3. pneumonia

Question 1

2 most common microbes responsible

Answer 1

streptococcus pneumonia (50%) - gram neg
haemophilus influenzae (20%)

Question 2

what are the 4 stages pneumonia?

Answer 2

1. congestion
2. red hepatisation - RBC, neutrophils, fibrin. Lungs are red, firm and airless. Occurs 2/3 days after congestion.
3. grey hepatisation - degradation of RBC. 2/3 days later. Lungs appear grey/brown/yellow. Persistence of fibrin exudate.
4. resolution

Question 3

symptoms

Answer 3

*HAEMOPTYSIS
*pleuritic chest pain
dyspnoea
cough
sputum with/without purulence

Question 4

signs on auscultation

Answer 4

DULL percussion
increased vocal resonance 
focal COARSE crackles
bronchial breathing
possible pleural rub

Question 5

general signs

Answer 5

tachycardia and tachypnoea
hypotension
cyanosis
pyrexia
fever
confusion
possible secondary sepsis

Question 6

tests

Answer 6

regular: ABG, CXR, FBC, U&E, CRP, LFT
blood and sputum - infection
viral PCR
atypical serology

*urine Ag for LEGIONELLA AND S.PNEUMONIAE

Question 7

what does CURB-65 stand for

Answer 7

Confusion: AMTS 8 or less
Urea > 7mmol
RR > 30/min
BP <90 sys and <60 dias
Age > 65

(one point for each)

Question 8

what is the scoring system for CURB 65

Answer 8

0-1 point = home treatment (oral Abx)
2 = consider hosp admission,IV Abx
3 -5 = hospital admission and consider ITU

Question 9

what is the initial management

Answer 9

1. o2, sats >94%
2. IV fluids - inotropes, haemofiltration
3. analgesia if pleuritic chest pain: paracetamol 1g/6hrs (max 4g in 24hrs). Antipyretics
4. oral antibiotics

Question 10

what is the management surrounding antibiotics

Answer 10

• within 4 hours
• start with empirical Abx, then narrow down if specific organism is cultured

> outpatient: penicillin derivatives
inpatient: moderate = 5 day course, penicillin derivative + MACROLIDE or AMOXICILLIN
inpatient severe = [dual antibiotics] 7-10days.
macrolide + IV B-LATAMASE resistant Abx (i.e. CO-AMOICLAV or CEPHALOSPORIN)

Question 11

complications

Answer 11

sepsis
pleural effusion
empyema
lung abscess
death

Question 12

aspiration pneumonia

Answer 12

> patients have unsafe swallow
Risk: stroke, Myasthenia gravis, bulbar palsy, alcoholism
mechanical causes: NG tube, ETT, tracheostomy, OGD, bronchoscopy
CXR: right lung more commonly affected (R bronchus is wider and straighter