Pneumonia CAP

Question 1

Pneumonia is classified into one of two categories which are?

Answer 1

Community acquired pneumonia (CAP) and hospital acquired pneumonia (HAP)

Question 2

CAP is the leading cause of what?

Answer 2

More childhood deaths worldwide than any other illness

Question 3

Which groups are most susceptible to pneumonia?

Answer 3

The very young and very old

Question 4

Name three bacteria that can cause CAP

Answer 4

Strep. Pneumoniae (most common!), staph. a, chlamdyia, legionella pneumophila

Question 5

Name three viral causes of CAP

Answer 5

Influenza, herpes simplex, varicella, coronavirus(SARS)

Question 6

Name three factors which predispose an individual to pneumonia?

Answer 6

Smoking, old age, HIV, alcohol, recent influenza infection, recent URT infection, pre-existing lung condition, corticosteroid therapy

Question 7

What 4 symptoms tend to predominate a pneumonia presentation?

Answer 7

Sweats, rigors, shivering and vomiting

Question 8

What pulmonary symptoms occur?

Answer 8

Breathlessness and cough

Question 9

What are the characteristics of this cough

Answer 9

Short, painful and dry will progress and be accompanied with mucopurulent (mucus and puss in it) sputum

Question 10

What does rust coloured sputum normally suggest?

Answer 10

Strep. Pneumoniae infection

Question 11

What other symptoms of a patient with CAP present with? (Name 2)

Answer 11

Loss of appetite, headache, pleuritic chest pain, chest wall tenderness

Question 12

What might the doctor hear on auscultation?

Answer 12

Bronchial breathing and crackles

Question 13

What is the key investigation?

Answer 13

CXR most infections will show a radio opaque consolidation within 12 hours of onset of symptoms

Question 14

What other investigations should be done?

Answer 14

Pulse oximetry, WBCs, CRP, sputum smear, blood cultures, serology, PCR

Question 15

You have detected legionella pneumophila, what must you do?

Answer 15

Report it to the local centre for infectious disease control

Question 16

What scoring system is used to assess disease severity?

Answer 16

CURB-65
C=confusion, U=BUN (blood urea nitrogen) greater than 7mmols/L, R=RR of more than 30, B=BP systolic less than 90 or a diastolic less than 60, 65 or older.
One point for each

Question 17

What are the key areas if management for CAP?

Answer 17

Oxygenation, prolonged illness and nutritional support

Question 18

What is the aim for oxygen?

Answer 18

Sats at least 92% or PaO2 of at least 8KPa

Question 19

IV antibiotics or oral for CAP?

Answer 19

Depends on severity, if not too severe then oral antibiotics are fine

Question 20

How does CURB-65 score affect management

Answer 20

0-1 suitable for home treatment
2 hospital supervised treatment (short stay or supervised outpatient)
3+ admit, assess for ICU esp if 4/5

Question 21

What is the antibiotic of choice for uncomplicated CAP and severe CAP?

Answer 21

Amoxicillin 500mg 8 hourly

Clarithromyocin and co-amoxiclav

Question 22

What is pneumonia?

Answer 22

Acute respiratory illness accompanied with pulmonary shadowing on a CXR

Question 23

Name 3 possible complications of pneumonia…

Answer 23

Resp failure, hypotension, AF, pleural effusion, empyema, lung abscess, scepticeamia, jaundice, pericarditis/myocarditis