Pneumonia

Question 1

What is the most common cause of community-acquired pneumonia (CAP)?

Answer 1

Streptococcus pneumoniae (pneumococcus).

Question 2

Which bacteria is commonly associated with pneumonia in alcoholics?

Answer 2

Klebsiella pneumoniae

Question 3

What viral agents can cause community-acquired pneumonia?

Answer 3

Influenza, Respiratory Syncytial Virus (RSV), and other respiratory viruses.

Question 3

What is the typical cause of pneumonia after an influenza infection?

Answer 3

Staphylococcus aureus

Question 3

What type of pneumonia is caused by Mycoplasma pneumoniae?

Answer 3

Atypical pneumonia.

Question 4

What are the characteristic features of pneumococcal pneumonia?

Answer 4

Rapid onset, high fever, pleuritic chest pain, and herpes labialis (cold sores)

Question 5

What criteria should be used for initial pneumonia assessment in primary care?

Answer 5

CRB65 criteria.

Question 6

Q: What are the components of the CRB65 criteria?

Answer 6

C: Confusion (abbreviated mental test score ≤ 8/10)

R: Respiration rate ≥ 30/min

B: Blood pressure: systolic ≤ 90 mmHg and/or diastolic ≤ 60 mmHg

65: Age ≥ 65 years

Question 7

What is the mortality risk and treatment recommendation for a CRB65 score of 0?

Answer 7

Mortality risk: less than 1%. Treatment: consider home-based treatment (alongside clinical judgment).

Question 8

What is the recommendation for a CRB65 score of 3 or 4?

Answer 8

Mortality risk: more than 10%. Urgent hospital admission recommended.

Question 9

What CRP level indicates no need for routine antibiotic therapy?

Answer 9

CRP < 20 mg/L.

Question 10

What is the recommendation for CRP levels between 20 - 100 mg/L?

Answer 10

Consider a delayed antibiotic prescription.

Question 11

What CRP level suggests antibiotic therapy should be offered?

Answer 11

CRP > 100 mg/L.

Question 12

What criteria is used for pneumonia assessment in secondary care (hospital)?

Answer 12

CURB65 criteria.

Question 13

What additional marker is included in the CURB65 criteria?

Answer 13

Urea > 7 mmol/L.

Question 14

What is the mortality risk and treatment recommendation for a CURB65 score of 0 or 1?

Answer 14

Mortality risk: less than 3%. Treatment: consider home-based care.

Question 15

What is the recommendation for a CURB65 score of 2?

Answer 15

Mortality risk: 3-15%. Consider hospital-based care.

Question 16

What CURB65 score indicates the need for intensive care assessment?

Answer 16

Score of 3 or more (mortality risk > 15%).

Question 17

What investigations are recommended for intermediate or high-risk pneumonia patients?

Answer 17

Chest X-ray

Blood and sputum cultures

Pneumococcal and legionella urinary antigen tests

Question 18

What is the role of CRP monitoring in pneumonia management in the hospital?

Answer 18

To help determine the response to treatment.

Question 19

What is the first-line treatment for low-severity community-acquired pneumonia?

Answer 19

Amoxicillin.

Question 20

What alternatives are there if a patient is allergic to penicillin?

Answer 20

Macrolide or tetracycline.

Question 21

How long should antibiotics be prescribed for low-severity community-acquired pneumonia?

Answer 21

5 days.

Question 22

What is the recommended treatment for moderate and high-severity community-acquired pneumonia?

Answer 22

Dual antibiotic therapy: amoxicillin and a macrolide.

Question 23

What is the recommended duration for antibiotics in moderate and high-severity pneumonia?

Answer 23

7-10 days

Question 24

What is recommended for high-severity community-acquired pneumonia if a beta-lactamase stable penicillin is needed?

Answer 24

Co-amoxiclav, ceftriaxone, or piperacillin with tazobactam and a macrolide.

Question 25

What criteria should be used to delay discharge in pneumonia patients?

Answer 25

If in the past 24 hours, the patient has 2 or more of the following: Temperature > 37.5°C Respiratory rate ≥ 24/min Heart rate > 100 bpm Systolic BP ≤ 90 mmHg Oxygen saturation < 90% on room air Abnormal mental status Inability to eat without assistance.

Question 26

How long should symptoms take to resolve after pneumonia?

Answer 26

1 week: Fever should resolve 4 weeks: Chest pain and sputum production should decrease 6 weeks: Cough and breathlessness should improve 3 months: Most symptoms should resolve, fatigue may persist 6 months: Most people will feel back to normal.

Question 27

When should a repeat chest X-ray be performed after clinical resolution of pneumonia?

Answer 27

6 weeks after resolution to ensure consolidation has resolved and no secondary abnormalities are present.