Pneumonia

Question 1

Complications of pneumonia pneumonic

Answer 1

SLAPPED HER
Septic shock
Lung abscess
AKI, ARDS
Pneumothorax
Post-infective bronchiectasis
pleural Effusion
DVT
Hypotension
Empyema
Respiratory failure

Question 2

Causes of CAP

Answer 2

Strep pneumoniae - 80%
H.influenzae
Moraxella catarrhalis
Staph aureus

Question 3

Bacterial causes of HAP

Answer 3

Staph aureus
Gram negative enterobacteria
Klebsiella pneumoniae
Psuedomonas spp

Question 4

What immunocompromised patients more likely to get pneumonia?

Answer 4

AIDS, lymphomas, leukaemias, immunosupressant drugs

Question 5

Causes of pneumoniae in immunocompromised?

Answer 5

Pneumocystits jirovecii - PCP, opportunisitc infection in AIDS
Adenovirus
CMV
Herpes simplex
Myobacterium TB

Question 6

What increases the risk of aspiration pneumonia?

Answer 6

Impaired swallowin from neurological disease eg stroke, dementia, Parkinsons disease
Decreased consciousness, oesophageal disease or iatrogenic intervention
Oropharyngeal anaeroobes

Question 7

Symptoms of pneumonia

Answer 7

SOB
Purulent cough - green/rust
Haemoptysis
Fever +/- rigors
Chest pain - pleuritic
SYSTEMIC - MALAISE, anarexia, fatigue

Question 8

Signs of pneumonia

Answer 8

Cyanosis, increased RR, confusion
Fever, tachycardia, dullness on percussion, increased tactile fremitus, decreased chest expansion, bronchial breathing, decreased air entry, vocal resonance, pleural rub

Question 9

What is tactile fremitus? When does it increase?

Answer 9

The vibrations heard in the chest on speech - increases when density of lung tissue increases eg pneumonia

Question 10

How to assess severity of pneumonia?

Answer 10

CURB 65
Confusion - AMTS score under 8
Urea over 7mmol/L
Resp rate >30
BP <90/60
65 yrs +

Question 11

What CURB 65 scores are boundaries for what care?

Answer 11

1 point for each positive aspect
0-1 = outpatient care
1-2 = admission
>3 consider ITU treatment

Question 12

What shows on bloods with pneumonia?

Answer 12

FBC - raised WCC
CRP
LFT deranged in legionella and sepsis
U+Es - assess severity - urea, hyponatremia in legionella
Serology - mycoplasma
Culture
Glucose

Question 13

Investigations for pneumonia

Answer 13

Sputum - gram stain, culture and sensitivity
CXR
ECG
Urine - pneumococcal or legionella (atypical) antigen
ABG - type I resp failure

Question 14

What see on CXR pneumonia

Answer 14

Lobar/multilobar infiltrates
Air bronchogram
Pleural effusion
Consolidation
Repeat 6 weejs after treatment to ensure resolution

Question 15

Management of pneumonia

Answer 15

Oxygen - >96%
IV fluids
Antibiotics - local guielines
Analgesia and antipyretics
Nebulised saline
NIV, intubation or ventialtion in ITU if severe

Question 16

Antibiotics used in aspiration pneumonia

Answer 16

Amoxicillin and metronidazole or co-amoxiclav for aspiration pneumonia

Question 17

Atypical causes of CAP

Answer 17

Atypical
Chlamydia pneumoniae
Legionella pneumoniae - fresh water
Mycoplasm pneumoniae

Question 18

Antibiotic for - uncomplicated CAP

Answer 18

Amoxicillin

Question 19

What antibiotic use for HAP? What if over f5 days after admission?

Answer 19

Co amoxiclav
> 5 days use tazocin, or broad spectrum quinolone or cephalosporin=

Question 20

What antibiotics use if allergic to amoxicillin

Answer 20

Clarithromycin or doxycycline

Question 21

HAP and VAP when

Answer 21

HAP >48 hrs after admission
VAP >48 hrs ventilated

Question 22

Fungal causes pneumonia

Answer 22

PCP, histpolasma, cryptococcus neogromans, aspergillus
Q fever - coxiella burnetti
Psittacosis - Chlamydiophila psitticai

Question 23

CRP criteria antibiotisc

Answer 23

<20 none
20-100 delayed prescription
>100 give antibiotics

Question 24

Risk factors pnuemonia

Answer 24

<5 >65
ASpiration risk eg neuro drisease
Smoker
Chronic resp disease COPD, CF
IVDUs
DM.CVD
Recentr viral resp tract infection

Question 25

Antibiotics for different CURB65 risk

Answer 25

low - amoxicillin
Mod - amoxicillin + macrolide
High risk - co-amoxiclav, piperacillin and tazobactam, ceftriaxone
+ macrolide

Question 26

When dont discharge a patient with penumonia criteria

Answer 26

> 2 of following in last 24 hrs:
->37.5 degree temp
-HR>100
-RR>24
-Cant eat without help
-abnormal mental status
-O2<90%
-BP <90%