Pneumonia

Question 1

Anatomic classification of pneumonia

Answer 1

Bronchopneumonia - patchy consolidation of different lobes

Lobar pneumonia - single lobe

Question 2

Aetiological classification of pneumonia

Answer 2

CAP
HAP
Aspiration pneumonia
Immunocompromised pneumonia

Question 3

Community Acquired Pneumonia causative agents

Answer 3

Pneumococcus
Mycoplasma
Haemophilus
S. aureus
Chlamydia
Legionella

Viruses 15%

Question 4

Hospital Acquired Pneumonia

Answer 4

> 48 hrs after hospital admission

Gram negative enterobacteria
S. aureus

Question 5

Aspiration pneumonia risk factors

Answer 5

Stroke
Bulbar palsy
GORD
Achalasia
Decreased GCS

Question 6

Aspiration pneumonia causative agents

Answer 6

Anaerobes

Question 7

Immunocompromised pneumonia causative agents

Answer 7

Usual organisms
PCP (pneumocystis pneumonia)
TB
Fungi
CMV/HSV

Question 8

Symptoms of pneumonia

Answer 8

Fever
Malaise
Dyspnoea
Cough - ?haemoptysis
Pleuritic pain

Question 9

Signs of pneumonia

Answer 9

Tachypnoea
Tachycardia
Cyanosis
Confusion
Dull percussion
Bronchial breathing
Crackles
Pleural rub
Consolidation

Question 10

Ix for pneumonia

Answer 10

Bloods inc. culture, ABG
Sputum MC&S
CXR

Question 11

Special Ix for pneumonia

Answer 11

Paired sera Abs for atypicals

Immunofluorescence - PCP

Question 12

Atypical pneumonias

Answer 12

Mycoplasma
Chlamydia
Legionella

Question 13

Severity scoring for pneumonia

Answer 13

CURB 65

Confusion
Urea > 7mM
RR > 30
BP < 90/60
Age > 65

Question 14

Interpretation of pneumonia severity score

Answer 14

< 2 - Home Rx
2 - Hospital Rx
3+ - Consider ITU

Question 15

Mx of pneumonia

Answer 15

Abx
O2
Fluids

Question 16

Mild CAP abx

Answer 16

Amoxicillin 500mg TDS
OR
Clarithromycin 500mg BD

Question 17

Moderate CAP abx

Answer 17

Amoxicillin 500mg TDS
+
Clarithromycin 500mg BD

Clarithro alone if penicillin allergic

Question 18

Severe CAP abx

Answer 18

Co-amoxiclav 1.2g TDS / Cefuroxime 1.5g TDS
+
Clarithromycin 500mg BD
(+ Flucloxacillin of staph suspected)

Question 19

Atypical pneumonia abx

Answer 19

Chlamydia - tetracycline
PCP - Co-trimoxazole
Legionella - Clarithro + rifampicin

Question 20

HAP severity

Answer 20

Mild - < 5 days

Severe - > 5 days

Question 21

Mild HAP abx

Answer 21

Co-amoxiclav 625 mg TDS

Question 22

Severe HAP abx

Answer 22

Tazocin +/- Vanc +/- Gent

Question 23

Aspiration pneumonia abx

Answer 23

Co-amoxilcav 625 mg TDS

Question 24

Pneumovax

Answer 24

Pneumonia vaccine

Revaccinate every 6 yrs

Question 25

Indications for Pneumovax

Answer 25

> 64 yrs
Chronic organ failure
DM
Immunocomprimised

Question 26

Complications of pneumonia

Answer 26

Respiratory failure
Hypotension
AF
Pleural effusion
Empyema
Lung abscess
Sepsis

Question 27

Types of respiratory failure

Answer 27

Type 1: Hypoxia

Type 2: Hypoxia + Hypercapnia

Question 28

Features of a lung abscess

Answer 28

Swinging fever
Cough - purulent sputum
Pleuritic pain
Clubbing
Empyema

Question 29

SIRS

Answer 29

Systemic Inflammatory Response Syndrome
2+ of:
- Tachycardia > 90
- Tachypnoea > 20
- Temperature < 36 or > 38
- WCC < 4 or > 12
- BM > 6.6 in NON diabetic

Question 30

Sepsis definition

Answer 30

SIRS caused by infection

Clinical suspicion of infection

Question 31

Severe sepsis

Answer 31

Sepsis + organ hypoperfusion

Eg. hypotension, confusion

Question 32

Septic shock

Answer 32

Sepsis + persistent hypotension despite fluid resus

Question 33

Features of Mycoplasma pneumonia

Answer 33

Dry cough

Flu-like prodrome

Question 34

Features of legionella pneumonia

Answer 34

Dry cough

Bi-basal consolidation

Question 35

Features of PCP

Answer 35

Dry cough
Bilateral creps
CXR normal or bilateral perihilar interstitial shadowing