Pneumonia

Question 1

Define: Pneumonia

Answer 1

Acute lower respiratory tract illness associated with fever, symptoms, chest signs and Xray abnormalities

Question 2

Top 2 causative organisms

Answer 2

Streptococcus pneumoniae

Haemophilus influenzae

Question 3

Sheffield’s favourite organism in the Immunocompromised

Answer 3

Pneumocystis jiroveci (fungus)

Question 4

Signs

Answer 4

Pyrexia
Cyanosis
Confusion
RR up. HR up, BP down
Consolidation signs:
- Dull percussion note
- increased tactile vocal fremitus/vocal resonance
- bronchial breathing
Pleural rub

Question 5

Symptoms

Answer 5

Fever, rigors
Anorexia
Dyspnoea, cough
Purulent sputum (green/yellow -unless its the classic rusty: S.p.)
haemoptysis 
pleural chest pain

Question 6

Tests

Answer 6

CXR - consolidation
ABG if sats <92%
BP (low - sepsis)
FBC. U&amp;Es, LFT, CRP, blood cultures
Sputum - microscopy, cultures, sensitivity

Question 7

Grading of pneumonia

Answer 7

CURB-65
Confusion
Urea 7
Resp rate 30
Blood pressure <90
Age >65

Question 8

CURB-65 =0-1 - what do?

Answer 8

Treat at home with oral amoxicillin

Question 9

CURB-65 = 2

Answer 9

Hospital, amoxicillin and clarithromycin PO

Question 10

CURB-65 = 3+

Answer 10

Hospital ?ITU - co-amoxiclav and clarithromycin IV

Question 11

60 y/o, cough, fever, pleuritic chest pain, rusty coloured sputum, bit of blood, bit confused.
U&Es normal, BP 105/80, HR 100, RR 20

Diagnosis and treatment, please

Answer 11

CAP
Strep pneumoniae
CURB65 = 1

Amoxicillin PO

Question 12

You are a phase 2a medical student sitting your end of phase exams in Sheffield. The ceiling has leaked and blurred all of the words on the page, except one word: Spain.
What is the diagnosis

Answer 12

Atypical pneumonia, caused by Legionella pneumoniae.
Also known as legionnaires disease.

Always think about this if someone has been to spain, or works with water tanks.

Wanna know why it was called legionnaires disease?

Question 13

BONUS QUESTION
For mad respect.

What on earth is Panton-valentine leukocidin

Answer 13

A Cytotoxin produced by some Staph aureus which can lead to fulminant necrotising pneumonia.