Important other

Question 1

What is penumonia

Answer 1

Inflammation of lung parenchyma caused by a lower respiratory tract infection.
It often occurs after a viral infection of the upper respiratory tract. It is uncertain how the bacteria reach the lower respiratory tract after attaching to disaccharide receptors on pharyngeal epithelial cells.

Question 2

Pathophysiology of pneumonia

Answer 2

Debatable methods of invasion include:

• Inhibition of IgA
• Pneumolysins, which inhibit ciliary beating
• Damage of epithelial cells by prior infection
• Hijacking the platelet aggregating factor receptor pathway to reach the alveoli

Question 3

Symptoms of pneumonia

Answer 3

Fever
Cough with purulent sputum
Dyspnoea
Pleuritic pain

Question 4

Signs of pneumonia

Answer 4

Percussion: dull
Auscultation: crackles, bronchial breathing
Respiratory failure: cyanosis, tachypnoea
Septicaemia: rigors

Question 5

Treatment of pneumonia

Answer 5

BAPP
Breathing (maintain oxygen saturation levels)
Antibiotics (treat the underlying cause)
Pain (give analgesics)
Pneumococcal vaccines for those at risk

Question 6

Which at risk patients (for pneumonia) are given pneumococcal vaccines

Answer 6

Diabetics
Immunosuppressed
>65 years old

Question 7

Complications of pneumonia

Answer 7

Respiratory failure
Septic shock
Pleural effusion
Empyema
Lung abscess
Hypotension

Question 8

How does pneumonia cause respiratory failure

Answer 8

By causing acute respiratory distress syndrome (ARDS)

Question 9

How does pneumonia cause septic shock

Answer 9

Causative agent enters the patient’s bloodstream, releasing cytokines

Question 10

Underlying cause of hypotension in pneumonia

Answer 10

Sepsis

Dehydration

Question 11

Investigations of pneumonia

Answer 11

CXR - look for infiltrates
Identify the causative organism by assessing a sputum sample
Monitor oxygen saturation
Bloods - look for raised WCC and raised inflammatory markers
Urinary antigen test - for Pneumococcal or Legionella antigen
ABG

Assess severity using CURB-65

Question 12

Describe how you would use CURB-65 to assess severity of pneumonia

Answer 12

Confusion
Urea >7mmol/L
Respiratory rate >30/min
BP<90/<60mmHg
>65 years old

Each section of the CURB-65 is worth 1 point:
1 = outpatient care
2 = admission
>3 = requires ICU aadmission

Question 13

Causative organisms in community acquired pneumonia

Answer 13

Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Viruses
(main ones)

Question 14

Causative organisms in hospital acquired pneumoniae

Answer 14

Gram-negative bacteria
Staphylococcus aureus
Streptococcus aureus
Streptococcus pneumoniae
Anaerobes
Fungi
Legionella pneumophila

Question 15

Causative organisms in children pneumonia

Answer 15

Viruses
Pneumococcus
Mycoplasma

Question 16

Causative organisms of pneumonia in immunocompromised patients

Answer 16

Pneumocystis jirovecii
Cytomegalovirus
Adenovirus
Herpes simplex virus
Mycobacterium tuberculosis
Bacterial infection e.g. Staphylococcus aureus