Pneumonia

Question 1

What are the main causative CAP organisms? which is the most common CAP?

Answer 1

1. Bacteria:
Strep pneumoniae (most common cap)
H influenzae 
Staph Aureus
M Pneumoniae
Legionella
2. Viruses - influenza, RSV,

Question 2

What are the sx in CAP?

Answer 2

• productive cough
• fever, rigors, sweats
• SOB
• pleuritic cp
• malaise, tired

Question 3

What can be found on examination in CAP?

Answer 3

• Decreased breath sounds
• Bronchial breath sounds
• Dull percussion
• Course creps
• Vocal fremitus

Question 4

What investigations would u do for CAP?

Answer 4

1. CXR (PA)
2. FBC, U&E
3. BM
4. ABG
5. Sputum culture
6. Blood culture
   2-4 help indicate severity of pneumonia

Question 5

Explain the CURB65 score

Answer 5

Confusion
Urea >7mmol/L
RR ≥ 30
BP - systolic <90, diastolic ≤ 60 
≥ 65yrs

0/1: low risk - outpatient care
2: mod risk - hospitalisation
3-5: high risk - consider ICU

Question 6

What is the treatment of CAP?

Answer 6

Low risk: oral amox 500mg TDS for 5 days
Mod: amox + oral clarithromycin/erythromycin
Severe: co-amox IV or PO + clarithromycin/erythromycin IV

Question 7

What is rx of CAP w penicillin allergy?

Answer 7

Oral doxycycline or clarithromycin

Question 8

what is the follow up of CAP and when is it indicated?

Answer 8

CXR after 6 weeks if:

• sx persist despite rx
• pt at higher risk of Ca e.g. smokers, >50

Question 9

What are the causative organisms of HAP?

Answer 9

Gram -ve bacilli:
Pseudomonas
E. Coli
Klebsiella pneumoniae

Question 10

What is HAP defined as?

Answer 10

> 48hr after hospital admission

Question 11

What are the most common causes of HAP?

Answer 11

aspiration of oropharyngeal pathogens

leakage of secretions containing bacteria around endotracheal tube cuff

Question 12

How can you test for atypical organisms?

Answer 12

Urine - legionella/pneumococcal urinary antigens

PCR of sputum

Question 13

What abx are used for legionella

Answer 13

fluoroquinolone + clarith

Question 14

What abx is for pneumocystis jirovecii

Answer 14

cotrimoxazole

Question 15

What is the rx of non-severe HAP?

Answer 15

Oral co-amox

Question 16

What are the complications of pneumonia?

Answer 16

pleural effusion
empyema 
lung abscess
resp failure
sepsis
pericarditis
AKI

Question 17

What should be given in pregnant women w pneumonia?

Answer 17

erythyromycin

Question 18

What is the treatment of severe HAP?

Answer 18

IV piperacillin w tazobactam
OR
Ceftriaxone
OR
cefuroxime

Question 19

What is Rx of MRSA?

Answer 19

vancomycin + abx for severe HAP