Pneumonia

Question 1

Two main classifications of pneumonia

Answer 1

Community acquired or hospital acquired

Question 2

What is aspiration pneumonia

Answer 2

Pneumonia which develops as a result of inhaling a foreign body

Question 3

What is hospital acquired pneumonia

Answer 3

Pneumonia which develops more than 48 hours after hospital admission

Question 4

Presentation of pneumonia

Answer 4

SOB, cough with sputum, fever, haemoptysis, pleuritic chest pain, delirium, sepsis

Question 5

Signs in pneumonia

Answer 5

Tachypnoea, tachycardia, hypoxia, hypotension, fever, confusio

Question 6

Chest sounds in pneumonia

Answer 6

Bronchial breath sounds, focal course crackles, dullness to percussion

Question 7

What is the CURB-65 score

Answer 7

Scoring system used in hospital to determine how severe the pneumonia is

Question 8

What does the CURB-65 stand for

Answer 8

Confusion
Urea>7
Resp rate >30
BP <90 sys <60 dia
Age over 65

Question 9

If someone has a score of 0/1 on CURB-65

Answer 9

Treatment at home

Question 10

If someone has a score of >2 on CURB65

Answer 10

Consider intensive care admission

Question 11

Two most common causes of pneumonia

Answer 11

Strep pneumoniae (50%)
Haemophilus influenza (20%)

Question 12

Other causes of pneumonia

Answer 12

Moraxella catarrhalis
Pseudomonas aeruginosa
Staph aureus

Question 13

Pneumonia associations of those with chronic pulmonary disease or immunocompromised

Answer 13

Moraxella catarrhalis

Question 14

Pneumonia associated with cystic fibrosis

Answer 14

Staph aureus and pseudomonas aeruginosa

Question 15

Pneumonia associated wiht bronchiectasis

Answer 15

pseudomonas aeruginosa

Question 16

5 Atypical pneumonias

Answer 16

Legionella pneumophilia
Mycoplasma pneumoniae
Chlamydophilia pneumoniae
Coxiella burnetii
Chlamydia psittaci

Question 17

Associations with Legionella pneumonphilia pneumonia

Answer 17

Typically caused by infected water supplies or air conditioning units, can cause hyponatraemia

Question 18

Associations with mycoplasma pneumoniae

Answer 18

Can cause erythema multiforme and neurological symptoms in young patients

Question 19

Associations with chlamydophilia pneumoniae

Answer 19

Can present in school aged child with chronic pneumonia and wheeze

Question 20

Associations with Coxiella burnetii

Answer 20

AKA Q fever, linked to exposure to animals and their bodily fluids

Question 21

Associations with Chlamydia psittaci

Answer 21

Typically contracted from contact with infected birds

Question 22

Who do fungal pneumonias typically present in

Answer 22

Immunocompromised

Question 23

Eg of fungal pneumonia

Answer 23

Pneumocystitis jiroveci (PCP)

Question 24

Presentation of fungal pneumonia

Answer 24

Subtly with dry cough, SOB on exertion and night sweats

Question 25

Treatment of fungal pneumonia

Answer 25

Co-trimoxazole (trimethoprim and sulfamethoxazole)

Question 26

Minimum investigations required

Answer 26

CXR, FBC, U&Es and CRP

Question 27

Investigations for more moderate to severe cases

Answer 27

Sputum and blood cultures, and legionella and pneumococcal urinary antigens

Question 28

Complications of pneumonia

Answer 28

Sepsis, pleural effusion, empyema, lung abcess, death

Question 29

Treatment of atypical pneumonias

Answer 29

Macrolides, fluoroquinolones or tetracyclines

Question 30

Treatment of mild CAP

Answer 30

5 day course of oral ABx such as amoxicillin or macrolide

Question 31

Treatment of moderate-severe CAP

Answer 31

7-10 day course of dual ABx such as amoxicillin and macrolide

Question 32

Eg of macrolide

Answer 32

Clarithromycin

Question 33

Eg of fluoroquinolone

Answer 33

Levofloxacin

Question 34

Eg of tetracycline

Answer 34

Doxycycline