pneumonia

Question 1

what is the CRB 65 score?

Answer 1

C- confusion AMTS 8 and down
R- RR 30 and up
B- SBP<90, DBP<60
65 and up

Question 2

how should you treat CRB 65 score of 0?

Answer 2

low risk
home treatment
1% mortality risk

Question 3

how should you treat CRB 65 score of 1 or 2?

Answer 3

intermmediate risk
consider hospital assessment
mortality risk 1-10%

Question 4

how should you treat CRB 65 score of 3 or 4?

Answer 4

high risk
urgent hospital admission/intensive care assessment
>10% mortality risk

Question 5

how is point-of-care CRP testing used?

Answer 5

CRP < 20 mg/L - do not routinely offer antibiotic therapy

CRP 20 - 100 mg/L - consider a delayed antibiotic prescription

CRP > 100 mg/L - offer antibiotic therapy

Question 6

what investigations are required for pneumonia?

Answer 6

CXR

BCX + sputum cx, pneumococcal + legionella urinary antigen tests in intermediate or high risk

monitor CRP to assess response to rx

Question 7

what is the treatment of low severity CAP?

Answer 7

1st line- amoxicillin
pen allergic- macrolide (clarithromycin) or tetracycline (doxycycline)

5 days

Question 8

what is the treatment of moderate severity CAP?

Answer 8

amoxicillin + macrolide
7-10 days

high severity- consider a beta-lactamase stable pencillin eg co-amox, ceftriaxone or tazocin + a macrolide in high severity

Question 9

what is the discharge criteria?

Answer 9

do not discharge if in past 24 hours 2 or more of following:
- T>37.5
- RR>/24
- HR>100
- SBP<90
- O2<90% OA
- abnormal mental status
- inability to eat without assistance

Question 10

what is post-discharge advice?

Answer 10

1 week- Fever should have resolved

4 weeks- Chest pain and sputum production reduced

6 weeks- Cough and breathlessness reduced

3 months- Most symptoms should have resolved but fatigue may still be present

6 months- Most people will feel back to normal.

repeat CXR in 6 weeks

Question 11

what are the anatomical classifications of pneumoina?

Answer 11

1. bronchopneumonia
   patchy consolidation of different lobes
2. lobar pneumoina
   fibrosuppurative consolidation of a single lobe

Question 12

what are the common causes of CAP?

Answer 12

pneumococcus, mycoplasma, haemophilus
S. aureus, moraxella, chlamydia, legionella
viruses- 15%

Question 13

what are the common causes of HAP?

Answer 13

> 48 hrs hospital admission
gram positive enterobacteria, S. aureus

Question 14

what increases risk of aspiration pneumonia?

Answer 14

stroke
bulbar palsy
reduced GCS
GORD
achalasia

caused by anaerobes

Question 15

what causes of pneumonia do you have to consider in immunocompromised patients?

Answer 15

PCP
TB
fungi
CMV/HSV

Question 16

what are the symptoms of pneumonia?

Answer 16

fever, rigors
malaise, anorexia
dyspnoea
cough, purulent sputum, haemoptysis
pleuritic pain

Question 17

what are the signs of pneumonia?

Answer 17

raised RR/HR
cyanosis
confusion

consolidation
- reduced expansion
- dull percussion
- bronchial breathing
- reduced AE
- crackles, pleural rub

Question 18

what is the treatment if pneumonia was caused by chlamydia?

Answer 18

tetracycline

Question 19

what is the treatment if pneumonia was caused by PCP?

Answer 19

co-trimoxazole

Question 20

what is the treatment if pneumonia was caused by legionella?

Answer 20

clarithromycin + rifampicin

Question 21

who should have pneumococcal vaccine?

Answer 21

65yo+
chronic HLKP failure or conditions
DM
immunosuppression- hyposplenism, chemo, HIV

re-vaccinate every 6 years

Question 22

what are the complications of pneumonia?

Answer 22

Respiratory failure
hypotension
AF
pleural effusion
empyema
lung abscess
sepsis