Pneumonia

Question 1

CURB-65

Answer 1

C = confusion (new disorientation in person, place or time)
U = urea > 7mmol/L
R = respiratory rate ≥30
B= Blood pressure <90 systolic (60 diastolic)
65 = age ≥65 y
1 point for each feature

Question 2

Streptococcus pneumonia

Answer 2

• acute onset , severe,
• lobar consolidation
• rust coloured sputum
• usually penicillin sensitive

Question 3

haemophilus influenzae pneumonia

Answer 3

more common with pre existing lung disease
green sputum
many produce B lactamase which break down penicillins

Question 4

Moxarella catarrhalis pneumonia

Answer 4

associated with smoking, in immunocompromised patients or those with chronic pulmonary disease

Question 5

klebsiella pneumonia

Answer 5

history of alcoholism
presentation of the redcurrant sputum, red purulent sputum
This organism is a gram negative anaerobic rod.
Treated with carbapenems eg Meropenem.

Question 6

Staph aureus pneumonia

Answer 6

• often secondary to influenzae
• often involves pus leading to cavitational areas which may represent abscesses on CXR and empyema in pleural space

Question 7

Pseudomonas aeruginosa pneumonia

Answer 7

in patients with cystic fibrosis or bronchiectasis

Question 8

Mycoplasma pneumoniae

Answer 8

epidemics occur in young adults
present with malaise and a dry cough
may be associated with autoimmune things like haemolytic anaemia/ITP, splenomegaly, cardidits, Guillain-Barre syndrome
erythema multiforme
deranged LFTS

Question 9

Legionella pneumophila pneumonia

Answer 9

hotel, infected water supplies or air conditioning
Dry cough, dyspnoea
associated with severe systemic illness which may include abdominal pain and diarrhea, lymphopenia ,fever, mnyalgia,malaise
hyponatraemia secondary to SIADH
deranged LFTs

Question 10

Coxiella burnetii ( Q fever)
pneumonia

Answer 10

Zoonoses
obtain from farm/domestic animals,transmitted by aerosols or milk,
cause of endocarditis

Question 11

Chlamydia psittaci ( psittacosis)
pneumonia

Answer 11

zoonoses, spread by birds by inhalation
Usually mild
The MCQ patient is a parrot owner

Question 12

Chlamydophila pneumoniae pneumonia

Answer 12

presentation might be a school aged child with a mild to moderate chronic pneumonia and wheeze.

Question 13

CURB score 0 Mx

Answer 13

5 day course of oral antibiotics eg first choice is amoxicillin , 500mg 3x day
doxycylcine is alternative
erythromycin (in pregnancy)

Question 14

CURB score 1 or 2

Answer 14

Prescribe oral amoxicillin 500 mg three times a day for 5 days
and (if atypical pathogens suspected) oral clarithromycin

Question 15

Arrange a chest X-ray after 6 weeks for adults:

Answer 15

With symptoms and signs that persist despite treatment.
Who are at higher risk of underlying malignancy (particularly smokers and people aged more than 50 years).

Question 16

CURB65 score of 3 or higher Mx

Answer 16

co amoxiclav intravenously for 5 days with clarithromycin

Alternative antibiotic if high severity, for penicillin allergy is levofloxacin

Question 17

Complications of pneumonia

Answer 17

Sepsis
Pleural effusion
Empyema
Lung abscess
Death
Atrial fibrillation can be triggered by pneumonia (both in known patients and as the first presentation)
Bacterial pericarditis can arise because of local spread of bacteria
Jaundice may arise from sepsis or antibiotic treatment.

Question 18

Hospital acquired pneumonia organisms

Answer 18

Klebsiella
Serratia
Enterobacter
Pseudomonas
Escherichia

Question 19

Pneumocystis jiroveci

Answer 19

occurs in patients that are immunocompromised eg HIV
Characteristic on examination is rapid desaturation on exercise or exertion.On examination, the chest is often clear, however sometimes there are end inspiratory crackles present
diffuse, perihilar and bilateral ( bat swing) infiltrates on CXR
Treat with septrin and co-trimoxazole ( sulfamethoxazole and trimethoprim, both folate antagonists)