Pneumonia

Question 1

What are the typical organisms which cause community acquired pneumonia?

Answer 1

Streptococcus pneumonia (gram pos diplococci, most common cause of CAP)

Haemophilus Influenzae (gram neg cocobacilli)

Moraxella catarrhalis

Question 2

What are the atypical causes of community acquired pneumonia?

Answer 2

Mycoplasma pneumonia
Legionella pneumonia
Chlamydophila pneumoniae
Chlamydophilia psttaci - contact with infected birds (think parrot owner)
Coxiella burnetti/Q fever - bodily fluids of animals (farmer with flu like illness)

Question 3

What is idiopathic interstitial pneumonia?

Answer 3

Non infective cause of pneumonia eg, cryptogenic organizing pneumonia

Question 4

What are the signs and symptoms of pneumonia?

Answer 4

Cough, purulent sputum, dyspnoea, pleuritic chest pain, fever.
Signs - tachypnoea, tachycardia, hypotension, dull percussion, increased vocal resonance, bronchial breathing, pleural rub

Question 5

Describe features of mycoplasma pneumoniae infections

Answer 5

Symptoms - prolonged and gradual.
Complications - Autoimmune haemolytic anaemia, erythema multiforme, erythema nodosum, GBS, meningoencephalitis, bullous myringitis, pericarditis/myocarditis, glomerulonephritis

Question 6

What are the investigations and treatment for mycoplasma pneumoniae?

Answer 6

Mycoplasma serology. May have positive cold agglutination test.
Treatment - Doxycycline or macrolide

Question 7

What are the feature of legionella?

Answer 7

Flu-line symptoms,
Dry cough,
Bradycardia,
Confusion,
Lymphopaenia,
SIADH leading to hyponatraemia,
Deranged LFTs,
Pleural effusions

Question 8

What are the investigations and treatment for legionella pneumophilia?

Answer 8

Investigations - urinary antigen
Treatment - erythromycin or clindamycin

Question 9

What are the risk factors for pneumonia?

Answer 9

Age under 5 or over 65,
Smoking,
Recent viral respiratory infection,
Chronic respiratory disease,
Immunosuppression,
Aspiration risk,
IVDU,
Non-respiratory co-morbidities eg, diabetes

Question 10

What is the scoring system for pneumonia?

Answer 10

CURB65
Confusion,
Urea > 7mmol/L
Respiratory rate > 30
BP: systolic < 90 or diastolic <60
Age > 65.
Score > 2 = severe

Question 11

What are the investigations for pneumonia?

Answer 11

• Chest X ray,
• Bloods and cultures: FBC, U&Es, CRP
• Sputum sample
• Pneumococcal and legionella urinary antigen tests

Question 12

What organism causing pneumonia is likely to be seen after influenza? and seen in alcoholics

Answer 12

Post influenza - S. aureus
Alcoholics - Klebsiella

Question 13

What are characteristic features of pneumococcal pneumonia?

Answer 13

Rapid onset, high fever, pleuritic chest pain, herpes labialis

Question 14

What is the management of low severity CAP?

Answer 14

1st line = amoxicillin for 5 days
2nd line = Macrolide or tetracycline for 5 days

Question 15

What is the management of moderate to high-severity CAP (CURB65>2)?

Answer 15

Dual antibiotic therapy with amoxicillin/co-amoxiclav and macrolide for 7-10 days.

Question 16

What is the follow up required for all cases of pneumonia?

Answer 16

Repeat chest X ray after 6 weeks to ensure consolidation has resolved an there is no underlying secondary abnormalities.
Fatigue can last up to 6 months

Question 17

What are the causative organisms for hospital acquired pneumonia?

Answer 17

Enterobacterales (Klebsiella - red current sputum, E.coli or enterobacter)
Pseudomonas aeruginosa
S.Aureus
Acinetobacter (ventilator acquired)
Stenotrophomonas (ventelator acquired)

Question 18

What is the treatment for non severe and severe HAP?

Answer 18

Non severe - Doxycycline for 5 days.
Severe is cotrimoxazole and gentamicin or tazocin. Or 2nd line levofloxacin (7 days)

Question 19

Which organisms will not be treated by beta lactams?

Answer 19

Myoplasma pneumoniae - Lack of cell wall
Legionella pneumophilia - intracellular

Question 20

What is the treatment for aspiration pneumonia

Answer 20

Normal empirical antibiotic guidelines with metronidazole

Question 21

What are the complications of pneumonia?

Answer 21

Spesis, ARDS, pleural effusion, Empyema, lung abscess, death