pneumonia

Question 1

two types and most common causative organism for both?

Answer 1

community acquired- strep pneumonia and viral

hospital acquired within first 48hrs- E.coli, pseudomonas, staph. aures

Question 2

symptoms and signs on physical exam?

Answer 2

fever, productive cough, SOB, pleuritic chest pain (worse when lying supine, coughing, breathing, and swallowing), pleural effusion

signs:
enhanced tactile vocal fremitus
dull percussion note
reduced or absent breath sounds
reduced chest expansion
bronchial breathing with coarse crackles
pain radiating to abdomen in children

Question 3

symptoms and physical exam findings of atypical pneumonia? common organisms?

Answer 3

dry cough
SOB
unremarkable auscultation
malaise, muscle pain, sore throat, headache

commonly caused by mycoplasma, legionella, chlamydia

Question 4

organisms causing CAP?
atypical organisms?

Answer 4

1. strep pneumonia
2. viral
   typical bacteria:
   -hemophilus influenza (COPD)
   -staph aurues (children, IV drug abusers)
   -aerobic gram negative (e.coli , klebsiella)

atypical:
mycoplasma pneumonia
-chlamydia pneumonia
-chlamydia psittaci
-legionella (hospitals and hotels)

Question 5

investigations?

Answer 5

CBC- high WBC, lymphopenia if legionella
sputum gram stain and culture
high CRP and ESR (unremarkable if atypical)
chest xray confirms consolidation/effusion

specific etiology:
cold agglutinins for mycoplasma
urine for legionella or pneumococcal antigens

Question 6

severity score CURB-65 with guide on management?

Answer 6

C: confusion
U: urea >7mmol
R: respiratory rate >30
B: BP< 90sys/60dias
age> 65

score:
0-1: home tx
2: hospital therapy
>2: ICU

Question 7

treatment?

Answer 7

symptomatic: analgesic for pleuritic pain, O2 therapy, IV fluids for BP

outpatient:
macrolide (clarithromycin) covers s. pneumo and atypical
if suspecting resistance: combine with B-lactam (amoxicillin). tx duration 7-10 days. review tx if still febrile after 72 hrs

inpatient:
macrolide + ceftriaxone , OR fluroquinolones

MRSA risk: vancomycin
pseudomonas: fluroquinolones plus imipenem/cefepime

Question 8

when to stop antibiotics?

Answer 8

afebrile for 48-72hrs
breathing without supplemental oxygen
no more than 1 clinical instability in vitals

Question 9

specific characteristics in mycoplasma and legionella?

Answer 9

mycoplasma: mild disease but bad xray, hemolytic anemia (cold agglutinins, thrombocytopenia), high IgM, WBC normal

legionella: common in young male smokers, positive urine antigens, leukopenia no leukocytosis