Pneumonia

Question 1

Signs of pneumonia

Answer 1

Tachypnoea, O2 mask, sputum (rusty = pneumococcus)
Reduced expansion
Dull percussion note
Focal coarse crackles, increased vocal resonance, bronchial breathing
Ask for temperature chart
If dull percussion note with absent vocal fremitus, think empyema/effusion

Question 2

Investigations in pneumonia

Answer 2

CXR: consolidation, air bronchogram
Bloods: CRP, WCC, urea, atypical serology (on admission and day 10)
Cultures: blood and sputum
Urine: legionella and pneumococcus antigens, haemoglobinuria (due to cold agglutinins due to mycoplasma)

Question 3

Commonest organisms for CAP

Answer 3

Streptococcus pneumoniae 50%
Mycoplasma pneumoniae
Haemophilus influenza (esp if COPD)
Chlamydia pneumonia

Question 4

Abx for CAP

Answer 4

1st line is penicillin OR cephalosporin, plus macrolide

Question 5

Special pneumonias in immunosuppressed patients

Answer 5

Fungal
TB
PJP
CMV

Question 6

Rx for fungal pneumonia

Answer 6

Amphotericin

Question 7

Rx for PJP

Answer 7

Co-trimoxazole + pentamidine

Question 8

Rx for CMV pneumonia

Answer 8

Ganciclovir

Question 9

Common area for aspiration pneumonia

Answer 9

Posterior segment of right lower lobe

Question 10

Rx for aspiration pneumonia

Answer 10

Add metronidazole for anaerobes

Question 11

Organism and Abx for post influenza pneumonia

Answer 11

Staph aureus.

Normal Abx plus flucloxacillin

Question 12

Severity score in pneumonia plus threshold

Answer 12

CURB65
Confusion
Urea>7
Respiratory rage >30
BP sys <90 or dia<60
Age >65
2 or more is severe

Question 13

Complications of pneumonia

Answer 13

Lung abscess
Para-pneumonic effusion/empyema
Haemoptysis
Septic shock & multi organ failure

Question 14

Common microbes in lung abscesses

Answer 14

Staph aureus
Klebsiella
Anaerobes