Pneumonia

Question 1

state two LRTIs?

Answer 1

bronchial infection

pneumonia

Question 2

what two anatomical types of pneumonia is there?

Answer 2

lobar

bronchopneumonia

Question 3

what does lobar pneumonia look like?

Answer 3

Fibrosuppurative consolidation of a single lobe

Question 4

does bronchopneumonia affect one lobe?

Answer 4

no

- patchy consolidation of different lobes

Question 5

what are the etiological classification of pneumonia?

Answer 5

community acquired
hospital acquired
aspiration
immunocompromised

Question 6

what organisms cause community acquired pneumonia ?

Answer 6

Pneumococcus, mycoplasma, haemophilus

S. aureus, Moraxella, Chlamydia, Legionella

Question 7

after how long in hospital does hospital acquired pneumonia occur?

Answer 7

> 48hrs

Question 8

what organisms cause hospital acquired pneumonia ?

Answer 8

Gm-ve enterobacteria, S. aureus

Question 9

what conditions increase the risk of aspiration pneumonia ?

Answer 9

stroke, bulbar palsy, ↓GCS, GORD, achalasia

Question 10

what organisms cause aspiration pneumonia ?

Answer 10

Anaerobes

Question 11

what organisms can immunocompromised pneumonia ?

Answer 11

PCP, TB, fungi, CMV/HSV

Question 12

how is severity determined for pneumonia ?

Answer 12

CURB65

Question 13

what special investigation can be done for PCP (pneumocystis jiorveci pneumonia)

Answer 13

Immunofluorescence

Question 14

what investigations should be done for pneumonia ?

Answer 14

Bloods: FBC, U+E, LFT, CRP, culture, ABG (if ↓SpO2)

Urine: Ag tests (Pneumococcal, Legionella)

Sputum: MC&S

Imaging: CXR

Paired sera Abs for atypicals
- Mycoplasma, Chlamydia, Legionella

pleural tap

Question 15

what does a score of 1,2,3 mean for where the patient can be treated with the CURB65 score ?

Answer 15

0-1 → home Rx

2 → hospital Rx

≥3 → consider ITU

Question 16

what is the treatment for mild pneumonia ?

Answer 16

amoxicillin 500mg three times daily PO for 5d
or
clarithro 500mg twice daily PO for 7d

Question 17

what is the treatment for moderate pneumonia ?

Answer 17

amoxicillin 500mg TDS
and
clarithro 500mg BD PO/IV (clarithro alone if pen allergy) for 7d

Question 18

what is the treatment for severe pneumonia ?

Answer 18

Co-amoxiclav 1.2g TDS IV / cefuroxime 1.5g TDS IV
and
clarithro 500mg BD IV for 7-10d

Add fluclox if staph suspected. (hospital acquired) Add vancomycin if MRSA is suspected

Question 19

what is the treatment for atypical pneumonia ?

Answer 19

Chlamydia: tetracycline

PCP: Co-trimoxazole

Legionella: Clarithro + rifampicin

Question 20

what is the treatment for hospital acquired pneumonia?

Answer 20

Mild / <5d: Co-amoxiclav 625mg PO TDS for 7d

Severe / >5d: Tazocin ± vanc ± gent for 7d

Question 21

what is the treatment for aspiration pneumonia?

Answer 21

Co-amoxiclav 625mg PO TDS for 7d

Question 22

what is pneumovax 23 used for?

Answer 22

It is used for the prevention of pneumonia caused by the 23 different types of pneumococci bacteria that are contained in the vaccine.

Question 23

what are the indications of pneumovax 23?

Answer 23

≥65yrs
Chronic heart, lungs, liver and renal (nephrosis, post transplant) failure or conditions
DM
Immunosuppression: hyposplenism (splenectomy, asplenia, sickle cell, coeliac disease), chemo, HIV

Question 24

what are the contraindications of pneumovax 23?

Answer 24

Pregnancy
breast feeding
fever

Question 25

when should pneumonia be followed up?

Answer 25

6 weeks

Question 26

state what type 1 and type 2 resp failure is ?

Answer 26

Type 1: PaO2 <8kPa + PaCO2 <6kPa (low o2) Type 2: PaO2 <8kPa + PaCO2 >6kPa (low O2 and high CO2)

Question 27

state some complications of pneumonia ?

Answer 27

``` resp failure hypotension AF pleural effusion empyema lung abscess sepsis pericarditis jaundice ```

Question 28

what is the Tx for acute AF caused by infection?

Answer 28

Digoxin or β-B for rate control

Question 29

what will pleural tap of empyema show?

Answer 29

turbid, pH<7.2, ↓glucose, ↑LDH

Question 30

what is the Tx for empyema?

Answer 30

US guided chest drain + Abx

Question 31

what are the symptoms of lung abscess?

Answer 31

``` Swinging fever 􏰀 Cough, foul purulent sputum, haemoptysis 􏰀 Malaise, wt. loss 􏰀 Pleuritic pain 􏰀 Clubbing 􏰀 Empyema ```

Question 32

what will a CXR for lung abscess show?

Answer 32

cavity ̄c fluid level

Question 33

what is augmentin?

Answer 33

oral antibacterial combination consisting of amoxicillin and the beta lactamase inhibitor, clavulanate potassium co-amoxiclav!!

Question 34

what two antibiotics used to treat pneumonia can cause jaundice?

Answer 34

flucloxacillin | co-amoxiclav

Question 35

SIRS (Systemic Inflammatory Response Syndrome) requires 2 out of 4 criteria for a diagnosis. what are the 4 criteria?

Answer 35

Temperature: >38°C or <36°C Heart rate: >90 Respiratory rate: >20 or PaCO2 <4.6 KPa WCC: >12x109/L or <4 x109/L or >10% bands

Question 36

what is severe sepsis?

Answer 36

Sepsis ̄c at least 1 organ dysfunction or hypoperfusion

Question 37

what is septic shock?

Answer 37

Severe sepsis with refractory hypotension

Question 38

what is Multiple organ dysfunction syndrome (MODS)

Answer 38

Impairment of ≥2 organ systems

Question 39

what are risk factors of S aureus pneumonia ?

Answer 39

Influenza infection IVDU Co-morbidities

Question 40

what are risk factors of pseudomonas pneumonia ?

Answer 40

Bronchiectasis CF

Question 41

what are risk factors of legionella pneumonia ?

Answer 41

Travel | Air conditioning

Question 42

what are risk factors of chlamydia psittaci pneumonia ?

Answer 42

parrots

Question 43

what types of atypical pneumonia cause a dry cough?

Answer 43

mycoplasma legionella chalmydia psittaci PCP

Question 44

what organism causes PCP?

Answer 44

pneumocystis jiroveci

Question 45

what CXR findings are there with PCP ?

Answer 45

normal or bilateral perihilar interstitial shadowing

Question 46

what CXR findings are there with pneumococcus?

Answer 46

lobar consolidation

Question 47

what CXR findings are there with s aureus?

Answer 47

Bilateral cavitating bronchopneumonia

Question 48

what CXR findings are there with legionella ?

Answer 48

bilateral consolidation

Question 49

what CXR findings are there with chlamydia psittaci ?

Answer 49

patchy consolidation

Question 50

what CXR findings are there with Klebsiella?

Answer 50

cavitating pneumonia

Question 51

what is the treatment for pseudomonas pneumonia ?

Answer 51

tazobactam

Question 52

how is a diagnosis of legionella made?

Answer 52

Urinary Ag or serology

Question 53

what is the treatment of legionella?

Answer 53

clarithromycin plus rifampicin

Question 54

what is the treatment of chalmydia psittaci?

Answer 54

clarithromycin

Question 55

how is a diagnosis of PCP made?

Answer 55

visualisation from BAL (Bronchoalveolar lavage), sputum, biopsy

Question 56

what is the treatment for PCP?

Answer 56

High dose co- trimoxazole or pentamidine

Question 57

when is prophylaxis for PCP given?

Answer 57

Prophylaxis if CD4<200 or after 1st attack

Question 58

what are extra pulmonary signs of clamydia psittaci?

Answer 58

Horder’s spots ~ rose spots Splenomegaly Epistaxis Hepatitis, nephritis Meningo-encephalitis

Question 59

what pneumonia can cause SIADH and confusion?

Answer 59

legionella

Question 60

what medication can be given to reduce the morbidity of influenza A?

Answer 60

oseltamivir

Question 61

what precautions can be taken to reduce the spread of influenza A?

Answer 61

appropriate hand hygiene don't spare utensils avoid face to face contact wear high efficiency masks and eye protection

Question 62

what is severe acute respiratory syndrome caused by?

Answer 62

SARS-CoV virus

Question 63

is there any medication available for severe acute respiratory syndrome?

Answer 63

no | - because it is viral

Question 64

what are the features of severe acute respiratory syndrome ?

Answer 64

``` fever rigors myalgia dry cough headache SOB diarrhoea ```