Pneumonia FCM

Question 1

Pneumonia = what are the classical:

1) symptoms
2) signs
3) CXR findings

Answer 1

Cough, fever (>39), sweating/aches/pains

Dullness on percussion, decreased chest expansion, crackles, raised ESR/CRP

CXR – lower lobe consolidation

Question 2

Rapid onset, high fever, productive cough

Are these symptoms classical for atypical CAP or typical CAP?

Answer 2

Typical community-acquired pneumonia (CAP)

Question 3

Muscle ache, initial fever, dry cough

Are these symptoms classical for atypical CAP or typical CAP?

Answer 3

Atypical community-acquired pneumonia (CAP)

Question 4

What organisms are responsible for typical community-acquired pneumonia (CAP)?

Answer 4

Strep pneumonia

Staph aureus

Haemophilus influenza

Question 5

What organisms are responsible for atypical community-acquired pneumonia (CAP)?

Answer 5

Mycoplasma pneumonia

Chlamydial pneumonia

Legionella

Question 6

PNEUMONIA - what is the most likely causative organism for CAP based on the below findings AND who is this most common in?

o gram (+) diplococci
o Rust coloured sputum
o associated with herpes labialis – patient may present with blisters on lip

Answer 6

Strep pneumonia (most common – especially in immunocompromised)

Question 7

PNEUMONIA - what is the most likely causative organism for CAP based on the below findings AND who is this most common in?

o gram (+) cocci 
o recent influenza infection

Answer 7

Staph aureus

common in elderly, IV drug users and lymphoma/leukaemia pxts

Question 8

PNEUMONIA - what is the most likely causative organism for CAP based on the below findings

o	gram (-) rod 
o	COPD patients – most common cause of infective exacerbation of COPD

Answer 8

Haemophilus influenza

Question 9

PNEUMONIA - what is the most likely causative organism for CAP based on the below findings

o	autoimmune haemolytic anaemia and erythema multiforme may be seen 
o	aerobic bacterium 
o	close proximity – schools/prison
o	flu-like symptoms 
o	younger patients

Answer 9

Mycoplasma pneumonia

Question 10

PNEUMONIA - what is the most likely causative organism for CAP based on the below findings

o abroad - air conditioning
o hyponatraemia and lymphopenia common

Answer 10

Legionella

Question 11

What scoring system is used to classify the severity and subsequent treatment of CAP?

Answer 11

CURB-65

C - confusion 
U - urea (>7)
R - RR (30)
B - BP (90/60)
>65 - age

Question 12

Patient presents and is diagnosed with CAP
Patient CURB65 score is calculated to be 0-1
What is recommended for their management?

Answer 12

first line for low severity (0-1) - amoxicillin

Question 13

Patient presents and is diagnosed with CAP
Patient CURB65 score is calculated to be 2
What is recommended for their management?

Answer 13

first line for mod/high severity (2-5)

dual therapy – amoxicillin + macrolide (e.g.-clarithromycin)

Question 14

What are examples of causative organisms for hospital-acquired pneumonia?

Answer 14

Pseudomonas aeruginosa

Klebsiella pneumonia

Question 15

Who is most at risk of the below:

pneumoncystitis jirovecii (carinii) pneumonia (PCP)

Answer 15

immunosuppressed - may present as recurrent chest infections in young and otherwise healthy individuals

e.g.- HIV/AIDS

Question 16

Which pneumonia is likely with the below description?

o Risk factor – alcohol
o Gram (-) anaerobic rod
o Red currant jelly

Answer 16

Klebsiella pneumonia

Question 17

Which pneumonia is likely with the below description?

o	gram (-) rod-shaped bacterium 
o	Common in bronchiectasis or cystic fibrosis patients

Answer 17

Pseudomonas aeruginosa

Question 18

What are risk factors for aspiration pneumonia?

Answer 18

• poor dental hygiene
• impaired consciousness (e.g.- stroke)
• recent intubation

Question 19

What are the common sites affected in aspiration pneumonia?

Answer 19

right middle and lower lung lobes are the most common sites affected

Question 20

First-line tx for pneumoncystitis jirovecii (carinii) pneumonia (PCP)

Answer 20

High dose oral co-trimoxazole, pentamidine

Question 21

What are the first-line treatments for the following atypical CAP:

A) Mycoplasma pneumonia

B) Chlamydial pneumonia

C) Legionella

Answer 21

A) Mycoplasma pneumonia: erythromycin/clarithromycin, tetracycline

B) Chlamydial pneumonia: azithromycin

C) Legionella: Erythromycin, IV antibiotics/fluid, Rifampicin BD orally or IV

Question 22

When should all patients with pneumonia have a repeat CXR?

Answer 22

All cases of pneumonia should have a repeat chest X-ray at 6 weeks after clinical resolution