RTI

Question 1

What is the most common organism to cause of CAP?

Answer 1

30-50% are Step pneumoniae
H.influenzae also common

Gram +ve (diplo Cocci)

Question 2

What is typical culture appreance of Strep pneumoniae?

Answer 2

Gram+ve diplocicci

+ve alpha haemolytic (greenish tinge)

Optochin sensitive: bacteria will not grow in the presence of optochin

Question 3

What is the antibiotic of choice for Pneumococcal pneumonia?

Answer 3

Always always penicillin sensitive –>

1st line with low severity: Amoxicillin (works well against mos typical CAP)

2nd line in higher severity pneumonia: Co-amoxiclav + Erythromycin/ Clarythromycin

Question 4

What is pneumonia?

Answer 4

Inflammation of the lung alveoli

Question 5

Other Strep pneumonia, what other organisms commonly cause CAP?

What are the population characteristics of each?

Answer 5

• Haemophilus influenzae (Smoking/ COPD)
• Staph Aureus (recent viral infection, e.g. influenza)
• Moraxella catarrhalis (Associatec with smoking, Gram -ve cocci)
• Klebsiella pneumoniae (in alcoholics, elderly - cause for haemoptysis)

Question 6

What is the most common pathogen to cause pneumonia in neonates (1monts)

Answer 6

E.coli
GBS
Listeria

Question 7

What criteria are included in the CURB-65 score?

Answer 7

• Confusion
• Urea >7
• RR >30
• BP <90 systolic <60diastolic
• > 65

Question 8

What is bronchitis?

Answer 8

Inflammation of medium sized airways

Question 9

What are risk factors in development of bronchitis?

Answer 9

Smoking

Question 10

What are the common pathogens causing bronchitis

Answer 10

Usually viral
But also similar organisms as Pneumonia (Pneumococcus and H.influenzae)

Question 11

What are characteristics of a H.influenzae pneumonia?

Answer 11

• more common in pre-existing lung disease
• Risk Factors: smoking/ COPD
• can be cavetating

Question 12

What is the microscopical appearanche of H.influenzae?

Answer 12

Gram -ve coccibacilli

Question 13

What is the antibiotic of choice for treatment of H.influenzae?

Answer 13

Can produce ß-lactamases
(Generally for all CAP: Amoxicillin/ Co-amoxicalv if ß-lactamase)

Question 14

What is a commmon presentation/ history for a Legionella pneumonia?

Answer 14

Exposure to Air conditioning/ Travel
and/or Water fountain

Other features
* confusion, abdo pain, diarrhoea
* lymphopenia, hyponataemia

Question 15

What investigations should be sent in a suspected legionella pneumonia?

Answer 15

Urinary or serum Legionella antigens

(If travel histroy might not detect all legionella species)

Question 16

What features could suggest an atypical pneumonia?

What ABX would you choose?

Answer 16

Flu-like prodrome before fever

Extrapulmonary features, such as:
* hepatitis
* hyponatremia

Mainly clues in history

Macrolides (clarythor/erythro)
Tetracyclines (Doxy)

Question 17

What is the abx choice for a Legionella pneumonia?

Answer 17

Sensitive to Macrolides

Question 18

What is an empyema?

Answer 18

Pulmonary abscess

Question 19

What are risk factors for the development of an empyema?

Answer 19

• Resistant organism
• Proximal obstruction (tumour)
• not recieving/ absorbing ABx
• Immunosuppression
• Other underlying lung disease

Question 20

What are common causes of pneumonia in 1-6 months olds?

Answer 20

Chlamydia trachomatis
S.aureus
RSV

Question 21

What is the most common cause of pneumonia in 6 months - 5year olds?

Answer 21

Mycoplasma
Influenza

Question 22

What are the most common pathogens to cause pneumonia in 16-30 year olds?

Answer 22

M.pneumoniae
S. pneumoniae

Question 23

What are characteristics of PCP/ Pneumocystic jiroveci penumonia?

Answer 23

Usually
* insidious onset
* dry cough, weight loss, SOB, malaise
* On CXR: bat’s wing (bilateral
* Walk test: decrease on exhaustion

Protozoa causing pneumonia

Question 24

What are the most common pathogens causing a HAP?

Answer 24

Usually Gram -ve organisms (as often gram+ve abx coverage given in hospitals)

*

Question 25

What aer common causes of pneumonia in neutropenic patients?

Answer 25

Aspergillosis

Question 26

What organisms cause pneumonia in patients with Stem cell transplants?

Answer 26

CMV

Question 27

What is the usual abx choice for a HAP?

Answer 27

Depending on trust guidelines

1st line: ciprofloxacin + vancomycin
* If severe: tazocin + vancomycin
* Aspiration pneumonia: tazocin + metronidazole

Question 28

What is Moraxella catarrhalis? What does it cause and in what patient group?

What is the microbiological appearance

Answer 28

-ve cocci could cause typical pneumonia, espeically in smokers

Question 29

What are the typical features of a Staph aureus pneumonia?

What is the microbiological appearance

Answer 29

Assoc. w/ recent viral infection (post- influenza) ± cavitation on CXR

Gram+ve cocci in “grape-bunch” clusters

Question 30

What are the typical features of a Klebsiella pneumonia?

What is the microbiological appearance?

Answer 30

Alcoholics, elderly.
May cause Haemoptysis

-ve rod, enterobacter

Question 31

What is the usual choice of antibiotics for a CAP?

Answer 31

Dependant on CURB score
(Penicillins work well against typical organisms
but don’t work against atypicals (as no cell wall). Therefore, macrolides are used to provide atypical cover)

Question 32

What is your diagnostic approach for diagnosis of pneumonia?

Answer 32

CURB 65 score

CXR: consolidation (if typical)

• Sputum MC&S
• Consider broncho- alveolar lavage if non-productive
• atypical screen: Legionella urine antigen, serum antibody tests for organisms difficult
  to culture (Chlamydia, Legionella)

Question 33

What is an atypical pneumonai?

Answer 33

Typical= classic signs and symptoms, classic CXR changes(i.e.consolidation), respond to penicillin Abx

Atypical can still be common

• Atypical=no/ atypical signs and symptoms, not in-keeping with CXR, don’t respond to penicillin Abx (because no cell wall). May have extra-pulmonary features, e.g. hepatitis, hyponatraemia