Pneumonia

Question 1

Name two complications of pneumonia

Answer 1

Lung abscess and empyema (parapneumonic)

Question 2

What are the typical and atypical pathogens that cause community acquired pneumonia?

Answer 2

Typical: strep pneumoniae, h. influenzae, pseudomonas aeruginosa, staph aureus
Atypical: myocplasma pneumoniae, legionella pneumonia, klebsiella pneumoniae, chlamydia pneumoniae

Question 3

Name some risk groups for CAP?

Answer 3

Nursing home residents, immunocompromised, infants, elderly, impaired swallowing, COPD, DM

Question 4

What is pneumonia caused by staph aureus usually secondary to?

Answer 4

Influenza

Question 5

What microbiology tests would you carry out to test for CAP?

Answer 5

Sputum culture, blood culture, serology, PCR, urinary Ag

Question 6

What are atypical pneumonia organisms?

Answer 6

organisms that don’t grow by normal staining mechanisms

Question 7

How would you test for legionella pneumoniae?

Answer 7

Urinary antigen

Question 8

How would you test for mycoplasma pneumoniae?

Answer 8

PCR

Question 9

What is the severity assessment for CAP and what is it used to determine?

Answer 9

CURB 65 (confusion, urea >7, RR >30/min, BP systolic 65)
Used to determine whether a patient should be admitted or not and whether they should be put in ICU

Question 10

What is the non-Abx treatment for pneumonia moderate > severe?

Answer 10

oxygen, analgesia (For pleuritic chest pain), IV fluids

Question 11

What is the empirical Abx for mild CAP?

Answer 11

Amoxicillin or clarithromycin

Question 12

What is the empirical Abx for moderate CAP?

Answer 12

Amoxicillin + clarithromycin

Question 13

What is the empirical Abx for severe CAP?

Answer 13

IV: Co-amoxiclav + clarithromycin

Question 14

What is PCP? Who does it affect? How do you treat it?

Answer 14

Pneumocystis jirovecii - a fungus
Opportunistic - affects immunocompromised causing a form of pneumonia characterised by rapid desaturation on exertion
Rx: anti-fungal = co-trimoxazole