Pneumonia

Question 1

What is the most common cause of pneumonia?

Answer 1

Streptococcus pneumoniae

High fever, rapid onset, herpes labialis
A vaccine to pneumococcus is available

Question 2

What is the most common organism to cause pneumonia in COPD patients?

Answer 2

H. Influenzae

Question 3

What is the most common organism to cause pneumonia in patients who have just had influenza?

Answer 3

Staphylococcus aureus

Question 4

What is the most common organism to cause pneumonia in patients who are alcoholics?

Answer 4

Klebsiella pneumoniae

Question 5

What is the most common organism to cause pneumonia in HIV patients? How does this present?

Answer 5

Pneumocystitis jiroveci

Presents with a dry cough, exercise-induced desaturations and the absence of chest signs

Question 6

Give two examples of atypical pneumonias

Answer 6

Mycoplasma pneumoniae: dry cough, atypical signs, erythema multiforme and haemolytic anaemia may be seen

Legionella pneumophilia: hyponatraemia is common

Question 7

What would investigations show in pneumonia?

Answer 7

FBC (neutrophilia)
U&E (may show dehydration)
Raised CRP

Question 8

What is CURB-65?

What do the results mean?

Answer 8

The management of patients with CAP

Confusion (test score <8/10)
Urea >7
RR >30
BP (SBP <90, DBP <60)
65 (aged >65)

0 = managed in the community
1 = O2 sats, should be >92%. Do a CXR, shadowing? = admission
2 = managed in hospital

Question 9

What is the treatment for CAP?

Answer 9

1) Amoxicillin PO 500mg every 8 hours (5-7 days)
If allergic: Clarithromycin PO 500mg every 12 hours

If CURB65: 3+
= Co-amoxiclav IV 1.2g first line PLUS Clarithromycin
If penicillin allergic: levofloxacin

Question 10

If a patient presents with pneumonia <4 days since admission, how should this be treated?

Answer 10

Treat as CAP

Add Teicoplanin IV if MRSA positive

Question 11

If a patient presents with HAP (>5 days since admission) what is the treatment?

Answer 11

1) Co-amoxiclav PO 625mg

If penicillin allergic: ciprofloxacin + teicoplanin

Question 12

What is the treatment of ventilator associated pneumonia?

Answer 12

Piperacillin-tazobactam IV 4.5g 8 hourly

If penicillin allergic: ciprofloxacin + teicoplanin