TCD questions - Pneumonia Flashcards
There is a GP practice meeting and doctors are reminded to avoid giving antibiotics for patients presenting with an acute cough (i.e. less than 21 days) likely to be due to infection. In which individual cases would you override this advice, based on your clinical judgement?
A Patient is 82 years old and also has stable heart failure.
- Give antibiotics .
- Do not give antibiotics .
Answer: Give antibiotics.
Patients over 80 years should be given antibiotics if they have at least 1 of the following co-existing conditions: diabetes type 1 or 2, history of heart failure, hospitalisation in the previous year or are being treated with oral corticosteroids
There is a GP practice meeting and doctors are reminded to avoid giving antibiotics for patients presenting with an acute cough (i.e. less than 21 days) likely to be due to infection. In which individual cases would you override this advice, based on your clinical judgement?
Patient is 25 years old and has a renal transplant
Give antibiotics .
Do not give antibiotics .
Answer: Give antibiotics.
Patients who are taking immunosuppressant drugs, as this patient will be to prevent organ rejection, should be given antibiotics.
There is a GP practice meeting and doctors are reminded to avoid giving antibiotics for patients presenting with an acute cough (i.e. less than 21 days) likely to be due to infection. In which individual cases would you override this advice, based on your clinical judgement?
Patient is 50 years old and has liver cirrhosis
Give antibiotics .
Do not give antibiotics
Answer: Give antibiotics.
Patients with significant heart, lung, renal, liver or neuromuscular disease should be given antibiotics.
There is a GP practice meeting and doctors are reminded to avoid giving antibiotics for patients presenting with an acute cough (i.e. less than 21 days) likely to be due to infection. In which individual cases would you override this advice, based on your clinical judgement?
A Patient is 67 years old and was admitted to hospital 3 months ago with biliary colic from which he has recovered. He takes no medications and is well otherwise.
Give antibiotics .
Do not give antibiotics
Answer: Do not give antibiotics.
For patients over 65 they should be given antibiotics if they have 2 or more of the of the following co-existing conditions: diabetes type 1 or 2, history of heart failure, hospitalisation in the previous year or are being treated with oral corticosteroids
There is a GP practice meeting and doctors are reminded to avoid giving antibiotics for patients presenting with an acute cough (i.e. less than 21 days) likely to be due to infection. In which individual cases would you override this advice, based on your clinical judgement?
A 35 year old man who looks unwell and has a high fever. He been unable go to work and has spent most of the weekend in bed with fevers, generalised aches and a cough productive of a small amount of green sputum. He is managing fluids, even though he has lost his appetite, and is usually very fit and well. He has some crackles on left when you auscultate his lungs with your stethoscope. His blood pressure is normal and his respiratory rate is not raised.
Give antibiotics .
Do not give antibiotics
Answer: Give antibiotics.
This gentleman has symptoms and signs consistent with pneumonia so antibiotics should be started without delay. He is young, has a normal blood pressure and respiratory rate and is not confused so could be treated at home with oral antibiotics with advice to ring GP urgently if he becomes short of breath, confused or dizzy and lightheaded.
Select the appropriate CURB 65 score
A 40 year old lady is admitted to A&E with a one week history of cough, productive of rust-coloured sputum, fever and anorexia. She is on no other medications and is otherwise well. On examination she is alert. Her pulse is 110 bts/min, BP 95/50 mmHg, heart sounds normal. She has a respiratory rate of 24 bths per minute and crackles in left lower lobe. Her temperature is 39 degrees Celsius. Her blood tests come back showing a CRP 180 (normal < 10), WCC 12.6 and Urea 9.5 mmol/l. Her CXR shows consolidation in the left lower lobe
CURB 65 = 2
diastolic BP < 60 mmHg and urea > 7 mmol/l
A 67 year old man is admitted to A&E with a one week history of cough, productive of rust-coloured sputum, fever and anorexia. He is on no other medications and is otherwise well. On examination he is alert. His pulse is 110 bts/min, BP 95/65 mmHg, heart sounds normal. He has a respiratory rate of 35 bths per minute and crackles in left lower lobe. His temperature is 39 degrees Celsius. His blood tests come back showing a CRP 100 (normal < 10), WCC 12.6 and Urea 6 mmol/l. His CXR shows consolidation in the left lower lobe.
Calculate the CURB 65 score
Answer: CURB 65 =2
Respiratory rate > 30 breaths per minute and age > 65 years
20 year old man is admitted to A&E with a one week history of cough, productive of rust-coloured sputum, fever and anorexia. He is on no other medications and is otherwise well. On examination he is confused. His pulse is 130 bts/min, BP 80/50 mmHg, heart sounds normal. He has a respiratory rate of 40 bths per minute and crackles in left lower lobe. His temperature is 39 degrees Celsius. His blood tests come back showing a CRP 260 (normal < 10), WCC 12.6 and Urea 8 mmol/l. His CXR shows consolidation in the left lower lobe.
Calculate the CURB 65 score
Answer: CURB 65 = 4
(Confusion; Urea > 7 mmols/l; Respiratory rate > 30 breaths per minute and BP < 90 mmHg systolic and < 60 mmHg diastolic)
An 85 year old lady is admitted to A&E with a one week history of cough, productive of rust-coloured sputum, fever and anorexia. She is on no other medications and is otherwise well. On examination she is alert. Her pulse is 95 bts/min, BP 100/70 mmHg, heart sounds normal. She has a respiratory rate of 18 bths per minute and crackles in left lower lobe. Her temperature is 39 degrees Celsius. Her blood tests come back showing a CRP 180 (normal < 10), WCC 12.6 and Urea 6 mmol/l. Her CXR shows consolidation in the left lower lobe.
Calculate the CURB 65 Score
Answer: CURB 65 = 1
age > 65 yrs
You see a 45 year old lady on your medical ward rounds. She was admitted with community acquired pneumonia (CURB 65 score 2) and has been having iv antibiotics for 2 days. She is keen to go home. You look at her observation charts. 12 hours ago she had a temperature of 38 degrees, respiratory rate 26 bths per minute, heart rate 110 bts per min. But after paracetamol and further antibiotics she settled and her temperature did not go above 37.5 degrees and her pulse rate above 100 or respiratory rate above 18 bths per minute. She is safe for discharge with oral antibiotics – True or False?
Answer: False.
In the last 24 hours her temperature has been > 37.5, respiratory rate > 26 bths/min and heart rate greater than 100 bts per minute. This would not be a safe discharge and you should change her to oral antibiotics and advise further review on ward round tomorrow.
Legionnaire’s disease is a cause of atypical pneumonia (True or False)?
Answer: True.
It can occur when you breath in water vapours infested with L. Pneumophilia. This bacteria is often found in water supplies of buildings or cooling towers.
Pneumocystis jiroveci pneumonia, caused by the fungus pneumocystis jiroveci, is a cause of atypical pneumonia (True or False)?
Answer: False.
The fungus does not cause pneumonia is healthy people, unlike the atypical pneumonias, but can cause pneumonia is anyone whose immune system is impaired by, for example, HIV virus or immunosuppressant drugs.
A person who has had persistent cough greater than 3 weeks with continuing night sweats, anorexia and weight loss and fatigue may have pulmonary TB (True or False)?
Answer: True.
Tuberculosis, TB, though uncommon now should be suspected in anyone with persisting signs of lower respiratory tract infection especially with prominent weight loss and night sweats. Haemoptysis can also occur.
A person living in a nursing home should be treated as having hospital acquired pneumonia (True or False)?
Answer: False.
Hospital acquired pneumonia is a pneumonia which develops after 48 hours admission to hospital or within 1 month after discharge. In hospital patients also come into contact with microbes not usually present in the community. People in nursing homes are exposed to microbes circulating in the community.
