Pneumonia

Question 1

Presentation of pneumonia?

Answer 1

Sob, fever, cough productive of sputum, haemoptysis, pleuritic chest pain. Delirium, sepsis

Question 2

Possible signs of pneumonia?

Answer 2

Tachycardia, tachypnoea, fever, hypoxia, hypotension, confusion

Question 3

Characteristic signs on chest of pneumonia?

Answer 3

Focal coarse crackles
Dullness to percussion
Bronchial breath sounds

Question 4

Severity assessment to CURB65?

Answer 4

Confusion
Urea>7
Resp rate>30
Blood pressure systolic less than 90 and diastolic equal to or less than 60
Age over 65 or equal

Question 5

Most common causes of pneumonia?

Answer 5

Streptococcus pneumonia, haemophilus influenza

Question 6

Other causes of pneumonia?

Answer 6

1. Moraxella catarrhalis- immunocompromised/ chronic pulmonary disease
2. Pseudomonas aeruginosa- cystic fibrosis or bronchiectasis
3. Staphylococcus aureus- cystic fibrosis

Question 7

Definition of atypical pneumonia?

Answer 7

Cannot be cultured or detected by gram stain. Don’t respond to penicillins, treated with macrolides (clarthiromycin), fluoroquinolones (levofloxacin), tetracyclines (doxycycline)

Question 8

Which organism can you get due to infected water supplies or air conditioning unity’s. It causes hyponatraemia by SIADH? (Cheap holiday)

Answer 8

Legionella pneumophila

Question 9

A milder pneumonia, with erythema multiform rash, target lesions pink rings pale centres. Can also cause neurological symptoms?

Answer 9

Mycoplasma pneumonia

Question 10

Mild- moderate chronic pneumonia in child with wheeze?

Answer 10

Chlamydophila pneumonia

Question 11

Exposure to animals and their bodily fluids. Think farmer with flu like illness?

Answer 11

Coxiella burnetii Qfever

Question 12

Contracted from infected birds, parrot owner?

Answer 12

Chlamydia psittaci

Question 13

5 causes of atypical pneumonia?

Answer 13

Legions of psittaci MCQ

Question 14

When do you get fungal pneumonia?

Answer 14

Pneumocystis jiroveci- immunocompromised- low CD4 count poorly controlled or new HIV.

Question 15

How does fungal pneumonia present?

Answer 15

Dry cough without sputum, night sweats, sob on exertion.

Question 16

Treatment for fungal pneumonia?

Answer 16

Co-trimaxazole ( trimethoprim/sulfmethoxazole) Septrin given prophylactically with those with low CD4 count

Question 17

When do you send a urine sample for antigen testing?

Answer 17

Legionella and pneumococcal urinary antigens

Question 18

Which antibiotics to give and how long for?

Answer 18

1. Mild CAP- 5 days amoxicillin or macrolide
2. Moderate to severe CAP- 7-10 days dual antibiotics amoxicillin/ macrolide
   Beta lactamase stable penicillin co-amoxiclav, ceftriaxone or pipperacillin with tazobactma and a macrolide in high severity

Question 19

Complications of pneumonia?

Answer 19

Sepsis, pleural effusion. Empyema, lung abscess, death

Question 20

CRP testing?

Answer 20

Less than 20mg/dL- dont offer antibiotics
20-100- consider delayed antibiotic prescription
More than 100- offer antibiotic therapy

Question 21

What should all cases of pneumonia have?

Answer 21

6 weeks CXR

Question 22

Progression of pneumonia?

Answer 22

1 week: fever resolved
4 weeks: chest pain and sputum production reduced
6 weeks cough and sob reduced
3 months: all symptoms resolved except fatigue
6 months: most people will feel back to normal

Question 23

Leading cause of bronchitis?

Answer 23

Viral- 80% episodes happen in winter/autumn

Question 24

Presentation of acute bronchitis?

Answer 24

Cough- productive or not
Wheeze
Rhinorrhoea
Sore throat
Low grade fever

Question 25

How do you diagnose acute bronchitis?

Answer 25

Clinically

Question 26

What is first line for acute bronchitis?

Answer 26

Doxycycline but not in children or pregnancy wmen