RRAPID Pneumonia

Question 1

Causative organisms of CAP? Most common? (4)

Answer 1

Step pneumonia: 40%
H.influenza 
Staph.aureus
Klebisella pneumoniae
Morexella Catarrhalis

Question 2

Atypical causative organisms? (3)

Answer 2

Mycoplasma Pneumonia
Legionella pneumophilia
Chylamdia pneumoniae

Question 3

Which organism is particularly associated with high fever, rapid onset, pleuritic chest pain, rust coloured sputum and herpes labialis?

Answer 3

Streptococcus pneumonia

Question 4

Which organism is particularly common in patients with COPD?

Answer 4

H.influenza

Question 5

Which organism often occurs in patient following influenza infection?

Answer 5

Staph.aureus

Question 6

Which organism is classically seen in alcoholics?

Answer 6

Klebsiella pneumoniae

Question 7

Which organism often presents with a dry cough and atypical chest signs/x-ray finding

Answer 7

Mycoplasma pneumoniae

Question 8

Presentation? (5)

Answer 8

Cough (productive/non-productive)
SOB
Fever
Pleuritic chest pain
Prodrome: coryzal symptoms
Respiratory distress

Question 9

Investigations? (5)

Answer 9

CXR
ABG
Bloods: FBC, U&E's, CRP, LFT's
Blood/sputum cultures
Urinanalysis (for legionella)

Question 10

What is used to asses severity of pneumonia?

Answer 10

CURB-65

Question 11

What does CURB-65 stand for?

Answer 11

Confusion <= 8 (GCS)
Urea > 7mmol
RR >= 30
BP =< 90 systolic or = <60 diastolic 
65 (>=65 years old)

Question 12

What does a CURB-65 score of > 3 mean?

Answer 12

Severe (inpatient)

Question 13

What does a CURB-65 score of 2 mean?

Answer 13

inpatient or supervised outpatient

Question 14

What does a CURB-65 score of 0-1 mean?

Answer 14

outpatient

Question 15

Mx?

Answer 15

ABCDE
O2
Fluids
Analgesia
Start empirical Antibiotics (review in 48 hrs) (5-7 days) (10 days in high risk patient)

Question 16

Antibiotic Rx for low-moderate severity CAP?

Answer 16

Amoxicillin PO

Add doxycycline or clarithromycin (for patients admitted or atypical)

Question 17

Antibiotic Rx for high severity CAP?

Answer 17

Co-amoxiclav IV + clarithromycin

OR

Cefotaxime/cefuroxime + clarithromycin
Plus Gentamicin if gram -ve bacilli

BNF guidlines:

Benzylpenicillin IV + clarithromycin

OR benzylpenicillin + doxycycline.

Question 18

Antibiotic Rx for HAP < 5 days admission?

Answer 18

Co-amoxiclav or cefuroxime (5-10 day course)

Question 19

Antibiotic Rx for HAP > 5 days admission?

Answer 19

Cefotaxime + metronidazole (5-10 day course)