Pneumonia

Question 1

Define HAP

Answer 1

Pneumonia in person 48 hours after admission and not suspected to be incubating at time of presentation

Question 2

Results of individual patient data review meta-analysis for steroids in pneumonia

Answer 2

No improved mortality
More insulin required, shorter stay
More likely to have readmission for CAP

Question 3

CXR vs. CT - concordance for pneumonia

Answer 3

only ~40% of patients with pneumonia on CT had CXR changes

Only 26% of CXR that were reported as having opacities had opacity on CT

Question 4

Define atypical pneumonia

Answer 4

negative gram stain
no response to penicillin
**clues include abnormal LFTs and GIT symptoms

Question 5

Define CAP

Answer 5

Pneumonia in someone not meeting criteria for HAP or VAP

Question 6

What are the causes of atypical pneumonia? (6)

Answer 6

Non-zoonotic
Chlamydia pneumophila
Mycoplasma pneumoniae
Legionella sp
Zoonotic
Coxiella brunetti (Q fever)
Chlamydia psittaci (psittacosis)
Francisella tularensis (northern hemisphere)

Question 7

What does a CURB65 score of 3-5 entail? (30 day mortality and management)

Answer 7

30 day mortality 22%

Admit and treat as severe CAP

Question 8

What does PSI score <130 entail?

Answer 8

27% 30 day mortality

Question 9

Define VAP

Answer 9

Pneumonia whose onset is 48 hours after initiation of endotracheal intubation

Question 10

Are steroids indicated in treatment of pneumonia?

Answer 10

Unclear but probably not

Question 11

What is the major risk factor for pseudomonas infection with respect to pneumonia?

Answer 11

ICU stay

Question 12

What percentage of CAP has a microbial diagnosis?

Answer 12

45% (55% do not have microbial diagnosis)

Question 13

What is the rate of pneumococcal resistance to doxycycline?

Answer 13

20%

Question 14

What does a CURB65 score of 0-1 entail? (mortality, suggested management)

Answer 14

30 day mortality is 1.5% with suggested home management

Question 15

What does a CURB65 score of 2 entail? (30-day mortality and suggested management)

Answer 15

30 day mortality of 9.2% and suggested admission to hospital

Question 16

Which patients with pneumonia should get blood cultures?

Answer 16

Only those with severe pneumonia

Question 17

What is the magnitude of increased cardiovascular risk for the 12 months following S. pneumoniae CAP?

Answer 17

3-5 fold higher risk, particularly of arrythmias (due to microlesions incorporated into myocardium)

Question 18

What are the most common bacterial causes of pneumonia? (5)

Answer 18

S. pneumo 14%
Mycoplasma pneumoniae 9%
Haemophilus influenzae 5%
Legionella sp. 3%
Moraxella catarrhalis 1%

Question 19

What does PSI score <70 entail?

Answer 19

0.6% 30 day mortality

Question 20

Pneumonia “red flags” (7)

Answer 20

RR>25
Sats <92% on r.a.
Multilobar
SBP<90
Acute confusion
HR>100
Serum lactate >2

Question 21

What is an appropriate step down from IV Augmentin?

Answer 21

Augmentin DF (1 tab, BD) plus Amoxicillin 1g midi

Question 22

Cochrane review of steroids in pneumonia

Answer 22

Suggested mortality benefit with NNT of 18

Question 23

What are the parameters for CURB65?

Answer 23

Confusion
Urea>7mmol/L
Respiratory rate >30
BP (SBP <90, DBP <60)
Age>65