications of pneumonia

Answer 23

Sepsis

Pleural effusion

Empyema

Lung abscess

Death