Pneumonia

Question 1

Commonest causes of community acquired pneumonia (CAP) [3]

Answer 1

Strep pneumoniae
Haemophilus influenzae
Mycoplasma pneumoniae

Question 2

Commonest causes of hospital acquired pneumonia (4)

Answer 2

Gram negative enterobacteria e.g. E.coli
Staph aureus
Pseudomonas
Klebsiella

Question 3

Patients who are more likely to aspirate? (3)

Answer 3

Stroke patients
Decreased consciousness e.g. post-ictal, drunk
Myasthenia, bulbar palsy

Question 4

Signs of pneumonia (6)

Answer 4

Dullness to percussion
Reduced air entry
Diminished expansion
Cyanosis
Fever
Increased vocal resonant

Question 5

CURB65 components

Answer 5

New onset confusion (AMT less than 8)
Urea higher than 7
Respiratory rate higher than 30
Blood pressure less than 90 systolic/60 diastolic
Aged over 65

Question 6

Interpretation of the CURB score

Answer 6

0-2 is moderate

3-5 is severe

Question 7

Dry cough, erythema multiforme rash with reticulo-nodular shadowing on CXR?

Answer 7

Mycoplasma pneumoniae

Question 8

Klebsiella pneumonia occurs in which groups of patient?

Answer 8

Alcoholics

Question 9

Pattern of klebsiella pneumonia?

Answer 9

Cavitating pneumonia of the upper lobes

Question 10

Often normal chest X ray, desaturation on exertion?

Answer 10

Pneumocystis jiroveci pneumonia

Question 11

Management of pneumocystic jiroveci?

Answer 11

Co-trimoxazole

Question 12

Pneumonia, hyponatraemia and deranged LFTs?

Answer 12

Legionella pneumonia

Question 13

X-ray findings in Legionella pneumonia?

Answer 13

Patchy alveolar infiltrates

Question 14

Symptoms of legionella? (4)

Answer 14

Flu-like including fever
Dry cough
Relative bradycardia
Confusion

Question 15

What lung complication is seen in around 30% of legionella pneumonia?

Answer 15

Pleural effusion

Question 16

Best diagnostic test for Legionella?

Answer 16

Urinary antigen

Question 17

Extra-pulmonary associations of mycoplasma pneumonia? (3)

Answer 17

Guillane-Barre syndrome
Cold agglutinin production –> haemolytic anaemia
Erythema multiforme

Question 18

Patients who aspirate vomit are more prone to developing pneumonia caused by which organisms?

Answer 18

Gram negative anaerobes

Question 19

Radiological signs of pulmonary oedema? (4)

Answer 19

Perihilar shadowing (bats wings)
Fluid in horizontal fissure
Kerley B lines
Pleural effusions