Pneumonia

Question 1

What are characteristics of Pneumococcal pneumonia?
Incidence?
Who is it common in?
Clinical features?
What does it show on CXR?

Answer 1

Commonest bacterial pneumonia
Commoner in the elderly, alcoholics, post-splenectomy
Clinical features - fever, pleurisy, herpes labialis, rusty coloured sputum
CXR shows lobar consolidation

Question 2

What are the characteristics of Staphylococcal pneumonia?
Who does it occur in?
Typical pathology?
Treatment?

Answer 2

May complicate influenxa infection or may occur in the young, elderly, IV drug users, or patients with unerlying disease e.g. CF/leukaemia
It causes bilateral cavitating bronchopneumonia
Treatment - flucolxacillin +/- rifampicin

Question 3

What are the characteristics of Klebsiella pneumonia?
Who does it occur in?
Common symptom?
Common pathology?
Significance with treatment?
Treatment?

Answer 3

Rare - occurs in the elderly, diabetics and alcoholics
Presents with red jelly sputum
Causes a cavitating pneumonia, particularly of the upper lobes
It is often drug resistant
Treat with cefotaxime or imipenem

Question 4

What are the characteristics of Pseudomonas pneumonia?
Which conditions is it associated with?
What type of infection does it cause?

Answer 4

Common pathogen in bronchiectasis & CF.

It also causes hospital acquired infections

Question 5

What are the characteristics of Mycoplasma pneumoniae?
Epidemiology
Symptoms?
Common CXR appearance?
Associated buzzword to do with haemolytic anaemia.

Answer 5

Occurs in epidemics every 3-4y
Presents with flu-like symptoms (headache, myalgia, arthralgia) followed by a dry cough
CXR - reticular nodular shadowing, or patchy consolidation, often of one lower lobe
Cold agglutinins may cause an autoimmune haemolytic anaemia
Complications include skin rash

Question 6

What are the characteristics of Legionella pneumophilia?
Where does it colonise?
Pathogenesis?
What disease does it cause?
Extra pulmonary symptoms?
CXR appearance?
Urinalysis?
What is diagnosis based on?

Answer 6

Colonises in air conditioning and dodgy water systems, causing outbreaks of Legionnaires disease
Invades alveolar macrophages and replicates
Flu-like symptoms precede a dry cough and dyspnoea
Extra pulmonary symptoms include anorexia, D&V, hepatitis, renal failure
CXR shows bi-basal consolidation
Urinalysis may show haematuria
Diagnosis - Legionella urine antigen/culture

Question 7

What are the characteristics of Chlamydophila pneumonia?

Preceeding symptoms?

Answer 7

Person to person spread occurs causing a biphasic illness - pharyngitis, hoarseness, otitis, followed by pneumonia

Question 8

What are the characteristics of Chlamydophila psittaci?

Answer 8

Typically acquired for affected birds

Symptoms include headache, fever, dry cough, lethargy,

Question 9

What are the characteristics of viral pneumonia?

Answer 9

Rapidly progressive pneumonia acquired from birds

Question 10

What does CURB65 stand for?

Answer 10

Confusion present
Urea (plamsa) > 7 mmmol/l
Respiratory rate >30/min
BP - systolic

Question 11

What are complications of pneumonia?

Answer 11

Pleural effusion - inflammation of the pleura adjacent to the pleural space may cause this
Empyema - should be expected if a patient with a resolving pneumonia develops a recurrent fever
Lung abscess - clinical features include swinging fever, foul smelling sputum, pleuritic chest pain
Resp failure - type I (PaO2 )

Question 12

80 yo man presents with bilateral cavitating bronchopneumonia after an influenza infection

Answer 12

Staph aureus

Question 13

Headache, skin rash, dry cough, cold agglutinins, anaemia

Answer 13

Mycoplasma pneumoniae

Question 14

Treatment for a 35-year-old patient on the ward admitted to hospital 10 days ago presents
with severe pneumonia.

Answer 14

IV ciprofloxacin

Question 15

Treatment for a 40-year-old builder who presents with a severe community-acquired pneumonia.
Atypical pathogens are suspected.

Answer 15

IV cefuroxime + erythromycin

Question 16

Treatment for a 22-year-old HIV-positive individual on anti-retroviral therapy presents with
Pneumocystis carinii pneumonia.

Answer 16

Oral tetracycline

Question 17

Cold agglutinins

Answer 17

Mycoplasma pneumonia

Question 18

What is the standard treatment for non-severe pneumonia?

Answer 18

Amoxicillin or clarithromycin for those allergic to penicillin

Question 19

In which type of pneumonia is CRP usually normal?

Answer 19

Mycoplasma

Question 20

How would you describe Strep pneumoniae microbiologically?

Answer 20

Gram-positive diplococci

Question 21

How would you describe Staph aureus microbiologically?

Answer 21

Gram positive, commonly in clusters like a bunch of grapes

Question 22

Buzzword for type of pneumonia presenting with pre-existing structural lung disease e.g. COPD, bronchiectasis

Answer 22

Haemophilus influenzae; Moraxella something

Question 23

What type of pneumonia is more common in young men and is recognized cause of endocarditis?

Answer 23

Coxiella burnetti (Q fever)

Question 24

What is a common opportunistic pathogen which causes pneumonia in the immunosuppressed; on long term corticosteroids; post organ transplantation?

Answer 24

Pneumocystic jirovecci

Question 25

What type of pneumonia causes lung abscesses?

Answer 25

Staphylococcal pneumonia

Question 26

Lung abscess
What type of necrosis?
What is it often caused by?
Risk factor?
Typical presentation?
Sequence of events leading to it?

Answer 26

Liquefactive necrosis
Caused by aspiration
RF - alcoholism
Presentation:
- Weight loss
- Lethargy, tiredness
- Cough plus or minus sputum
Sequence: pneumonia --> staph pneumonia --> cavitating pneumonia --> abcess

Question 27

What antibiotics are given for empyema?

Answer 27

Amoxicillin and metronidazole

Question 28

What is bronchopulmonary sequestration?

Answer 28

A piece of tissue that ultimately develops into lung tissue is not attached to the pulmonary arterial blood supply, as is the case in normally developing lung. As a result, this sequestered tissue is not connected to the normal bronchial airway architecture, and as a result, fails to function in, and contribute to, respiration of the organism

Question 29

Most common causative organism in COPD patient who develops pneumonia?

Answer 29

Haemophilus influenzae

Question 30

Most common causative organism in patient with pneumonia who recently had influenza infection?

Answer 30

Staphylococcus aureus