PNEUMONIA

Question 1

Types of microbes that can cause pneumonia

Answer 1

Bacteria
Virus
Fungi

Question 2

CURB-65 score parameters

Answer 2

Confusion
Uremia >7mmol/l
Respiratory rate > 30 in adults and >50 in children
Blood pressure, systolic<90 or diastolic<60
Age <5yrs or >65yrs

Question 3

Different approaches managing pneumonia patient based on their CURB65 scores

Answer 3

0-1 outpatient management
2-3 short inpatient hospitalisation
>3 admit and consider intensive care

Question 4

Additional factors that warrant hospitalisation in pneumonia patients

Answer 4

Comorbidities such as chronic lung disease, heart failure or renal disease
Extensive disease, multiple lobes involved
Low oxygen saturation SpO2, < 92% on room air
Severe tachycardia

Question 5

4 Major types of pneumonia

Answer 5

Community acquired pneumonia CAP
Hospital acquired pneumonia
Aspiration pneumonia
Ventilator associated pneumonia

Question 6

Other types of pneumonia

Answer 6

Viral
Pneumocystis jirovecii pneumonia
Other fungal pneumonia in immunocompromised patients

Question 7

Bacterial causes of community acquired pneumonia

Answer 7

Streptococcus pneumoniae
Streptococcus pyogenes
Haemophilus influenzae
Klebsiella pneumoniae
Mycoplasma pneumoniae
Legionella pneumoniae
Staphylococcus aureus

Question 8

Risk factors for staph aureus CAP

Answer 8

Children after viral illness like measles
Diabetes
Elderly during ‘flu’ epidemics

Question 9

Consitutional symptoms of pneumonia

Answer 9

Fever
Malaise
Chills
Sweating
Muscle aches

Question 10

Respiratory symptoms of pneumonia

Answer 10

Productive cough
Dyspnoea
Pleuritic chest pain
Haemoptysis

Question 11

Signs of pneumonia

Answer 11

Fever
Tachypnea
Tachychardia
Use of accessory muscles of respiration and flaring of the nasal margins
Signs of consolidation or pleural effusion on chest examination
Restlessness
Confusion
Drowsiness
Low blood oxygen saturation by pulse oximetry < 92%

Question 12

Signs of pneumonia that occur only in children

Answer 12

Grunting
Lower chest wall indrawing

Question 13

Complications of pneumonia

Answer 13

Pleural effusion
Lung abscess
Empyema
Pericardial effusion
Pericarditis
Pneumothorax
Septicemia
Adult respiratory distresssyndrome
Meningitis

Question 14

Investigations conducted in pneumonia

Answer 14

FBC
C-reactive protein
Chest X-ray
Sputum gram stain
Sputum culture and sensitivity
Ziehl-Neelsen stain for acid-fast bacilli (to exclude TB)
Blood culture and sensitivity
Blood urea and electrolytes

Question 15

First line therapy for low severity pneumonia CURB65<2 in adults

Answer 15

Amoxicillin 1g 8hourly for 7 days
and
Azithromycin 500mg daily for 6 days
or
Erythromycin 500mg 6 hourly for 7 days

Question 15

First line therapy for low severity pneumonia CURB65<2 in children

Answer 15

Amoxicillin for 7days
5-12 yrs 500mg 8hrly
1-5 yrs 250mg 8hrly
6months-1 yr 125mg 8hrly
and
Azithromycin 10mg/kg for 6 days
or
Erythromycin 6hrly for 7days
8-18yrs 250-500mg
2-8yrs 250mg
6months-2yrs 125mg

Question 16

Second line therapy for low severity pneumonia CURB65<2 in adults

Answer 16

Cefuroxime 500mg 12 hourly for 7 days
or
Doxycycline 100mg 12hourly for 7-14days

Question 17

Second line therapy for low severity pneumonia CURB65<2 in children

Answer 17

Cefuroxime
3 months-12 years; 30 mg/kg/day in two divided doses for 7
days
> 12 years; 250-500 mg 12 hourly for 7 days
or
Doxycycline 100 mg 12 hourly for 7-14 days

Question 17

First line treatment for Hospitalised patient: Severity score, ≥ 2 in children

Answer 17

Oxygen + IV fluids + Paracetamol+
IV Amoxicillin/Clavulanic
3 months-18 years; 30 mg/kg 8 hourly, max. 1.2 g 8 hourly for
7-10 days
< 3 months; 30 mg/kg 12 hourly for 7-10 days
+
Azithromycin oral
10 mg/kg once daily for 3-7 days

Question 18

First line treatment for Hospitalised patient: Severity score, ≥ 2 in adults

Answer 18

Oxygen + IV fluids + Paracetamol+
IV Amoxicillin/Clavulanic acid 1.2 g 8 hourly for 7-10 days
+
Azithromycin oral
500 mg daily for 3-7 days
or
Azithromycin IV
500 mg daily for 3 days, continue with oral to complete 7 days

Question 18

Second line treatment for Hospitalised patient: Severity score, ≥ 2 in children

Answer 18

Ceftriaxone, IV,
All ages 25 mg/kg 12 hourly (max. 75 mg/kg daily)
and
Azithromycin (IV not used in children for pneumonia, use oral

Question 19

Target for oxygen saturation

Answer 19

> 92%

Question 19

IV fluids used in pneumonia

Answer 19

Normal saline
Dextrose saline

Question 20

Second line treatment for Hospitalised patient: Severity score, ≥ 2 in adults

Answer 20

IV Ceftriaxone 2g daily for 7-10 days
and
Azithromycin IV

Question 20

Treatment for aspiration pneumonia in adults

Answer 20

IV Ceftriaxone or Amoxicillin/Clavulanic acid or IV Ciprofloxacin
and
IV Metronidazole or
IV Clindamycin

Question 21

Dose for IV clindamycin in aspiration pneumonia

Answer 21

Adults
300-600 mg 6 hourly for 7 days

Children
3-6 mg/kg 6 hourly for 7 days

Question 22

Dose for IV Ceftriaxone in aspiration pneumonia

Answer 22

Adult
2 g daily for 7-10 days

Children
All ages 50-75 mg/kg/day in divided 12 hourly doses

Question 23

Dose for IV Amoxicillin/Clavulanic acid in pneumonia

Answer 23

Adults
1.2 g 8 hourly for 7-10 days

Children
3 months-18 years; 30 mg/kg 8 hourly, max 1.2 g 8 hourly for
7-10 days
< 3 months; 30 mg/kg 12 hourly for 7-10 days

Question 24

Dose for IV Ciprofloxacin in pneumonia management

Answer 24

Adults
400 mg 8-12 hourly for 7 days

Children
10 mg/kg (max. 400 mg) 12 hourly for 7 days

Question 25

Dose for IV Clindamycin in pneumonia management

Answer 25

Adults
300-600 mg 6 hourly for 7 days

Children
3-6 mg/kg 6 hourly for 7 days

Question 26

Dose for IV Metronidazole in aspiration pneumonia

Answer 26

Metronidazole, IV,
Adults
500 mg 8 hourly for 7 days

Children
7.5 mg/kg 8 hourly for 7 days