Resp - Pneumonia

Question 1

which organisms commonly cause CAP?

Answer 1

1. Streptococcus pneumoniae (65%)
2. Haemophilus influenza
3. Atypical organisms lacking cell wall (15%), e.g. Legionella pneumophila, Mycoplasma pneumoniae

Question 2

which organisms commonly cause HAP?

Answer 2

Often caused by multiple organisms, inc. GNB e.g. P. aeruginosa, Staph. aureus and Strep. pneumoniae.

Question 3

describe the common symptoms of pneumonia

Answer 3

• cough +/- sputum production (green)
• dyspnoea
• pleuritic chest pain
• fevers and rigors
• malaise, nausea and vomiting

Question 4

describe the common signs of pneumonia

Answer 4

• pyrexia
• tachypnoea
• tachycardia
• dullness to percussion
• bronchial breathing
• crackles

Question 5

which investigations would you perform on a pt with suspected pneumonia?

Answer 5

Bloods

• FBC: raised WCC
• CRP: raised
• UandEs: ?raised urea
• LFTs
• blood cultures (if CURB-65 2+): ?sepsis
• ABG

Bedside tests

• pneumococcal and legionella urinary Ag (if CURB-65 2+)
• sputum culture (if CURB-65 2+)

Imaging
- CXR: consolidation

Question 6

which scoring system would you use to determine if a pneumonia pt needs hospitalisation?

Answer 6

CURB-65 score

• Confusion (AMTS <8 or new disorientation)
• Urea >7 mmol/L
• RR >30
• BP <90 systolic, <60 diastolic
• > 65 yrs

0-1: low risk
2: intermediate risk
3-5: high risk

Question 7

how would you manage mild CAP?

Answer 7

AMOXICILLIN 500 mg 8 hourly for 5 days

Question 8

how would you manage moderate-severe CAP?

Answer 8

1. O2 if hypoxia, ventilation if severe
2. fluids if low BP
3. NSAIDs and paracetamol for pleuritic chest pain
4. nebulised saline: may help expectoration
5. antibiotics - 7-10 day course dual therapy:
   
   • CO-AMOXICLAV PO/IV
   • CLARITHROMYCIN or DOXYCYCLINE

Question 9

how would you manage HAP?

Answer 9

1. O2 if hypoxia, ventilation if severe
2. fluids if low BP
3. NSAIDs and paracetamol for pleuritic chest pain
4. nebulised saline: may help expectoration
5. antibiotics - 5-10 day course:
   
   • 1st line: CO-AMOXICLAV
   • 2nd line: PIPPERACILLIN + TAZOBACTAM

Question 10

suggest possible complications of pneumonia

Answer 10

1. peri-pneumonic effusion (usually sterile)
2. empyema - persistence of fever and leucocytosis after 4-5 days of antibiotics
3. lung abscess - classically seen in pts with Klebsiella or staphylococcal pneumonia. Can rupture into pleural cavity causing pyopneumothorax.
4. pneumothorax
5. spread of infection, e.g. septicaemia, pericarditis, endocarditis, osteomylelitis, septic arthritis, meningitis
6. post-infective bronchiectasis
7. AKI