Pneumonia

Question 1

Most common causative organism of pneumonia

Answer 1

Streptococcus pneumoniae (pneumococcus)

Question 2

Causative organism of pneumonia common with COPD

Answer 2

Haemophilus influenzae

Question 3

Common causative organism of pneumonia following influenza

Answer 3

Staphylococcus aureus

Question 4

How does mycoplasma pneumoniae present

Answer 4

atypical pneumonia
dry cough, atypical chest signs/x-ray findings
Autoimmune haemolytic anaemia and erythema multiforme may be seen

Question 5

Legionella pneumophilia symptoms

Answer 5

Another one of the atypical pneumonias
Hyponatraemia and lymphopenia (low lymphocytes) common
Classically seen secondary to infected air conditioning units

Question 6

Causative organism seen in alcoholics

Answer 6

Klebsiella pneumoniae

Question 7

Symptoms of pneumocystis jiroveci and where is it seen

Answer 7

Typically seen in patients with HIV
Presents with a dry cough, exercise-induced desaturations and the absence of chest signs

Question 8

Symptoms and signs of Pneumonia

Answer 8

Symptoms
cough
sputum (rust colour/bloodstained)
dyspnoea
chest pain: may be pleuritic
fever

Signs
signs of systemic inflammatory response
- fever
- tachycardia
- hypotension
reduced oxygen saturations

Question 9

pneumonia signs seen on examination

Answer 9

auscultation:
- reduced breath sounds
- bronchial breathing
dullness on percussion

Question 10

Investigations and findings

Answer 10

xray - consolidation (white opacity), may be effusion
fbc - raised white cells
U and E - check for dehydration
CRP - raised
blood cultures
sputum sample - diagnose causative organism
ABG - if oxygen sats are low or pre existing resp disease

Question 11

CURB-65, what does it stand for, treatment related to score

Answer 11

C - confusion
U - urea (raised blood urea nitrogen (BUN)) >7mmol/l, shows decline in kidney function
R - resp >= 30/min
B - blood pressure systolic <= 90 mmHg and/or diastolic <= 60 mmHg, shows dehydration
65 - aged 65 or over

if 0, home based care, amoxicillin 1st line
2 or more - hospital assessment

Question 12

Management of low-severity community acquired pneumonia

Answer 12

amoxicillin is first-line
if penicillin allergic then use a macrolide or tetracycline
NICE now recommend a 5 day course of antibiotics for patients with low severity community acquired pneumonia

repeat xr 6 weeks to ensure no consolidation or tumour

Question 13

Management of moderate and high-severity community acquired pneumonia

Answer 13

dual antibiotic therapy is recommended with amoxicillin and a macrolide
a 7-10 day course is recommended
NICE recommend considering a beta-lactamase stable penicillin such as co-amoxiclav, ceftriaxone or piperacillin with tazobactam and a macrolide in high-severity community acquired pneumonia

repeat xr 6 weeks to ensure no consolidation or tumour

Question 14

Pathophysiology of pneumonia

Answer 14

pathogen -> inflammatory cascade -> neutrophils migrate, release cytokines, activate immune response and fever
accumulation of fluid and pus, impairing gas exchange and hypoxic state