Lobar Pneumonia

Question 1

What is it?

Answer 1

An acute lower respiratory tract infection

Question 2

What does it show histologically? (2)

Answer 2

Acute inflammation, intense infiltration of neutrophils in alveoli and bronchioles

Question 3

What are the classifications of Lobar Pneumonia? (3)

Answer 3

Community acquired, Hospital acquired, Aspiration

Question 4

What is Community Acquired Pneumonia? (3)

Answer 4

Pneumonia that is contracted outside of hospital, can be primary or secondary to underlying disease, usually caused by Streptococcus Pneumoniae or Haemophilus Influenzae, or Virus

Question 5

What is Hospital acquired pneumonia? (2)

Answer 5

Pneumonia that presents >48 hours after hospital admission, usually caused by Gram Negative Enterobacteria or Staph Aureus

Question 6

What is aspiration pneumonia? (2)

Answer 6

People with dysphagia e.g stroke patients or reduced consciousness may aspirate food/drink into their lungs, caused by oropharyngeal anaerobes

Question 7

Is lobar pneumonia common?

Answer 7

Yes, affects 5-11 per 1000 people

Question 8

Who is affected?

Answer 8

High incidence in old and young, 21% of pneumonia cases in hospital will die

Question 9

What are the risk factors? (11)

Answer 9

Age (old and young), smoking, alcohol, preceding viral infection, respiratory illness e.g Asthma, COPD, CF, Malignancy etc, immunosuppression, IV drug use, hospitalisation, neurological disease, Diabetes, Cardiovascular disease

Question 10

Symptoms (9)

Answer 10

Cough, purulent sputum, pyrexia, dyspnoea, malaise, anorexia, rigors, haemoptysis, pleuritic pain

Question 11

Signs (7)

Answer 11

Cyanosis, confusion, tachypnoea, tachycardia, hypotension, dull percussion (shows consolidation), pleural rub

Question 12

Differentials (8)

Answer 12

Different causative organism, pulmonary oedema, pleural effusion, pneumothorax, P.E, COPD, Bronchiectasis, Neoplasm

Question 13

What bloods would you do? (5)

Answer 13

FBC, CRP, U&E, LFTs, Blood Cultures

Question 14

Other investigations (7)

Answer 14

Pneumococcal and legionella urinary antigen tests, Chest xray, sputum exam/culture, pulse oximetry, ABG. Aspiration of pleural fluid, bronchoscopy

Question 15

What mnemonic is used for pneumonia?

Answer 15

CURB 65

Question 16

What does CURB 65 mean?

Answer 16

1. Confusion (AMTS <8)
2. Urea >7mmol
3. Respiratory Rate >30
4. BP <90/60
5. Age >65

Question 17

What do you do with the results from CURB 65?

Answer 17

1= manage at home
2=hospital admission
3=severe pneumonia, probably needs ICU admission

Question 18

Treatment (6)

Answer 18

Antibiotics for CAP= IV Co-Amoxiclav 1.2g/8 hours and Clarithromycin or Levofloxacin/Cefuroxime if Penicillin Allergic, Oxygen therapy, IV fluids, Analgesia if pleurisy, paracetamol for pyrexia, VTE prophylaxis

Question 19

Complications (8)

Answer 19

Pleural effusion, empyema, respiratory failure, sepsis, pneumothorax, DVT, post infective bronchiectasis, AKI

Question 20

Is there a good prognosis?

Answer 20

Mortality in Community managed is <1%, up to 20% of hospital pneumonia patients die, legionella has the most severe course

Question 21

Is there anything to prevent it? (3)

Answer 21

Appropriate antibiotic therapy, influenza and pneumococcal vaccination, smoking cessation