Approach to Pneumonia

Question 1

Contrast lobar pneumonia and interstitial pneumonia.

Answer 1

Lobar pneumonia- consolidation of lobe

Interstitial pneumonia- diffuse infiltrate that often involves more than one lobe (atypical)

Question 2

What typical organisms cause lobar pneumonia?

Answer 2

S. pneumoniae
H. influenzae
Moraxella

Question 3

What typical organisms cause interstitial pneumonia?

Answer 3

Viruses (influenza, CMV, RSV, adenoviruses)
Mycoplasma
Legionella
Chlamydia

Question 4

Why is pneumonia considered a “great neglected disease of mankind”?

Answer 4

Hard to diagnose initially
Hard to make microbiologic diagnosis
Hard to study

Question 5

What signs are associated with pneumonia?

Answer 5

Fever
Increased RR
Abnormal lung sounds

Question 6

What are symptoms associated with pneumonia?

Answer 6

Cough
Sputum (often, but not always)
Chest pain

Question 7

What CXR finding is common for consolidation of the right middle lobe?

Answer 7

Obscures R heart border

Question 8

What is the most common cause of acute pneumonia in adults 18-40?

Answer 8

Mycoplasma

Question 9

What is the most common cause of acute pneumonia in adults over the age of 40?

Answer 9

S. pneumoniae

Question 10

What is the most important virulence factor of S. pneumoniae?

Answer 10

Capsule

Question 11

How can you determine if a patient with pneumoniae should be admitted to the hospital?

Answer 11

C: confusion
U: uremia
R: RR >30
B: BP, systolic less than 90 or diastolic less than 60
65 (age)

1 point for each, at least 2 points go to ward, if 5 ICU

Question 12

What is the pneumococcal vaccine best at preventing?

Answer 12

Bacteremia