LOBAR PNEUMONIA

Question 1

What is it?

Answer 1

acute lower respiratory tract infection with fever

Question 2

What is community acquired pneumonia?

Answer 2

pneumonia contracted by someone who has had little contact with healthcare system

Question 3

What organism is mainly responsible for community acquired pneumonia?

Answer 3

streptococcus pneumoniae

Question 4

What is hospital acquired pneumonia?

Answer 4

pneumonia contracted by a patient in hospital at least for 48-72hrs after being admitted.

Question 5

What usually caused HAP? (2)

Answer 5

• Gram negative enetrobacteria

- s.aureus

Question 6

What is aspiration pneumonia?

Answer 6

• aspiration of gastric contents causing pneumonia

Question 7

What conditions/state increase your risk of aspiration pneumonia? (5)

Answer 7

• stroke
• myasthenia gravis
• decreased consciousness
• oesophageal disease
• poor dental hygiene

Question 8

What causes immunocompromised pneumonia?

Answer 8

pneumocystis jiroveci

Question 9

What are the characteristic symptoms of immunocompromised pneumonia? (3)

Answer 9

• high fever
• breathlessness
• cough

Question 10

What are the risk factors for pneumonia? (9)

Answer 10

1. AGE
   - extreme ages
2. LIFESTYLE

• smoking
• alcohol

3. PRECEDING VIRAL INFECTIONS
   - flu
4. RESP CONDITIONS

• asthma
• COPD
• Malignancy
• bronchiectasis
• CF

5. IMMUNOSUPPRESSION
6. IV DRUG ABUSE
7. HOSPITALISATION
8. ASPIRATION
9. UNDERLYING DISEASE

• Diabetes mellitus
• CVD

Question 11

What are the symptoms? (9)

Answer 11

1. fevers
2. rigors
3. malaise
4. anorexia
5. dyspnoea
6. cough
7. purluent sputum
8. haemoptysis
9. pleuritic pain

Question 12

What are the signs? (11)

Answer 12

1. pyrexia
2. cyanosis
3. confusion
4. tachypnoea
5. hypotension
6. decreased expansion
7. dull percussion note
8. increased tactile fremitus
9. increased vocal ressonace
10. bronchial breathing
11. pleural rub

Question 13

Differential diagnosis (3)

Answer 13

1. Pulmonary oedema
2. pleural effusion
3. pneumothorax

Question 14

Investigations (7)

Answer 14

1. CXR
2. O2 sats
3. BP
4. bloods
5. sputum
6. urine
7. pleural fluid

Question 15

What investigations would you do in ITU? (2)

Answer 15

1. bronchoscopy

2. bronchoalveolar lavage

Question 16

What is the aim of investigating pneumonia?

Answer 16

diagnosing, idnetifying pathogen and assessing severity of pneumonia

Question 17

How is severity of pneumonia assessed?

Answer 17

1. CURB-65

- get 1 point for each

Question 18

What is the criteria to gain a point in CURB-65? (5)

Answer 18

1. CONFUSION
   - AMTS <8
2. UREA
   - > 7mmol/l
3. RESPIRATORY RATE

> 30/min

4. BP

< 90 systolic

< 60 diastolic

5. Age

> 65 years

Question 19

What do you look for in a CXR? (3)

Answer 19

• lobar
• multilobar
• bronchial

Question 20

What bloods do you do? (5)

Answer 20

• FBC
• U&Es
• LFTs
• CRP
• blood culture

Question 21

What do you test the urine for? (2)

Answer 21

• low albumin

- pneumococcal antigen

Question 22

Treatments (4)

Answer 22

1. antibiotics - co-amoxiclav or doxycycline
2. O2
3. IV fluids
4. analgesia