Pneumonia

Question 1

What is pneumonia?

Answer 1

Inflammation in the substance of the lung usually caused by bacteria

Question 2

What are the most common agents of communities acquired pneumonia in the young and old, and middle aged respectivitely

Answer 2

Young/Old: Pneumococcus, Haemophilus influenzae

Middle aged: Mycoplasma pneumoniae, Chlamydophila

Question 3

What are the most common agents of hospital acquired pneumonia? When does it occur?

Answer 3

Gram negative enterobacteria or Staph aureus, Pseudomonas, Klebsiella

48 hours post admission

Question 4

What are some rarer causes of pneumonia?

Answer 4

Legionella

Moraxella catarrhalis

Coxiella burnetii

Question 5

What rarer type of pneumonia can occur in patients with animal exposure?

Answer 5

Q fever caused by Coxiella burnetii

Question 6

What are some symptoms of pneumonia?

Answer 6

Fever

Rigors

Malaise

Anorexia

Dyspnoea

Cough

Purulent sputum

Haemoptysis

Pleuritic pain

Question 7

What are some signs that can be present with pneumonia?

Answer 7

Pyrexia

Cyanosis

Confusion (elderly)

Tachypnoea

Tachycardia

Hypotension

Signs of consolidation (creps, dull percussion, bronchial breathing)

Pleural rub

Question 8

How might you Ix pneumonia?

Answer 8

Blood cultures, ABG

CXR

Bloods: FBE, LFT, UEC, CRP, ESR

Sputum: culture and micro

Urine: MCS, urine antigen (Legionella)

Question 9

What is the CURB-65 index and what does it indicate?

Answer 9

Confusion

Urea: >7mmol/L

RR: >30

BP: <90systolic or 60diastolic

>65 years old

If 0-1 manage at home, if 2 at hospital, if >3 = severe pneumonia

Question 10

What are some potential complications of pneumonia?

Answer 10

Pleural effusion

Empyema

Lung abscess

Respiratory failure

Septicaemia

Brain abscess

Pericarditis

Myocarditis

Cholestatic jaundice

Question 11

Which antibiotics and doses are used to treat mild, community acquired pneumonia?

Answer 11

Oral amoxicillin 500mg-1g/8h (or benzyl penicillin)

+

Doxycycline 200mg loading then 100mg per day

Question 12

Which antibiotics are used to treat hospital acquired pneumonia?

Answer 12

Aminoglycoside IV

3rd Gen cephalosporin

Question 13

When do you want to administer broad spectrum antibiotics by?

Answer 13

Within an hour

Question 14

How do you approach a patient with ?CAP

Answer 14

Ix

• CXR
• FBE, UEC, CRP
• Sputum/urine culture
• ?ABG/Blood cultures

Mx

• O2, aim sats >94%
• Empirical abx and convert to orals if required
• If T > 38 - blood cultures