Pneumonia

Question 1

Causes of CAP and most common

Answer 1

Strep pneumonia - most common
Mycoplasma, haemophilus
S. aureus

Question 2

Causes of atypical CAP

Answer 2

Legionella, chlamydia, pneumocystois

Question 3

Cause of pneumonia in COPD/immunocompromised (and what is most common cause)

Answer 3

Haemophilus - most common
Moraxella catarrhalis (infective exacerbation not pneumonia)
Strep pneumonia, mycoplasma, staph aureus

Question 4

Causes of pneumonia in CF

Answer 4

Early - S. aureus

Chronic - Pseudomonas, Burkholderia

Question 5

Points on CURB65

Answer 5

Confusion - AMT less than/= to 8
Urea >7
RR >30/min
BP -

Question 6

Mx based on CURB65

Answer 6

0-1 - home
2 - hospital
Over/=3 - consider ITU

Question 7

Causes of HAP

Answer 7

Gram -ve enterobaceria

S. aureus

Question 8

Mx in mild, moderate and severe

Answer 8

Mild - Amoxicillin/clarithro (PenA: clarith)
Mod - Amox + clarith
Severe - Co-amox/cef + clarith

Question 9

COPD + infective exacerbation Mx

Answer 9

Amoxicillin

Question 10

Mx mild and severe HAP

Answer 10

Mild - Co-amox

Severe - Tazocin +/- vanc +/- gent

Question 11

Mx aspiration pneumonia

Answer 11

Co-amox 625mg PO TDS

Question 12

Pneumococcal pneumonia risk factors

Answer 12

Elderly, alcoholic, post-splenectomy

Question 13

Pneumococcal pneumonia CXR, extra pulmonary, sputum

Answer 13

CXR - lobar consolidation
Extra pulmonary - herpes labialis, urinary antigen
Sputum - Rusty/blood sputum

Question 14

Staph pneumonia risk factor, CXR, treat

Answer 14

Risk factor - Post influenza, IVDU
CXR - bilateral cavitating bronchopneumonia
Treat - fluclox/vanc

Question 15

Treat pneumococcal pneumonia

Answer 15

Amox/benpen/ceph

Question 16

Klebsiella risk factor, CXR, features, treat

Answer 16

Risk factor - alcoholics
CXR - cavitating upper lobes
Features - abscess, aspiration pneumonia
Treat - Cefotaxime

Question 17

Mycoplasma pneumonia pulmonary features

Answer 17

Reticulo-nodular shadowy/pathcy consolidation

Dry cough

Question 18

Mycoplasma pneumonia extrapulmonary features

Answer 18

Flue like prodrome (headache)
Cold agglutins --> AIHA 
Bullous myringits
Cryoglobulin 
Erythema multiforme 
SJS, GBS, hepatitis

Question 19

Mycoplasma diagnose and treat

Answer 19

Serology/urinary antigens

Clari/doxy/fluroquinolone

Question 20

Legionella pulmonary features

Answer 20

Dry cough, dyspnoea, bi-basal consolidation

Question 21

Legionella extra pulmonary

Answer 21

Flu like prodome
Anorexia, D&V
Hepatitis, renal failure
SIADH –> low Na –> confusion

Question 22

Legionella diagnose and treat

Answer 22

Lymphopenia, low Na, deranged LFTs
Urinary antigen or serology
Treat - clari +/- rifampicin

Question 23

Chlamydia pneumonia features, diagnose, treat

Answer 23

Pharyngitis, sinus pain,
Dx - serology
Treat - clari

Question 24

Chlamydia psittaci risk factor, pulmonary features, diagnose and treat

Answer 24

Parrots
Dry cough, patchy consolidation
Diagnose - serology
Treat - Clari

Question 25

Chlamydia psittaci extra-pulmonary features

Answer 25

Rose spots, spenomegaly, epistaxis, hepatitis, nephritis, meningo-encephalitis

Question 26

PCP features and CXR

Answer 26

Dry cough, exertional dyspnoea, bilateral crep

CXR - normal/bilateral peri-hilar interstitial shadowing

Question 27

PCP diagnose and treat

Answer 27

Dx - visualise from BAL, sputum, biopsy

Treat - Co-trimazole or pentamidine