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 organismsPCP (pneumocystis pneumonia)

TB

Fungi

CMV/HSV

Question 8

Signs of pneumonia

Answer 8

Consolidation: Dull percussion

Bronchial breathing

Crackles

Pleural rub

Question 9

Atypical pneumonias

Answer 9

Mycoplasma

Chlamydia

Legionella

Question 10

Severity scoring for pneumonia

Answer 10

CURB 65

Confusion

Urea > 7mM

RR > 30

BP < 90/60

Age > 65

Question 11

Interpretation of pneumonia severity score

Answer 11

< 2 - Home Rx

2 - Hospital Rx

3+ - Consider ITU

Question 12

Mx of pneumonia

Answer 12

Abx

O2

Fluids

Question 13

Mild CAP abx

Answer 13

Amoxicillin 500mg TDS

OR

Clarithromycin 500mg BD

Question 14

Moderate CAP abx

Answer 14

Amoxicillin 500mg TDS

+Clarithromycin 500mg BD

Clarithro alone if penicillin allergic

Question 15

Severe CAP abx

Answer 15

Co-amoxiclav 1.2g TDS / Cefuroxime 1.5g TDS

+Clarithromycin 500mg BD

(+ Flucloxacillin of staph suspected)

Question 16

Chlamydia abx

Answer 16

Chlamydia - tetracycline

Question 17

PCP abx

Answer 17

co-trimoxazole

Question 18

Legionella abx

Answer 18

Clarithro + rifampicin

Question 19

HAP severity

Answer 19

Mild - < 5 days

Severe - > 5 days

Question 20

Mild HAP abx

Answer 20

Co-amoxiclav 625 mg TDS

Question 21

Severe HAP abx

Answer 21

Tazocin +/- Vanc +/- Gent

Question 22

Aspiration pneumonia abx

Answer 22

Co-amoxilcav 625 mg TDS

Question 23

Pneumovax

Answer 23

Pneumonia vaccine

Revaccinate every 6 yrs

Question 24

Indications for Pneumovax

Answer 24

> 64 yrs

Chronic organ failure

DM

Immunocomprimised

Question 25

Types of respiratory failure

Answer 25

Type 1: Hypoxia

Type 2: Hypoxia + Hypercapnia

Question 26

Features of a lung abscess

Answer 26

Swinging fever

Cough - purulent sputum

Pleuritic pain

Clubbing

Empyema

Question 27

SIRS

Answer 27

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 28

Sepsis definition

Answer 28

SIRS caused by infection

Clinical suspicion of infection

Question 29

Severe sepsis

Answer 29

Sepsis + organ hypoperfusion

Eg. hypotension, confusion

Question 30

Septic shock

Answer 30

Sepsis + persistent hypotension despite fluid resus

Question 31

Features of Mycoplasma pneumonia

Answer 31

Dry cough

Flu-like prodrome

Question 32

Features of legionella pneumonia

Answer 32

Dry cough

Bi-basal consolidation

Question 33

Features of PCP

Answer 33

Dry cough

Bilateral creps

CXR normal or bilateral perihilar interstitial shadowing

Question 34

Differntiating between exudate and transudate?

Answer 34

• Effusion protein < 25g/L = transudate
• Effusion protein >35g/L = exudate
• Between 25-35g/L: apply Light’s Criteria

Question 35

Light’s criteria

Answer 35

An exudate has one of:

• Effusion : serum protein ratio >0.5
• Effusion : serum LDH ratio >0.6
• Effusion LDH is 0.6 x ULN

Question 36

Cause of exudate?

Answer 36

↑ capillary permeability

Question 37

Cause of transudate?

Answer 37

↑ capillary hydrostatic or ↓ oncotic pressure

Question 38

3 conditions leading to transudate formation?

Answer 38

CCF

Renal failure

Reduced Albumin (eg due to liver failure)

Question 39

Signs of pleural effusion?

Answer 39

• Tracheal deviation away from effusion
• ↓ expansion
• Stony dull percussion
• ↓ air entry
• Bronchial breathing just above effusion

Question 40

Pleural tap method?

Answer 40

• Percuss upper boarder and go 1-2 spaces below
• Infiltrate down to pleura ̄c lignocaine.
• Aspirate ̄c 21G needle

Question 41

Mx of pleural effusion?

Answer 41

• Rx underlying cause
• May use drainage if symptomatic (≤2L/24h)