Pneumonia

Question 1

Classification

Answer 1

Anatomical: lobar, broncho-pneumonia, diffuse

Setting - community vs hospital vs ventilator acquired

Question 2

Prevalence

Answer 2

In very young and very old

25% require hospital admission

Question 3

Examination

Answer 3

RR, HR, BP, Sats
Reduced air entry/percussion note
Bronchial breathing
Increased vocal resonance 
Crackles

Question 4

Diagnostics

Answer 4

Blood tests (test for infection, inflammation, liver, renal, blood cultures, HIV)
Sputum
Viral throat swab
Urine
ABG

Question 5

Management

Answer 5

Rest, fluids, analgesics, antibiotics
Refer if no improvement
Hospital: oxygen, fluid replacement, antibiotics

Question 6

Prescribing Antibiotics

Answer 6

Depends on: setting, severity, co-morbidity, allergies
Community: beta lactam
Hospital: amoxicillin +/- doxycycline
Hospital (severe): amoxicillin + doxycycline

Question 7

Critical Care

Answer 7

nasal HiFlow
CPAP
NIV (non invasive ventilation)
Intubation and invasive ventilation
ECMO - extracorporeal membrane oxygemation

Question 8

Complications

Answer 8

Resp failure and sepsis

Local: pleural effusion, empyema, lung abscess, organising pneumonia

Question 9

Empyema - complication

Answer 9

Indications for drainage:
Visible purulent effusion
Radiologically located effusions
Positive microbial culture
Pleural pH less than 7.2

Question 10

Lung Abscess

Answer 10

Need lavage
Consider endocarditis
Prolonged antibiotic course

Question 11

Differential Diagnosis

Answer 11

Atypical pneumonia - antibiotics ineffective

COPD, hypersensitivity pneumonitis, HF, vasculitis