PNEUMONIA

Question 1

What is HAP defined as?

Answer 1

Hospital acquired pneumonia - develops within 48 hours of admission to hospital OR within 1 month following discharge from hospital.

Question 2

What is a lower respiratory tract infection?

Answer 2

Acute illness present for 21 days or less with cough +; fever, sputum, SoB, wheeze or chest discomfort/pain

Question 3

What is antibiotic therapy for low severity CAP?

Answer 3

5 day course of oral amoxicillin

Question 4

What is antibiotic therapy for moderate severity CAP?

Answer 4

7 to 10 days of dual antibiotic therapy with a penicillin + macrolide = co-amoxiclav + clarithromycin

Question 5

What is co-amoxiclav?

Answer 5

Amoxicillin (a penicillin) + clauvanic acid (beta lactamase inhbitor)

Question 6

Name a macrolide? and how do they work?

Answer 6

Clarithromycin, Azithromycin, Erythromycin. Macrolides work by binding to ribosomes and inhibit protein synthesis thereby inhibiting bacterial growth.

Question 7

Who should be given antibiotics?

Answer 7

• If > 80 y/o/ give if; have at least one of; >65 y/o/ have at least 2 of; DM1, DM2, hx HF, hospitalisation in last year, being treated with oral corticosteroids
• patients with significant heart, lung, liver, renal or neuromuscular disease
• patients on immunosuppressant drugs

Question 8

What are the 7 findings of which if a patient has 2 or more of would constitute not discharging from hospital following pneumonia treatment?

Answer 8

1) Temperature > 37.5
2) RR >/= 24 bpm
3) HR > 100 bpm
4) SBP = 90 mmHg
5) O2 sats < 90% on air
6) Abnormal mental status
7) Inability to eat or drink without assistance

Question 9

What is Legionairre’s disease?

Answer 9

It is a type of atypical pneumonia

Question 10

How can Legionairre’s disease occur?

Answer 10

By breathing in water vapours infested with L. Pneumophilia. (this bacteria is often found in water supplies of buildings of cooling towers).

Question 11

Name a fungal pneumonia which can occur in those with impaired immune system such as; HIV virus or on immunosuppresent drugs

Answer 11

Pneumocystis jiroveci pneumonia caused by fungus pneumocystis jiroveci.

Question 12

Which antibiotic is usually always just given orally despite severity of pneumonia due to lack of difference in efficacy and bioavailability between IV and oral route?

Answer 12

Clarithromycin (a macrolide)

Question 13

which bacteria causes the rust coloured sputum in pneumonia infections?

Answer 13

Pneumococcal pneumonia.

Question 14

What are the 3 most common bacteria causing CAP?

Answer 14

Streptococcus pneumoniae, Haemophilus Influenza, Moraxella catarrhalis

Question 15

What are the atypical bacteria causing CAP?

Answer 15

Mycoplasma pneumoniae, Legionella pneumophila

Question 16

Most common bacteria to cause HAP?

Answer 16

Staphylococcus aureus

Question 17

What can the fungus Aspergillus fumigatus cause?

Answer 17

1) Chronic cough + haemoptysis 2) Pneumonia

Question 18

What does the urine antigen test look for?

Answer 18

Pneumococcal antigen and Legionella antigen

Question 19

What test can be done to rule out fungal infection?

Answer 19

Beta-D-glucan

Question 20

What is HBsAg and what does it indicate?

Answer 20

Hepatitis B surface antigen AND indicates pt. is infectious.

Question 21

What is anti-HBs and what does its level indicate?

Answer 21

Hepatitis B surface antibody AND indicates recovery and immunity from Hepatitis B virus infection and successful vaccination against Hepatitis B.

Question 22

What is anti-HBc and what does it indicate?

Answer 22

Hepatitis B core antibody AND it appears at the onset of symptoms in acute Hepatitis B and persists for life (therefore indicates previous or ongoing infection).

Question 23

What is IgM anti-HBc and what does it indicate?

Answer 23

IgM antibody to Hepatitis B core antigen AND positivity indicates recent infection (<6 months).

Question 24

What is the pathophysiology of Pneumonia?

Answer 24

• neutrophil infiltration
• inflammatory exudate in the intersitium leading to thickening of alveolar septa
• alveolar oedema
• alveolar haemorrhage
• loss of alveolar spaces

Question 25

What type of bacteria are STAPHYYLOCCI and STREPTOCOCCI

Answer 25

gram positive cocci

Question 26

Which bacteria is the most common cause of CAP?

Answer 26

STREPTOCOCCUS PNEUMONIAE (gram +ve coccus)

Question 27

Name the 4 typical bacterial causes of PNEUMONIA.

Answer 27

• Streptococcus pneumoniae
• Haemophilus influenzae
• Klebsiella pneumoniae
• Staphylococcus aureus

Question 28

Who is at risk of contracting the gram -ve baccilus Klebsiella pneumoniae?

Answer 28

elderly patients and those with comorbidities and alcohol excess.

Question 29

What are the atypical bacterial causes of pneumonia?

Answer 29

• Mycoplasma pneumoniae
• Legionella pneumonophilia
• Chlamydia pneumoniae
• Chlamydia psittaci

Question 30

What type of organisms can be cultured in the laboratory?

Answer 30

Typical organisms

Question 31

What type of organisms are intracellular and can not be cultured in a laboratory, and therefore require treatment with macrolide antibiotics

Answer 31

Atypical

Question 32

Why can atypical organism not be treated with penicillin or cephalosporins?

Answer 32

because they are intracellular and do not have a cell wall on which these antibiotics can act.

Question 33

What are the most common viruses to cause viral pneumonia?

Answer 33

Influenza A and B

Question 34

Besides the common Influenza A and B, what other viruses can cause viral pneumonia?

Answer 34

• Adenovirus
• Para-influenzae
• Respiratory syncytial virus

Question 35

What is the most common fungus to cause fungal pneumonia and what type of patients are more susceptible to this fungal pneumonia?

Answer 35

Pneumocystis jiroveci pneumonia.

Immunocompromised patients; HIV, post transplantation immunosuppression

Question 36

What is a common complication of pneumonia?

Answer 36

Exudative pleural effusion.

Question 37

What can a pleural effusion become and what is this?

Answer 37

Empyema. This a collection of pus in the pleural space; swinging fevere + high CRP. Must sample the fluid and if diagnosed as empyema; fluid is drained.

Question 38

What is a rare complication of pneumonia?

Answer 38

Lung abscess

Question 39

What is a lung abscess and how do you treat it?

Answer 39

Localised collection of pus within the lung tissue, seen on x-ray/CT.

Question 40

What are the causative organisms of pneumonia in neonates? (infant < 4 weeks)

Answer 40

• E. Coli
• Group B Strep
• Listeria Monocytogenes

Question 41

What are the causative organisms of pneumonia in children 1-6 months of age?

Answer 41

• Chlamydia trachomatis
• Staph Aureus
• Respiratory syncytial virus

Question 42

What are the causative organisms of pneumonia in children aged 6 months to 5 years?

Answer 42

• RSV

- Para-influenzae virus

Question 43

What bacteria cause late onset (>5 days since admission) HAP ?

Answer 43

• Enterobacteria: E.coli, Klebsiella sp.
• Staphylococcus aureus
• Gram -ve bacilli; Pseudomonas, E-coli
• Environmental gram negatives; Acinetobacter sp, Stenotrophomonas maltophilia
• mixed flora if aspiration pneumonia is suspected

Question 44

name the CXR findings in a Pleural effusion;

Answer 44

• dense opacification with loss of lung markings
• clear markings of opacification
• non visible costo-phrenic + cardio-phrenic angles
• meniscus sign due to fluid level

Question 45

when should patients with pneumonia be followed up post discharge?

Answer 45

6 weeks later

Question 46

Although the fever should have subsided 1 week post admitted with pneumonia ; when should they feel back to normal completely?

Answer 46

6 months later.

at 3 months all symptoms resolved except for fatigue.