pneumonia

Question 1

signs of pneumonia in adults with lower respiratory tract infection

Answer 1

temperature >37.5
crepitations (crackles)
sats <95%
HR>100
additional signs: rigors, pleuritic chest paiin, tachypnoea at rest, dullness to percussion, poor air entry, bronchial breath sounds that do not clear with coughin

Question 2

signs that the diagnosis is more likely to be acute bronchitis

Answer 2

patients with acute bronchitis are not likley to have rigors, tachycardia, or tachypnoea at rest
fever may be presennt but subsides after the first few days of illness
wheeze may be present with some crepitations but these should clear with coughin

Question 3

imaging to confirm pneumonia

Answer 3

evidence of new chest consolidation on chest x-ray is diagnositc of pneumonia

Question 4

most common cause of community acquired pneumonia

Answer 4

strep pneumoniae

Question 5

sputum gram stain and culture

Answer 5

at the onset of CAP, many patients are not able to produce sputum
if a sputum sample can be collected before starting antibiotic therapy, sputum gram stain and culture can indcate the likley pathogne

Question 6

blood culture

Answer 6

two samples from two different peripheral sites, or one site at two points in time

Question 7

typical CAP pathogens

Answer 7

strep pneumonie
haemophilus influenzae
morxell ctrhalis
klebsiella pneumoniae
staphylococcus aureus

Question 8

atypical CAP pathogens

Answer 8

mycoplasma pneumoniae
chlamydophila pneumoniae
chlamydiphila psittaci
legionella pneumophila (legionellosis)
coxiella brunetti (Q fever)
francisella tularensis (tularemia)
+ virsues

Question 9

lab findings in CAP

Answer 9

leukocytosis
incresed CRP and ESR, my be norml in atypical CAP
increased procalcitonin
ABG: decresed partil pressure of oxygen
LFTs to evaluate for end organ damage

Question 10

microbiological studies to obtain for severe CAP patient

Answer 10

2 sets of blood cultures
sputum culture and gram stain
influenza nd covid 19 testing
pneumococcal urinary anntigen
legionella urinary antigen

Question 11

microbiological tests for obtain for the non-severe CAP patient

Answer 11

influenza and COVID test
legionella urinary antigen
sputum stain if Hx parenteral antibiotics or lung disease

Question 12

x-ray findings in pneumonia

Answer 12

lobar: opacity in one or more lobes and air bronchograms
atypical or interstitial pneumonia: reticular opacity, absent or minimal consolidation
typical pnuemonia usually appears as lobar pneumonia

Question 13

Abx for mild CAP

Answer 13

amoxycillin plus doxycyclne PO
manage as outpatient

Question 14

Abx for moderate CAP

Answer 14

manage as inpatient
benzylpenecillin IV and doxycycline PO

Question 15

Abx for severe CAP

Answer 15

ceftriaxone and arithromycin IV, consider switch to amoxycillin and doxycycline PO after 2-3 days

Question 16

CURB-65

Answer 16

acute onsent confusion
Urea >7mmol/L or BUN >19mg/dL
Respiratory rate >30
SBP<90, or DBP<60
age 65 or older

Question 17

red flags for hospital admission in CAP

Answer 17

tachypnoaea >22
HR>100
hypotension
acute onset confusion
oxygen saturation <92% on room air, or lower than baseline in patients with comorbid lung disease
multilobal involvement on chest x-ray
blood lactate concentrtion >2