Pneumonia

Question 1

pneumonia caused by what organism is most commonly found in alcoholics?

Answer 1

klebsiella pneumoniae

Question 2

pneumonia caused by what organism is most commonly found in patients with COPD?

Answer 2

haemophilus influenza

Question 3

pneumonia caused by what organism is commonly occurs in patients following the flu?

Answer 3

staphylococcus aureus

Question 4

what are features of pneumonia caused by mycoplasma pneumonia?

Answer 4

atypical organism
dry cough, abnormal chest signs/CXR findings
autoimmune haemolytic anaemia and erythema multiform may be seen

Question 5

what are features of pneumonia caused by legionella pneumonia?

Answer 5

atypical organism
hyponatraemia and lymphopenia may be seen
classically seen in infected air conditioning vents

Question 6

what is the presentation of pneumocystis jiroveci pneumonia and what is the treatment?

Answer 6

associated with HIV infection

dry cough
exercise induced desaturations
absence of chest signs

treatment = Co-trimoxazole

Question 7

describe how a patient presenting with signs/symptoms of pneumonia is assessed in primary care.

Answer 7

CRB 65 score (don’t include urea due to blood test not readily available)

CRB65 score 0 - at home treatment
CRB 1 and above - hospital assessment

point of care CRP testing can also be used if available for determining antibiotic therapy
CRP < 20 - don’t routinely offer
CRP 20-100 - delayed antibiotic therapy
CRP > 100 - offer antibiotic therapy

Question 8

describe the assessment of a patient presenting with signs/symptoms of pneumonia in secondary care.

Answer 8

CURB 65 score

CURB 65 score 0 = manage in community

CURB 65 score 1

• If sats <92% hospital treatment
• do CXR and if bilateral or multilobular shadowing then hospital treatment

CURB 65 score > 2 = hospital care

CURB 3-4 = intensive care

Question 9

what is the CURB 65 features?

Answer 9

confusion (abbreviated mental test score < 8/10)
urea > = 7 
respiratory rate >= 30 bpm 
BP >= systolic 90 and/or diastolic 60
>= 65 yrs old

Question 10

what is first line treatment for low risk CAP?

Answer 10

1st line = amoxicillin 5 days

penicillin allergic = macrolide

Question 11

what is the first line treatment for intermediate/high risk CAP?

Answer 11

1st line: amoxicillin + macrolide 7-10 days course

if high risk consider use of co-amoxiclav, ceftriaxone or piperacilin
+ macrolide
+ tazobactam

Question 12

what features would indicate you could not discharge the patient?

Answer 12

2 or more features in the past 24 hours;

- temp > 37.5
respiratory rate > 24
heart rate > 100
oxygen sats < 90% on air 
unable to eat without assistance 
abnormal mental status 
BP systolic 90 or less