Pneumonia

Question 1

Name some of the risk factors of pneumonia

Answer 1

Smoking
Chronic lung disease
Chronic heart disease
Alcohol excess
Immunosuppression

Question 2

What are the four broad classifications of pneumonia?

Answer 2

Community acquired pneumonia
Hospital acquired pneumonia
Aspiration pneumonia
Immunocompromised pneumonia

Question 3

What are some of the presenting complaints of pneumonia?

Answer 3

Shortness of breath
Cough
Sputum production
Pleuritic chest pain
Fever
Confusion

Question 4

How will a patient with pneumonia present on examination?

Answer 4

Tachycardia
Tachypnoea
Pleural rub
Dull percussion note
Coarse crepitations

Question 5

What patients are at risk of CAP?

Answer 5

Healthy adults

Those with an underlying lung disease (COPD, ILD)

Question 6

What patients are at risk of HAP?

Answer 6

Elderly
Immobile
Immunosuppressed
Immunocompromised

Question 7

What patients are at risk of aspiration pneumonia?

Answer 7

Alcoholics

Question 8

What patients are at risk of immunocompromised pneumonia?

Answer 8

HIV
Transplant patients
Chemotherapy

Question 9

Name the common causative organisms for CAP

Answer 9

Strep pneumoniae
H. influenzae
M. pnuemoniae

Question 10

Name the common causative organisms for HAP

Answer 10

Staph aureus
Gram negative enterobacteria
Pseudomonas
Klebsiella

Question 11

Name the commoncausative organisms for aspiration pneumonia

Answer 11

Anaerobes
Gram negative bacteria
Staph aureus

Question 12

Name the common causative for immunocompromised pneumonia

Answer 12

HAP and CAP organisms
Viruses
Fungi
Mycobacteria

Question 13

What is the most common bacteria causing CAP?

Answer 13

Strep pneumoniae

Question 14

What are the characteristics of H. influenzae pneumonia?

Answer 14

Seen in patients with COPD - will cause exacerbations of the disease

Question 15

What are the characteristics of staph aureus pneumonia?

Answer 15

Commonly seen in patients with weakened immune system or alcoholics. Can be an exacerbation of influenza, and causes cavitations

Question 16

What are the characteristics of mycoplasma pneumoniae?

Answer 16

Has epidemics every 3-4 years, usually seen in young patients
Causes flu-like symptoms, and penicillin is ineffective as there is no cell wall

Question 17

What are the characteristics of legionella pnuemophilia?

Answer 17

Commonly caused by faulty cooling towers and air conditioning
Will cause flu-like symptoms with shortness of breath and diarrhoea
High mortality

Question 18

How is the causative organism determined?

Answer 18

Sputum culture

Question 19

What investigations can be carried out to determine pneumonia? Why are these investigations carried out?

Answer 19

Full blood count (raised inflammatory markers)
CRP (as above)
U and E’s (dehydration common in pneumonia)
LFT’s (may be deranged in atypical pneumonia)
CXR (evidence of consolidation/effusion)

Question 20

How is the management of pneumonia determined?

Answer 20

CURB65 score

Question 21

What antibiotics are given in moderate CAP?

Answer 21

Amoxicillin + clarithromycin

Question 22

What antibiotics are given in severe CAP?

Answer 22

Co-amoxiclav + clarithromycin

Question 23

What antibiotics are given in HAP?

Answer 23

Tazocin + gentamicin

Question 24

What antibiotics are given in aspiration pneumonia?

Answer 24

Co-amoxiclav + metronidazole

Question 25

What are the key complications of pneumonia?

Answer 25

Respiratory failure
Empyema
Abscess
Atrial fibrillation