Community Acquired Pneumonia Exam
Questions And Answers Graded A+
Most common causes of CAP?
- streptococcus pneumoniae
- resp viruses
- haemophilus influenza
- mycoplasma pneumonia
- enteric gram neg bacteria
- chlamydia psittaci
- staph aureus
- legionella
- mycobacterium tb
Risk factors of CAP
- age over 50
- alcoholism
- indigenous background
- smoking
- institutionalisation
- COPD
- asthma
- dementia
- heart failure
- immunosuppression
- seizures
- strokes
Investigations for CAP
- FBE, UEC, LFTs
- ABGs
- blood culture
- sputum cultures (MCS)
- ESR and CRP
- Nasal flocked swabs for influence and NPA (nasopharyngeal aspirate)
- CXR
- legionelle urinary antigen
- serology
What if you're suspecting TB? What should you do with your investigations?
3 early morning sputum cultures collected early in the morning
Ziehl-Neelson stain
TB culture
PCR
How to manage CAP?
Based on severity of the pneumonia
e.g. use PSI risk
Grade 1-2 = outpatient setting, use oral amoxycillin + (oral roxithromycin or doxycycline)
, Grade 3-4 = Hospital; IV benpen + oral (roxithromycin or doxycycline)
Grade 5 = Possibly ICU; (IV ceftriaxone or cefotaxime) + IV erythromycin
For mild to moderate CAP inpatients what to give?
IV ceftriaxone 1g daily
Oral clarithromycin 250mg bd
What other management strategies?
DVT prophylaxis
Maintain hydration
Analgesia for pleuritic chest pain
Keep oxygen saturation >95%
Chest physio
If patient is not improving even though it appears that you've got the right antibiotics for the infection
that they've got?
!! Pleural infection
Other causes of fever: PE, peripheral catheter infection
What Ix if you're suspecting a pleural fluid infection?
CT scan
US
Chest X-ray
If you're going to do a diagnostic pleural fluid tap, what Ix should you do before that?
US of pleural space
What test to order after a pleural fluid tap?
Chest X-ray in case of pneumothorax
What is the most important factor to consider in the management of CAP?
initial assessment of severity
What does CORB stand for
Acute Confusion
Oxygen sat ≤90%
RR ≥30
B - SBP <90 or DBP <60
Severe if ≥2
Describe the SMART COP scoring system
SMART COP is used after CAP is confirmed on CXR
If ≤50yo
Questions And Answers Graded A+
Most common causes of CAP?
- streptococcus pneumoniae
- resp viruses
- haemophilus influenza
- mycoplasma pneumonia
- enteric gram neg bacteria
- chlamydia psittaci
- staph aureus
- legionella
- mycobacterium tb
Risk factors of CAP
- age over 50
- alcoholism
- indigenous background
- smoking
- institutionalisation
- COPD
- asthma
- dementia
- heart failure
- immunosuppression
- seizures
- strokes
Investigations for CAP
- FBE, UEC, LFTs
- ABGs
- blood culture
- sputum cultures (MCS)
- ESR and CRP
- Nasal flocked swabs for influence and NPA (nasopharyngeal aspirate)
- CXR
- legionelle urinary antigen
- serology
What if you're suspecting TB? What should you do with your investigations?
3 early morning sputum cultures collected early in the morning
Ziehl-Neelson stain
TB culture
PCR
How to manage CAP?
Based on severity of the pneumonia
e.g. use PSI risk
Grade 1-2 = outpatient setting, use oral amoxycillin + (oral roxithromycin or doxycycline)
, Grade 3-4 = Hospital; IV benpen + oral (roxithromycin or doxycycline)
Grade 5 = Possibly ICU; (IV ceftriaxone or cefotaxime) + IV erythromycin
For mild to moderate CAP inpatients what to give?
IV ceftriaxone 1g daily
Oral clarithromycin 250mg bd
What other management strategies?
DVT prophylaxis
Maintain hydration
Analgesia for pleuritic chest pain
Keep oxygen saturation >95%
Chest physio
If patient is not improving even though it appears that you've got the right antibiotics for the infection
that they've got?
!! Pleural infection
Other causes of fever: PE, peripheral catheter infection
What Ix if you're suspecting a pleural fluid infection?
CT scan
US
Chest X-ray
If you're going to do a diagnostic pleural fluid tap, what Ix should you do before that?
US of pleural space
What test to order after a pleural fluid tap?
Chest X-ray in case of pneumothorax
What is the most important factor to consider in the management of CAP?
initial assessment of severity
What does CORB stand for
Acute Confusion
Oxygen sat ≤90%
RR ≥30
B - SBP <90 or DBP <60
Severe if ≥2
Describe the SMART COP scoring system
SMART COP is used after CAP is confirmed on CXR
If ≤50yo
