Respiratory

Question 1

Pneumonia definition

Answer 1

Infection of functional units of the lungs. Alveoli fills with fluid, bacteria and inflammatory cells.

Chest x-ray reveals consolidation in the lungs.

Question 2

Pneumonia symptoms

Answer 2

dry or thick yellow cough, chest pain (pleural pain), difficulty breathing (dyspnoea), rapid heartbeat, fever >38.5C, rapid breathing (tachypnoea)

Question 3

Community-acquired pneumonia diagnostic tool

Answer 3

CRB65: Confusion (>8 AMTS test), Respiratory rate (>30breaths/min), Blood pressure (SBP<90mmHg or DBP<60mmHg), Age >65yo

CRB65=0 can be safely managed at home. Low risk of mortality (<1%).
CRB65=1 hospital assessment required. Intermediate risk of mortality (1-10%).
CRB65=2 hospital assessment required. High risk mortality (>10%).

Question 4

Hospital-acquired pneumonia diagnostic tool

Answer 4

CURB65
Confusion (AMTS >8), Blood urea nitrogen (>7), Respiratory rate, blood pressure

Patients who have pneumoniae are usually dehydrated and that results from increase BUN excretion from the kidneys.

CURB65=0 or 1 suitable for treatment at home
CURB65=2 consider short hospital stay
CURB65>3 require hospital management

Question 5

Blood urea nitrogen

Answer 5

BUN level show a reduced in renal perfusion and indirectly predicts the severity of pneumonia.

Question 6

Causative organism for pneumoniae

Answer 6

s. pneumoniae (strep)- most common cause of CAP
h. influenzae

Pneumococcal antigen testing recommended for all patients with moderate or high severity CAP.

Question 7

Low severity CAP

Answer 7

Amoxicillin (or ampicillin)

Amoxicillin -penicillin - beta lactam abx
500mg TDS
-broad spectrum
-bactericidal
-inhibit cell wall synthesis by binding to penicillin binding protein to prevent cross-linking of peptidoglycan
-cautions in ALL, CLL, CMV and glandular fever- increases risk of erythematous rash.