Pneumonia

Question 1

Bronchopneumonia

Answer 1

Patchy consolidation of different lobes

Question 2

Lobar Pneumonia

Answer 2

Fibro-suppurative consolidation of a single lobe

Congestion → red → grey → resolution

Question 3

Community Acquired Pneumonia

Answer 3

Streptococcus pneumoniae

Mycoplasma pneumoniae

Haemophilus Influenzae - especially in COPD pts

Question 4

Hospital acquired pneumonia

Answer 4

> 48hrs after hospital admission

Gm -ve enterobacteria
S. aureus

Question 5

Aspiration pneumonia risk factors

Answer 5

Stroke
↓GCS
GORD
Achalasia

Question 6

Immunocompromised

Answer 6

Unusual causative organism:

• Pneumocystis jirovecci
• TB
• CMV
• Herpes simplex virus

Question 7

Presentation of pneumonia

Answer 7

Fever

Rigors

Malaise

Anorexia

Dyspnoea

Cough - purulent sputum

Haemoptysis

Pleuritic pain

Question 8

Signs of pneumonia

Answer 8

↑RR, ↑ HR

Low oxygen saturation

Cyanosis

Confusion

Consolidation - dull to percuss and increased vocal resonance

↓ expansion

Bronchial breathing

Crackles

Pleural rub

Question 9

Investigations of pneumonia

Answer 9

Respiratory examination
Basic obs 
Bloods: FBC, U+E, LFT, CRP
Blood culture
Sputum MC&S
ABG (if ↓SpO2)
Imaging: CXR

Question 10

CXR

Answer 10

Opacification

Effusion

Question 11

CURB 65

Answer 11

Confusion (AMT < 8)
Urea > 7mmol
RR > 30
BP < 90 systolic < 60 diastolic

65+ yo

(At GP CRB 65)`

Question 12

Mx CURB 65 = 0-1

Answer 12

Treat at home

Amoxicillin 5 - 7 days

Question 13

Mx CURB 65 = 2

Answer 13

Admit to hospital

Amoxicillin + Clarithromycin 7 days

Question 14

Mx CURB 65 = 3+

Answer 14

Consider ITU
Co- amoxiclav + clarithromycin
7 - 10 days

Question 15

In hospital mx

Answer 15

Abx
O2: PaO2≥8, SpO2 94-98%
Fluids
Analgesia
Chest physio

Consider ITU if shock

Follow up at 6wks with CXR

Question 16

Abx for atypical pneumonis

Answer 16

Chlamydia: tetracycline
Pneumocystis jirovecci: Co-trimoxazole
Legionella: Clarithromycin + rifampicin

Question 17

Hospital acquired pneumonia abx

Answer 17

Mild: Co-amoxiclav - 7 days

Severe >5d: Tazocin ± vanc ± gent for 7d

Question 18

Aspiration pneumonia abx

Answer 18

Co-amoxiclav for 7d

Question 19

Complications of Pneumonia

Answer 19

Respiratory failure
Hypotension - dehydration and sepsis 
Septic shock 
Pleural effusion 
Empyema
Lung abscess

Question 20

Type 1 resp failure

Answer 20

Hypoxia + normal CO2

Question 21

Type 2 resp failure

Answer 21

Hypoxia + hypercapnia

Question 22

Empyema

Answer 22

Pus in the pleural cavity
Assoc. with recurrent aspiration
Pt. with resolving pneumonia develops recurrent fever

Ix:
Pleural tap: turbid, ↓glucose, ↑LDH

Mx: US guided chest drain + Abx

Question 23

Lung abscess

Answer 23

Swinging fever
Cough, foul purulent sputum, haemoptysis Malaise, wt. loss
Pleuritic pain
Clubbing
Empyema

Question 24

Atypical causative organism and RF

Answer 24

Klebsiella - DM or alcohol - Cefotaxime

Pseudomonas - CF/Bronchiectasis - Tazocin

Legionella - air conditioning

Staph aureus - influenza

Pneumocystis jirovecci - if immunocompromised - Co - trimoxazole

Question 25

Pneumonia pathophysiology

Answer 25

Pathogens in lung parenchyma overwhelms host defences and cause intra alveolar exudate

Question 26

Mycoplasma pneumoniae

Answer 26

Dry cou
May get autoimmune haemolytic anaemia
Erythema multiforme

Question 27

What live is aspiration normally seen in

Answer 27

Right middle and lower lobes as larger and more vertical