Pneumonia Flashcards
1
Q
What is the most common etiological agent responsible for community-acquired pneumonia?
A
Streptococcus pneumoniae (70%).
2
Q
Which pathogen is commonly associated with pneumonia in the elderly and patients with COPD?
A
Haemophilus influenza (5%).
3
Q
What is the common etiological agent for pneumonia in people who inject drugs (PWIDs), often following influenza?
A
Staphylococcus aureus (4%).
4
Q
What are some atypical pathogens associated with pneumonia?
A
Atypical pathogens include Legionella, mycoplasma pneumonia, Coxiella burnetii (Q fever), Chlamydia psittaci, Klebsiella, and Pneumocystis jiroveci.
5
Q
How do you get legionella?
A
inhalation of contaminated water droplets
6
Q
How do you get mycoplasma pneumonia?
A
children and young adults, peaks every 4 years
7
Q
How do you get Coxiella burnetii (Q fever) ?
A
farming
8
Q
How do you get Chlamydia psittaci?
A
birds (pets)
9
Q
How do you get Klebsiella?
A
aspiration (e.g. from alcoholism)
10
Q
How do you get Pneumocytis jiroveci?
A
mmunocompromised e.g. AIDS patients
11
Q
How does lobar pneumonia differ from bronchopneumonia in terms of pathophysiology?
A
Lobar pneumonia involves confluent consolidation of a complete lung lobe, while bronchopneumonia starts in the airways and spreads to adjacent alveolar lung tissue
12
Q
What are some common symptoms of pneumonia?
A
Dyspnea
Pleuritic chest pain
Productive cough with high fever in younger patients
Atypical symptoms such as confusion, diarrhea, and reduced mobility in older patients.
13
Q
What are some typical signs of pneumonia?
A
Typical signs include rigors, crackles and rub on auscultation, and tachypnea
14
Q
What investigations are typically conducted for patients admitted to the hospital with pneumonia?
A
FBCs - Full blood count
CRP- C reactive Proteins
U+Es - urea + electrolytes
CXR
Sputum examination and culture
Blood culture
Tests for legionella and pneumococcal urinary antigens in cases of moderate/severe pneumonia
15
Q
What is the CURB65 risk score used for in pneumonia management?
A
The CURB65 risk score helps assess the severity of pneumonia based on confusion, urea levels, respiratory rate, blood pressure, and age (65 years or older).
16
Q
What are the components of the CURB65 risk score?
A
- Confusion (<=8/10)
- Urea level (≥7 mmol)
- Respiratory rate (>30 breaths per minute)
- Blood pressure (systolic <90 mmHg or diastolic ≤60 mmHg)
- Age (≥65 years).
17
Q
How do bronchopneumonia and lobar pneumonia differ in terms of their spread within the lungs?
A
Bronchopneumonia starts in the airways and spreads to adjacent alveolar lung tissue, while lobar pneumonia involves confluent consolidation of an entire lung lobe.
18
Q
What type of sputum is typically associated with Streptococcus pneumoniae?
A
Rust-colored sputum
19
Q
What type of sputum is typically associated with Pseudomonas and Haemophilus infections?
A
Green sputum
20
Q
What type of sputum is typically associated with Klebsiella infections?
A
Red currant-jelly sputum
21
Q
What type of sputum is typically associated with anaerobic infections?
A
Foul-smelling and bad-tasting sputum.
22
Q
Hospital-acquired non-severe antibiotics
A
amoxicillin (if penicillin allergic: doxycycline)
23
Q
Hospital-acquired severe antibiotics
A
IVamoxicillin+gentamicin(if penicillin allergic: doxycycline + gentamicin)
24
Q
Aspiration pneumonia non-severe antibiotics
A
amoxicillin+metronidazole(if penicillin allergic: doxycycline + metronidazole)
25
Aspiration pneumonia severe antibiotics
IV amoxicillin + metronidazole + gentamicin (if penicillin allergic: doxycycline)
26
What is the complication with empyema?
pus in pleural space
27
What would be used to differentiate between empyema and abscess?
CT
28
Preferred investigation?
ultrasound scan
29
Foul-smelling and bad-tasting sputum is from what infection?
anerobic
30
Red currant-jelly sputum is from what infection?
klesbellia
Gram Negative Anaerobic
31
Green sputum is from what infection?
Pseudomonas and Haemophilus infections?
32
Rust-coloured sputum is from what infection?
Streptococcus pneumoniae
33
What infection is seen when people return from travelling
Legionella pneumophila
Associated with > hyponatremia and bi- basal consolidation
34
What would be a good test for suspected pneumonia?
Sputum culture
35
If a person has most likely got pneumonia, what is the most useful test when determining the underlying cause of the pneumonia?
Blood serology
36
What is the best stain to use for Pneumocystis jirovecii?
sliver stain
37
A 37-year-old woman presents to A&E with shortness of breath, a dry cough and a fever. She has recently been on a business trip to Romania and stayed in a local hotel.
What is the best investigation to obtain a definitive diagnosis in this patient?
Urinary antigen enzyme immunoassay test
38
A 68-year-old patient presents to Accident and Emergency following a two week history of productive cough, fever and shortness of breath. The patient has had a similar episode of these symptoms two years ago, which required a hospital admission.
Observations are taken and are recorded as follows:
HR: 104bpm
RR: 25
BP: 100/72 mmHg
SpO2: 91% on air
Temp: 38.5C
What is the next best investigation to carry out?
Arterial Blood Gas (ABG)
39
Curb 65 score of 0
send home
40
Curb 65 score of 1
send her home with amoxicillin / alternative if allergic
41
Curb 65 score of 2
hopistal visit
42
What infection is more common in the elderly, diabetics and alcoholics?
Klebsiella pneumoniae
43
A 66-year-old man with a history of hypertension and hyperlipidaemia presents with a productive cough and shortness of breath. On examination, his respiratory rate is 32 and his BP is 130/75 mmHg. He is admitted to the hospital and commenced on amoxicillin and clarithromycin for community-acquired pneumonia.
What medication should be held during his treatment?
Any statin
44
A 60-year-old man presents to the emergency department with a 1-week history of cough and fever. He has also noticed that his cold sores around the mouth have returned. He has no other past medical history. On examination, he looks well but is tachypneic. His heart sounds are normal, with right-sided basal crackles. His abdominal examination is unremarkable. He is oriented to time, place and person.
Blood tests taken are pending.
What is the most likely cause of this condition?
Streptococcus pneumoniae
45
Someone comes in with a culture of growing gram-positive cocci and symptoms of pneumonia. What infection does he most likely have, and what antibody would be the best treatment to use?
Staphylococcus Aureus pneumonia
= Flucloxacillin
46
A patient suspected to have pneumonia has a chest X-ray, which shows evidence of consolidation.
Explain the mechanism of consolidation in this patient’s lungs.
An inflammatory response has occurred in the lung tissue
47
What is consolidation?
Refers to lung tissue that has filled with liquid
48
A 92-year-old woman with a past medical history of a right-sided stroke is admitted with a 2-day history of diarrhoea. Today after eating, she was noticed to have had a coughing fit before becoming drowsy. Her oxygen saturation on room air is 82% and she has coarse crepitations over her right middle zone.
What is the most likely cause of her deterioration? and why?
Aspiration pneumonia
= This woman has a history of stroke which may predispose her to having an unsafe swallow. Coupled with the coughing during eating, it is likely she aspirated food contents and is now suffering from an aspiration pneumonia
49
A 48-year-old female patient is admitted to the hospital with severe community-acquired pneumonia. She initially appears to be recovering well with intravenous antibiotics, but on day 3 begins to experience significant rigors with a recurrence of fever intermittently (see list):
03:00 - 37.5
07:00 - 38.3
11:00 - 36.9
15:00 - 38.6
19:00 - 37
What complication of their pneumonia is most likely to have occurred? and why?
Empyema
= Empyema is the term given for the complication of pneumonia where a collection of pus forms within the pleural space. Treated with surgical drainage.
50
A 92-year-old woman with advanced dementia, osteoarthritis, Type II diabetes, and two previous strokes is normally bedbound and looked after by 24-hour carers. They noticed at home that she has been coughing a lot more after food in the last couple of days. She has been more lethargic than usual and has been sweaty and clammy in the last day. She arrives at A&E with a heart rate of 120 blood pressure 90/60 RR 28 her oxygen saturation of 90% on room air. She is diagnosed with aspiration pneumonia.
What would be the best antibiotic to prescribe?
Co-amoxiclav
= A broad antibiotic which is made of amoxicillin and clavulanate acid. It has good gram-positive, negative and anaerobic cover which is needed for aspiration pneumonia
51
You are called to see a 74-year-old male on the respiratory ward. He had been admitted for treatment of community-acquired pneumonia five days ago, and the nurses are concerned he has deteriorated in the last 12 hours. He has a background of type 2 Diabetes Mellitus and smokes half a packet of cigarettes per day.
On examination, he is hemodynamically stable and alert, but on mental state examination, he scores 5/10. He feels peripherally warm and looks dehydrated and tachypnoeic. Respiratory examination reveals dullness to percussion at the right lung base with decreased breath sounds and decreased vocal resonance. His observation chart shows he has been spiking temperatures for the last 48 hours.
What would be the correct investigation to reveal the underlying cause of his deterioration? and why?
Pleural aspirate
= This will allow a fluid aspirate sample to be sent for testing. Given his symptoms suggest an empyema, analyzing the pH and centrifuging the sample (to differentiate it from chylothorax) will allow this diagnosis to be confirmed
52
A 75-year-old man presents to Accident and Emergency following a week of productive cough, fever and shortness of breath. He has not had any foreign travel, however is a chronic smoker with a 15-pack/year history.
What is most likely to be found on examination of this patient’s chest?
Increased tactile vocal fremitus and dull percussion note
53
A 30-year-old woman develops a five-day history of a productive cough and high fever. She also has been short of breath progressively over the past few days.
Furthermore, she complains of painful blue fingers and toes over the past two days, which occur whenever she is outdoors and the temperature has dropped. Yet when indoors she has noticed they return to their normal colour.
What additional findings would you expect to see on examination?
Multiple erythematous papules with deeply erythematous borders
54
How should a patient with a CURB 65 score of between 3-5 be managed?
intravenous antibiotics
55
A young man presents with signs and symptoms consistent with infective endocarditis. He has no history of injecting drug use, but the doctor notes that he has poor dental hygiene. Which organism is likely to have caused this?
Streptococci viridans
56
Which type of bacteria is penicillin most active against?
Gram positive bacteria with a peptidoglycan rich cell wall
57
A 33-year-old female presents to an outpatient clinic with shortness of breath. She was diagnosed with COVID-19 2 weeks ago and was recovering, but over the last few days, her symptoms have worsened. She reports fever, chills, fatigue, and a productive cough. On a physical examination, there is dullness to percussion over the right lower lobe and crackles at the base of the right lung. The physician orders a chest X-ray. What structure will be most likely affected and what disease does this patient have?
Alveoli
Lobar Pneumonia
58
A 4-year-old male was playing with Legos when his parents noticed that he was having difficulty breathing. They bring the child to the emergency department, where he starts to cough, wheeze, and present with hemoptysis. The physician suspects that the child has aspirated a small Lego piece. Where in the respiratory tract is the toy most likely located?
Middle lobe of right lung as carina faces that lung
59
A 67 year old female presents to the Emergency Department with a 2 week history of fever, malaise and progressive shortness of breath.
Observations show a temperature of 38.3 degrees Celsius, respiratory rate of 30, oxygen saturation of 89% on room air, heart rate of 75 beats per minute, and blood pressure of 105/70. On examination, there is dullness to percussion and coarse crepitations heard over the left lower lobe. She has a painful purplish discolouration of her fingers and toes, which she says are exacerbated in the cold weather.
What is the most likely causative organism? and why?
Mycoplasma pneumoniae
= This has an insidious onset and an incubation period of 2-3 weeks after exposure. The painful purplish discolouration of the extremities are suggestive of cold autoimmune haemolytic anaemia (AIHA). Intravascular haemolysis occurs in the cold, leading to acrocyanosis or Raynaud's phenomenon
60
A 36 year old male presents to A+E with a 24-hour history of abdominal pain and yellowing of his skin and eyes. He is HIV positive and had been started last week on medications for pulmonary TB.
Which antibiotic is most likely to be responsible for his presentation?
Pyrazinamide
61
To diagnose pneumococcal pneumonia, what is the best test to use?
Urinary antigen testing
62
Polymerase chain reaction (PCR) testing is the best test for which organisms?
Mycoplasma or Chlamydia, Legionalla
63
A 30 year old female presents to the Emergency Department with a 4 week history of fever, night sweats and progressive shortness of breath. She has also developed haemoptysis over the past 3 days. Sputum samples for acid-fast bacilli were positive, and chest X-ray revealed a cavitating lesion in the right upper lobe.
She was initiated on a treatment regimen of rifampicin, isoniazid, pyrazinamide and ethambutol.
What is the most appropriate additional medication to prescribe?
Vitamin B6
64
A 54-year-old male farmer presents to A&E acutely with a six-hour history of new-onset fever, breathlessness, dry cough and myalgia. He is normally fit and healthy, walking many miles per day on the hills of his farm without shortness of breath. He has never smoked. A chest radiograph shows bilateral upper zone consolidation but is otherwise normal. What is the most likely diagnosis?
Extrinsic allergic alveolitis
65
A 34-year-old male presents to his GP with a four-week history of increasing shortness of breath on exertion and a dry cough. He reports having a mild fever and feeling very lethargic. On examination, the chest is clear. The GP asks him to walk a short distance in the practice and measures his oxygen saturations. They drop from 95% before the walk to 85% immediately after. He was diagnosed with HIV-1 year in his early 20s but is not currently taking antiretroviral therapy. Given the likely diagnosis, what treatment should the patient receive?
Co-trimoxazole
66
A 40-year-old male presents to his GP with haemoptysis and a several-month history of night sweats and cough. He has been living in shared accommodation for some time now and is normally fit and well. He appears malnourished, but his observations are normal. He is referred for a chest x-ray, which shows apical consolidation on the right upper lobe.
What is the next investigation to perform to aid in diagnosis?
Sputum sample
67
A 57 year old male has a dry cough. His past medical history includes ischaemic heart disease and a previous renal transplant. On examination, his chest is clear but his saturations drop after walking around the room. He has no medication allergies.
Given the likely diagnosis, what is the most appropriate antibiotic to prescribe. No other info lol
Co-trimoxazole
68
A 26-year-old South African woman with known sarcoidosis and a history of tuberculosis (TB) in childhood returns to the attention of her specialist team as she's developed worsening shortness of breath and dry cough. Her sarcoidosis has been clinically inactive since she completed a course of steroids a few months ago.
Which investigation would most reliably demonstrate whether her symptoms are due to recurrent active TB infection?
TB sputum culture
69
erythema multiforme (target-shaped lesions) is seen in what infections
Mycoplasma pneumonia
70
An 82-year-old man presents to A&E with a 2-day history of cough and shortness of breath. The cough is productive of yellow-green sputum. On auscultation, some crackles are noted on the right lung base. He seems agitated and slightly confused; an altered mental test score (AMTS) is used to assess this, and he scores 8/10. Observations are as follows: respiratory rate 24/min, SpO2 95% on room air, pulse rate 110/min, blood pressure 105/82, temperature 37.8. Sputum cultures are sent, and a chest x-ray is performed which shows a lobar consolidation in the right lower zone. A diagnosis of community-acquired pneumonia is made.
What further investigation would guide the further management of this patient?
Urea + electroyes
71
Lobar pneumonia on a radiograph - first time seeing them though. What to do
Repeat in 6-8 weeks to ensure reolution. If still present refer to CT chest
