clinical consequences of respiratory infection

Question 1

what are the anatomical classifications of pneumonia?

Answer 1

• lobar
• broncho-pneumonia
• diffuse

Question 2

what are the setting classifications of pneumonia?

Answer 2

• community acquired
• hospital acquired
• ventilator required

Question 3

what are the signs of pneumonia?

Answer 3

• reduced air entry/PN
• bronchial breathing
• increased vocal resonance
• crackles

Question 4

what are the blood tests used for pneumonia?

Answer 4

• assess for evidence infection/inflammation
• assess renal function
• assess liver function
• blood cultures
• HIV test

Question 5

what are the other tests for pneumonia?

Answer 5

• sputum
• viral throat swab: mycoplasma
• urine: legionella Ag
• arterial blood gas

Question 6

how do you assess the severity of pneumonia?

Answer 6

the CURB 65 score

• confusion
• raised blood urea (>7mmol/L)
• raised respiratory rate (>30/min)
• low blood pressure (S<95;D<60)
• age >65

Question 7

how do you manage community pneumonia?

Answer 7

• rest
• push fluids
• analgesics
• antibiotic
• safety next
• refer if no improvement in 48 hours

Question 8

how do you manage hospital pneumonia?

Answer 8

• oxygen if required
• fluid replacement if required
• antibiotics
• critical care management

Question 9

what antibiotics do you use for community pneumonia?

Answer 9

beta-lactam (amoxicillin) OR doxycyline

Question 10

what antibiotics do you use for hospital (not severe) pneumonia?

Answer 10

amoxicillin +/- doxycycline OR doxycyline

Question 11

what antibiotics do you use for hospital (severe) pneumonia?

Answer 11

amoxicillin AND doxycyline OR ceftriaxone/levofloxacin

Question 12

how do you treat patients in critical care?

Answer 12

can give higher oxygen concentration, positive pressure and reduce work of breathing

• nasal HiFlo
• CPAP (continuous positive airway pressure)
• NIV (non-invasive ventilation)
• intubation and invasive ventilation
• if everything fails consider ECMO (extracorporeal membrane oxygenation)

Question 13

what are the general complications with pneumonia?

Answer 13

• respiratory failure

- sepsis: multi-system failure

Question 14

what are the local complications with pneumonia?

Answer 14

• pleural effusion
• empyema
• lung abscess
• organising pneumonia

Question 15

what are possible reasons for the body not responding to pneumonia?

Answer 15

• wrong or incomplete diagnosis
• antibiotic problem
• complication developing
• underlying bronchial obstruction
• approach: re-review

Question 16

what is pleural parapneumonic effusion?

Answer 16

• can be: simple parapneumonic, complicated parapneumonic, empyema
• dominant microbiology is Pneumococcus but also consider Staph. aureus and Step. milleri
• consider differential diagnosis of pleural tuberculosis

Question 17

what are the indications for draining with empyema?

Answer 17

• visibly purulent effusion
• radiologically located effusions
• positive microbial culture from effusion
• pleural pH less than 7.2

Question 18

what do you need to think of regarding lung abscess?

Answer 18

• formation of abscess can be another cause of failure to respond
• need to think of cause
• need lavage
• consider endocarditis
• prolonged antibiotic course

Question 19

what are the common differential diagnosis of pneumonia?

Answer 19

• LRTI and lung cancer
• LRTI and heart failure
• pulmonary emboli/infarction

Question 20

what are the unusual differential diagnosis of pneumonia?

Answer 20

• specific infections

- complicating chronic bronchial suppuration

Question 21

what are the rare differential diagnosis of pneumonia?

Answer 21

• vasculitis
• pulmonary eosinophilia
• crytogenic organising pneumonia