Pneumonia

Question 1

Presentation?

Answer 1

• Dyspnoea
• Cough
• Productive yellow sputum
• chest pain: pleuritic
• fever
• reduced O2 ats
• reduced breath sounds/crackles

Question 2

What are the investigations done in suspected pneumonia?

Answer 2

• Observations
• CXR
• bloods: FBC, U&Es, CRP
• Consider ABG if low O2 sats

Question 3

What does CURB 65 stand for?

Answer 3

• C onfusion
• U rea > 7mmol/L
• R esp rate >30
• B P <90 systolic
• 65 aged or over

Question 4

What does a CURB 65 score of 0 mean for management?

Answer 4

Patients with a CURB-65 score of 0 should be managed in the community.

Question 5

What does a CURB 65 score of 1 mean for management?

Answer 5

Patients with a CURB-65 score of 1 should have their Sa02 assessed which should be >92% to be safely managed in the community and a CXR performed. If the CXR shows bilateral/multilobar shadowing hospital admission is advised.

Question 6

What does a CURB 65 score of 2 mean for management?

Answer 6

*Patients with a CURB-65 score of 2 or more should be managed in hospital as this represents a severe community acquired pneumonia.

Question 7

What does a CURB 65 score of 4 mean for management?

Answer 7

• Increase risk of mortality

* Critical care team involvement

Question 8

What are the common causes of CAP?

Answer 8

1st: Strep pneumniae
2nd: Haem influenzae, Staph aureus
3rd: atypicals e.g. mycoplasma pneumoia

Question 9

What antibiotic is used to treat low-severity CAP in the community?

Answer 9

• 1st line amoxicillin

* If penicillin allergic used macrolide or tetracycline

Question 10

What antibiotic is used to treat moderate to high-severity CAP?

Answer 10

• dual antibiotic therapy is recommended with amoxicillin and a macrolide
• a 7-10 day course is recommended
• NICE recommend considering a beta-lactamase stable penicillin: co-amoxiclav, ceftriaxone or taz

Question 11

What is defined as hospital acquired pneumonia?

Answer 11

Contracted by a patient in a hospital at least 48–72 hours after being admitted.