Pneumonia

Question 1

Common pathogens in pneumonia

Answer 1

streptococcus pneumonia, which is generally community-acquired, followed by Haemophilus influenzae, staph aureus (after influenza)

Question 2

Common pathogens: HAP

Answer 2

Pseudomonas aeruginosa, Staphylococcal aureus, and Enterobacteria

> 48hr in hospital

Question 3

Klebsiella pneumonia

Answer 3

Primarily in upper lobes
red currant sputum
gram-negative anaerobic rod.
higher risk of complication e.g. empyema
More common in immunosuppressed e.g. ALCOHOLICS, diabetes, meds

Question 4

Mycoplasma pneumonia

Answer 4

Younger pts
Assoc w/ SJS, erythema multiforme, GBS and meningoencephalitis
Arthralgia and fever
Hemolytic anaemia (cold agglutinins)

Question 5

Legionella pneumonia

Answer 5

poor hotel air conditioning.
hyponatraemia and deranged LFTs on blood tests. Legionella antigen may be present in the urine.

Question 6

Chlamydophila psittaci

Answer 6

Infected birds
Pneumonia features + arthralgia
Hepatosplenomegaly and kidney involvement

Question 7

Pneumocystis pneumonia

Answer 7

Commonly in immunosuppressed
pneumocystis jiroveci and is a fungus
HIV-positive –> PCP risk increases when the CD4+ <200 cells/uL.

Question 8

CURB-65

Answer 8

One point for each:
C – confusion: An abbreviated mental test of ≤8
U – urea: >7mmol/L
R - Respiratory rate: ≥30/ min
B - blood pressure <90 systolic and/ or <60mmHg diastolic
65 - age: >65year old

Result and risk of mortality
0 – 0.7%
1 – 3.2%
2 - 13%
3 - 17%
4 - 41.5%
5 - 57%

A CURB-65 score of 0-1 requires home treatment, 2 requires consideration for hospital treatment, however 3-5 would need hospital admission alongside consideration for ITU referral.

Question 9

When to repeat XRay post-pneumonia

Answer 9

At 6 weeks

Question 10

Haemophilus influenza

Answer 10

Bronchiectasis

Question 11

Strep pneumonia

Answer 11

Most common
Rust-coloured sputum

Question 12

Staph aureus

Answer 12

Upper lobe bilateral cavitating pneumonia
IVDU users
Post influenza infection