Pneumonia

Question 1

What causes pneumonia in HIV patients?

Answer 1

Penumocystis jiroveci (pneumcystis carinii)

Question 2

What is the investigation of choice in a HIV patient with peumonia?

Answer 2

Bronchoscopy with bronchoalveolar lavage

Question 3

List some risk factors for pneumonia.

Answer 3

winter months
very young and very old 
immunosuppression 
chronic lung, heart, renal or liver disease 
Diabetes mellitus
Institutionalization

Question 4

Define pneumonia.

Answer 4

an infection of the alveoli, distal airways and interstitium of the lungs that occurs outside the hospital setting.

Question 5

How is pneumonia acquired?

Answer 5

Inhalation or aspiration of pathogenic organism into the lungs

Question 6

What is the number 1 cause of pneumonia in a patient with COPD?

Answer 6

Haemophilus influenzae

Question 7

Patient has suspected pneumonia. They have just returned from a cruise. What is the most likely infecting organism?

Answer 7

Legionella spp.

Question 8

Patent just got a new parrot. What is the most likely infecting organism of their new onset pneumonia?

Answer 8

Chlamydia psittaci

Question 9

Patient has just spent a week helping at a farm during the lambing season. What is the most likely infecting organism of their pneumonia?

Answer 9

Coxiella burnetti

Question 10

What are the most common infecting organisms of CAP?

Answer 10

Strep. pnemoniae
H. influenzae
followed by: Legionella, Staph aureus, M. pneumoniae, and other atypicals

Question 11

What are the symptoms of CAP?

Answer 11

SOB 
Cough productive of purulent sputum 
occasional haemoptysis 
pleuritic chest pain 
fever/sweats

Question 12

If it is a lower lobe pneumonia, what else can the patient present with?

Answer 12

Shoulder tip pain - irritation of the diaphragm

Question 13

Give the signs of CAP.

Answer 13

Fever
tachypnea 
tachycardia 
dull to percussion 
bronchial breathing 
crackles 
pleural friction rub

Question 14

Investigations for CAP.

Answer 14

CXR 
Sputum culture (prior to initiation of antibiotics)
Blood cultures 
FBC      U&Es     LFTs
CRP 
Serology for atypical 
legionella urinary antigen if suspected

Question 15

What is used to grade the severity of CAP?

Answer 15

CURB-65

Question 16

What is CURB-65?

Answer 16

Confusion (new)
Urea >7mmol/L
Respiratory rate >30
Blood pressure Systolic <60 
65 years

Question 17

What is the general management for CAP?

Answer 17

High flow oxygen
Monitor ABGs
IV fluids
Paracetamol for pleuritic pain

Question 18

What is given for mild/moderate CAP?

0-2 CURBS 65

Answer 18

Amoxicillin

Penicillin allergic doxycycline

Question 19

What is given for severe CAP?

3-5 CURBS 65

Answer 19

Co-amoxiclav IV and clarithromycin IV/doxycycline PO

Penicillin allergic Levofloxacin IV

Question 20

How can CAP be prevented?

Answer 20

Influenza and pneumococcal vaccinations

Question 21

Define HAP.

Answer 21

A pneumonia contracted after 48 hours of being admitted to the hospital

Question 22

What are the main causal organisms of HAP?

Answer 22

Gram neg bacilli (Klebseilla and pseudomonas 50%)
Staph aureus (15%)
Often caused by multiple organisms

Question 23

Risk factors for HAP?

Answer 23

Alcoholism 
being ventilated 
aspiration 
chest surgery 
immunosuppresion 
recent sever illness

Question 24

What is given for non- severe HAP?

Answer 24

Amoxicillin and Metronidazole

Question 25

What is the treatment for severe HAP?

Answer 25

IV amoxicillin and Metronidazole and Gentamicin

MAG