PNEUMONIA

Question 0

What are common CAP pathogens?

Answer 0

Typical

• Strep pneumoniae (+)
• staph aureus (+)
• haemophilus influenza (-)
• pseudomonas aeruginosa (-)

Atypical

• mycoplasma
• chlamydia
• legionella
• viruses: influenza, adenovirus, RSV

Anaerobes if history of aspiration

Question 1

What are the types of pneumonias?

Answer 1

CAP
VAP
HAP

Question 2

Why are atypical organism atypical?

Answer 2

Difficult to culture

B-lactam resistant

Question 3

RF for CAP?

Answer 3

Alcoholism -> aspiration
Immunosuppressive
Asthma
Institutionalisation

Question 4

How do you get VAP?

Answer 4

Colonisation of oropharynx with pathogens

ETT facilities microaspiration

Immunocompromised

Question 5

Common HAP organisms?

Answer 5

Pseudomonas aeruginosa
E. coli
Klebsiella

Question 6

S + S?

Answer 6

Non-specific - fatigue, myalgia, headache
Resp - cough, mucus, blood sputum, SOB, pleuritic chest pau
GI symptoms in some (esp legionella) - ABDO pain, diarrhoea, N + V
FEVER

Question 7

Ix?

Answer 7

LAB
CBE EUC LFT
SPUTUM MCS

Not routine: ABG, legionella urinary antigen test, viral PCR, blood cultures (usually negative)

RAD
CXR
- lobar consolidation usually dt typical bacterial
- interstitial infiltrate dt Virus or fungus
- GI symptoms think atypical or viral

Question 8

How do you assess severity of pneumonia?

Answer 8

CURB-65

• confusion
• urea > 7
• rr > 30
• BP < 90
• age > 65

Question 9

Complications of pneumonia?

Answer 9

Lung

• abcess (aspiration)
• para-pneumonic effusion -> empyema
• lobar collapse
• respiratory failure

Non-lung

• sepsis -> shock, DIC
• SIADH
• metastatic infection (brain abcess, endocarditis)

Question 10

Antibiotics for mild, moderate severe CAP?

Answer 10

Mild - AMOXYCILlin and CLARITHROMYCIN

Moderate - Benzyl penicillin AND CLARITHROMYCIN

Severe - ceftriaxone or cefotaxime or Tazocin PLUS azithromycin

Question 11

ABx for hap?

Answer 11

Low risk - augmentin or Tazocin

High risk - Tazocin

Question 12

ABx for aspiration pneumonia?

Answer 12

Benzyl penicillin and metronidizole

Question 13

What is SIADH?

Answer 13

Excessive release of ADH from posterior pituitary gland -> dilutional hyponatraemia.

SCLC releases ectopic hormones ADH and ACTH