LRTI - Pneumonia

Question 1

Types of pneumonia?

Answer 1

Community acquired
Hospital acquired
Aspiration
Immuno-compromised

Question 2

Symptoms?

Answer 2

Fever
Pleuritic chest pain
Cough with purulent sputum
Dyspnoea

Question 3

What is the problem with symptoms?

Answer 3

They are vague and fit other LRTIs easily

Question 4

Signs of examination?

Answer 4

Inspection:
Tachypnoea
Central cyanosis

Percussion:
Dullness on percussion of affected lobes

Auscultation:
Bronchial breath sounds
Inspiratory crepitations
Increased vocal resonance

Question 5

Why is there dullness on percussion and increased vocal resonance?

Answer 5

Consolidation of lobe

Question 6

Investigations?

Answer 6

CxR
FBC
Blood culture
Sputum culture
Throat swab
Urinary legionella antigen

Question 7

Why is a throat swab done?

Answer 7

To look for atypical organisms

Question 8

What will a CxR see?

Answer 8

Lobar or multilobar infiltrates
Cavitation
Pleural effusion

Question 9

Why are tests done?

Answer 9

Establish diagnosis
Identify pathogen
Assess severity

Question 10

Common bacterial causes

Answer 10

Strep pneumoniae
H influenza
M catarrhalis

Question 11

Atypical bacterial causes?

Answer 11

Legionella
Staph aureus
Mycoplasma pneumoniae
Chlamydia 
Viruses

Question 12

How is severity assessed?

Answer 12

CURB 65

Confusion
Blood UREA
RR - <30
Diastolic BP -<60
Over 65

Question 13

Score for low risk patient and action plan?

Answer 13

0- 1 treat in community

Amoxicillin
OR
Clarithromycin/doxycycline

Question 14

Score for medium risk patient and action plan?

Answer 14

2 - Hospital treatment needed

Amoxicillin and Clarithromycin combo

OR
Levofloxacain if penacillin allergic

Question 15

Score for high risk patient and action plan?

Answer 15

> 3 - ITU due to high risk of death

Co-amoxiclav and clarithromycin

OR

Levofloxacin if allergic

Question 16

Why is co-amoxiclav used in severe?

Answer 16

Broader spectrum

Question 17

Other non-pharma treatment options?

Answer 17

Intubation and ventilation
Supplemental O2
IV fluids
Antipyretics/Analgesia

Question 18

Treatment for children?

Answer 18

Nothing if mild
Stepped approach

1 - oral amoxicillin
2 - oral macrolide
3 - Only use IVs if vomiting

Question 19

Common differentials?

Answer 19

TB 
Lung cancer
Pulmonary embolism
Cardiac failure
Pulmonary vasculitis

Question 20

How to tell TB and pneumonia apart?

Answer 20

TB tends to affect upper lobes

Follows a previous illness commonly so patient will be ill for a few weeks

Question 21

Why is a pulmonary embolism confused with pneumonia?

Answer 21

Makes infarcts appear on CxR that look like pneumonia

Question 22

What is pulmonary vasculitis?

Answer 22

Destruction of vessels in lung/pulmonary system

Question 23

Complications of pneumonia ?

Answer 23

Empyema 
Lung abcess
Septicaemia
Acute kidney injury
Haemolytic anaemia
ARDS

Question 24

Why can pneumonia cause anaemia?

Answer 24

In mycoplasma caused pneumonia - RBCs are destroyed

Question 25

What is ARDS? What to do if patient gets this?

Answer 25

Acute respiratory distress syndrome

Damage to alveoli leads to a massive inflammatory response and fibrosis of interstitium

Transfer to ICU