Lecture 11: Clinical consequences

Question 1

What are some signs of pneumonia from examination?

Answer 1

Reduced Air Entry/PN

Bronchial Breathing

Increased Vocal resonance

Crackles

Question 2

What are the essential components of a social history when investigating pneumonia?

Answer 2

Pets, jobs, hobbies, travel, risk for immunocompromised state, home situation, smoking

Question 3

What is CURB65?

Answer 3

Method to assess severity of pneumonia

Confusion

raised blood Urea (>7 mmol/L)

raised Respiratory rate (>30/min)

low Blood pressure (S<95; D≤60)

age > 65 years

Question 4

Above what CURB score would a patient be admitted to hospital?

Answer 4

2

Question 5

What are the community options for pneumonia management?

Answer 5

Rest

Push fluids

Analgesics

Antibiotic

Refer if no improvement in 48 hrs

Question 6

What are the hospital options for pneumonia management?

Answer 6

Oxygen if required

Fluid replacement if required

Antibiotics

Critical care management

Question 7

What must be taken into account when deciding on antibiotics?

Answer 7

Setting

Severity

Co-morbidities (esp resp disease)

Epidemiology

Patient allergies

Question 8

What are the likely antibiotic choices for community, hospital (not severe) and hospital (severe)?

Answer 8

Community:
Beta-Lactam (Amoxicillin)
or Doxycyline

Hospital – not severe:
Amoxicillin +/- Doxycycline
or Doxycyline

Hospital – severe:
Amoxicillin AND Doxycyline
or Ceftriaxone /Levofloxacin

Question 9

What is the normal clearance rate of pneumonia in adults aged 18-60?

Answer 9

95% of CAP will clear within 6 weeks (hence CXR at 6/52)

Question 10

What is the normal clearance rate of pneumonia in older adults?

Answer 10

35. 1% within 3 weeks
36. 2% within 6 weeks
37. 2% within 12 weeks

Question 11

What may slow down the rate of pneumonia clearance?

Answer 11

Increased comorbidity
Bacteremia
Multilobar involvement
Enteric gram-negative bacilli pneumonia

Question 12

What is ECMO?

Answer 12

Oxygenating the blood through external system

Question 13

What are the general and local complications of pneumonia?

Answer 13

General:

• respiratory failure
• sepsis - multi-system failure

Local:

• pleural effusion
• empyema
• lung abscess
• “organising pneumonia”

Question 14

What 4 things may result in a patient failing to respond to treatment?

Answer 14

Wrong or incomplete diagnosis

Antibiotic problem

Complication developing

Underlying bronchial obstruction

Question 15

What are the differential diagnoses of pneumonia?

Answer 15

Common:

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

Unusual:
- specific infections, eg Tuberculosis
- complicating chronic bronchial suppuration,
eg bronchiectasis, Cystic Fibrosis

Rare:

• vasculitis
• pulmonary eosinophilia
• Crytogenic organising pneumonia