Pneumonia

Question 1

What are the 4 types of pneumonia?

Answer 1

Community-accquired pneumonia (CAP)
Hospital-acquired pneumonia (HAP)
Atypical pneumonia
Aspiration pneumonia

Question 2

What is the most common cause of pneumonia and empyema?

Answer 2

Strep. pneumoniae

Question 3

When can HAP occur?

Answer 3

> 48hrs after admission to hospital

Question 4

Patient with redcurrant jelly sputum and right lower lobe consolidation on CXR.

What is likely cause of pneumonia?

Answer 4

Klebsiella pneumoniae - redcurrant sputum

Right lower lobe - most common site in aspiration pneumonia - (due to more proximal vertical orientation of right bronchi)

Question 5

Who is most likely to get aspiration pneumonia?

Answer 5

Alcoholics and diabetics

Question 6

Why may you require broad-spectrum antibiotics in HAP?

Answer 6

Generally caused by gram-negative bacteria and staph. aureus

Question 7

Pneumonia associated with birds?

Answer 7

Chlamydia psittaci

Question 8

Pneumonia assoc. with hot tubs, water source with poor ventilation? ?

Answer 8

Legionella

Question 9

Bacteria assoc. with pneumonia post viral URTI (upper resp tract infection)?

Answer 9

Staph aureus

Question 10

How may the lung look macroscopically on autopsy?

Answer 10

Red hepatisation - looks like liver due to consolidation

Question 11

What pneumonia is associated with sheep?

Answer 11

Coxiella burnetti

Question 12

Clinical features?

Answer 12

Pyrexia
Chills
Tachypnoea
Tachycardia
Productive cough 
Pleuritic chest pain

Question 13

How may atypical pneumonia (coxiella burnetti, klebsiella, chylamdia psittaci, mycoplasma pneumoniae) present

Answer 13

Atypical symptoms but normal CXR

Question 14

Pneumonia causes an exudate (high in protein) to be produced but what else is characteristic of it?

Answer 14

Fibrin rich

Question 15

Pathophysiology of pneumonia?

Answer 15

Infectious organisms reach alveoli -> produce exudate -> fills infected and neighbouring alveolar spaces -> proliferation of NEUTROPHILS

Question 16

Defintion

Answer 16

Infection of distal air spaces with a NEW infiltration on CXR

Question 17

What bug can cause minimal chest symptoms but associated with GI symptoms?

Answer 17

Legionella

Question 18

What criteria is used to estimate MORTALITY with CAP - hence determine inpatient vs. out-patient care

Explain it and what the scoring means

Answer 18

CURB-65

Confusion (<8 on Abbreviated Mental Test Score)
Urea (>7mmol/L)
Resp rate (>30/min)
Blood pressure (<90/<60)
=/> 65

LOW RISK 0-1 = out-patient
MOD RISK 2 = in patient
HIGH RISK >3 = consider ICU assessment

Question 19

CAP manangement (CHECK AGAINST SIGN)

Answer 19

Amoxicillin - most important

Low risk = amoxicillin/doxycycline

Mod risk = oral amoxicillin (clarithromycin if atypical)

High risk = IV co-amoxiclav + clarithromycin

Question 20

***** HAP management (CHECK AGAINST SIGN)

Answer 20

Co-amoxiclav - most important

Low risk = PO amoxicillin

High severity = IV amoxicillin + gentamicin

THIS CHANGES DEPENDANT ON GUIDELINES - ALWAYS CHECK LOCAL GUIDELINES

Question 21

What can be found on examination?

Answer 21

Dull percussion - (effusion)
Reduced chest expansion
Crackles on auscultation

Question 22

Match the following sputum types to bacteria:
Rusty brown
Redcurrant jelly like
Mucoid

Answer 22

Rusty brown - strep. pneumoniae
Redcurrant jelly like - klebsiella
Mucoid - Chlamydia psittaci

Question 23

Difference between pneumococcus and Strep. pneumoniae

Answer 23

Same thing

Question 24

Aspiration pneumonia management

Answer 24

PO Amoxicillin + metronidazole

Severe = IV amoxicillin + metronidazole + gentamicin

Question 25

What is abscess formation in pneumonia suggestive of?

Answer 25

Staph aureus infection

Question 26

What is persistent fever in spite of antibiotics suggestive of?

Answer 26

Potential presence of empyema

Question 27

What can appear as a complication of aspiration pneumonia?

Answer 27

Lung abscess

Question 28

Myoplasma can be treated with amoxicillin. True or false?

Answer 28

False

Doxcycline

Question 29

What type of infection is most common in immunocomprimised patients?

Answer 29

Pseudomonas aeruginosa

Question 30

If patient does not respond in way expected to antibiotics, what should be suspected?

Answer 30

Malignancy