Pneumonia

Question 1

What is Pneumonia

Answer 1

Infection that causes inflammation of lung tissue and sputum filling airways and alveoli

Question 2

How is pneumonia seen on a chest Xray

Answer 2

Consolidation

Question 3

List the three types of pneumonia and their differences

Answer 3

1- Community acquired pneumonia : develops out of hospital
2- Hospital acquired pneumonia : develops >48hrs after hospital admission
3- Aspiration pneumonia : develops after inhaling foreign material

Question 4

What is the presentation of pneumonia ( Hint : 7)

Answer 4

1- SOB 
2- Cough with sputum 
3- Fever 
4- Haemoptysis 
5- Pleuritic chest pain 
6- Delirium 
7- sepsis

Question 5

What signs can indicate sepsis secondary to pneumonia ( Hint : 6)

Answer 5

1- Tachypnoea 
2- Tachycardia 
3- Hypoxia 
4- Hypotension 
5- Fever 
6- Confusion

Question 6

List the three chest signs of pneumonia

Answer 6

1- Bronchial breath sounds
2- Focal coarse crackles
3- Dullness to percussion

Question 7

Describe bronchial breath sounds and their cause

Answer 7

Harsh breath sounds equally loud on inspiration and expiration.
Cause: consolidation of lung tissue around airway

Question 8

What causes focal coarse crackles

Answer 8

Air passing through sputum

Question 9

What causes dullness to percussion

Answer 9

Lung tissue collapse or consolidation

Question 10

What is the CURB-65 scoring system and list what is assessed.

Answer 10

The system used for severity assessment to predict mortality.
C: confusion 
U: ureas> 7 
R: respiratory rate >= 30
B: Blood pressure < 90s <=60d 
65: Age >= 65

Question 11

A CURB-65 score of 0-1 means what

Answer 11

consider treatment at home

Question 12

A CURB-65 score of 2 or more means what

Answer 12

consider hospital admission

Question 13

A CURB-65 score of 3+ means what

Answer 13

consider intensive care assessment

Question 14

What are the common causes of pneumonia ( Hint: 2 )

Answer 14

1- Streptococcus pneumonia

2- Haemophilus influenzae

Question 15

What can cause pneumonia in immunocompromised patients or those with chronic pulmonary disease

Answer 15

Moraxella catarrhalis

Question 16

What can cause pneumonia in patients with cystic fibrosis or bronchiectasis

Answer 16

Pseudomonas aeruginosa

Question 17

What can cause pneumonia in patients with cystic fibrosis

Answer 17

Staphylococcus aureus

Question 18

What is atypical pneumonia

Answer 18

Pneumonia caused by an organism that can’t be cultured or detected using gram stain. Can’t be treated with penicillins.

Question 19

List possible treatments for atypical pneumonia ( hint: 3 )

Answer 19

1- Macrolides : clarithomycin
2- Fluoroquinolones : levofloxacin
3- Tetracyclines : doxycycline

Question 20

What is Legionella pneumophila

Answer 20

Disease caused by infected water supply or air conditioning. Causes hyponatraemia.

Question 21

How would a typical patient present with legionella pneumophila ( legionnaires’ disease )

Answer 21

Recently had a cheap hotel holiday and presents with hyponatraemia

Question 22

Explain Mycoplasma pneumoniae

Answer 22

Organism that causes milder pneumonia and a rash known as erythema multiforme, and neurological symptoms ( in young patients ).

Question 23

What is erythema multiforme

Answer 23

Rash that has varying sized target lesions that have pink rings and pale centres

Question 24

How does clamydophila pneumoniae present

Answer 24

School aged child with mild to moderate chronic pneumonia and wheeze

Question 25

What is linked with Coxiella burnetii ( Q fever )

Answer 25

exposure to animals and their bodily fluids

Question 26

What would be a typical patient with Coxiella burnetii present as

Answer 26

A farmer with flu like illness

Question 27

How is chlamydia psittacosaurus interacted and what would a typical patient present as

Answer 27

Contracted from contact with infected birds. | Typical patient will be a parrot owner.

Question 28

What are the 5 causes of atypical pneumonia

Answer 28

``` 1- Legionnaires' disease 2- Mycoplasma pneumoniae 3- Chlamydydophila pneumoniae 4- Q fever 5- Chalmydia psittaci ```

Question 29

What is pneumocystis jiroveci ( PCP )

Answer 29

Organism that causes fungal pneumonia in immunocompromised patients.

Question 30

How does PCP present

Answer 30

1- dry cough 2- SOB on exertion 3- Night sweats

Question 31

How is PCP treated

Answer 31

1- co-trimaxazole ( septrin ) | 2- prophylactic oral co-trimoxazole if patient has low CD4 count

Question 32

What minimum investigations are done for pneumonia

Answer 32

1- Chest xray 2- FBC 3- U&E 4- CRP

Question 33

What investigations are done for moderate or severe pneumonia

Answer 33

1- Sputum cultures 2- Blood cultures 3- Legionella and pneumococcal urinary antigens

Question 34

What tests are used to monitor progress of patient

Answer 34

WBC and CRP levels

Question 35

What are the possible complication of pneumonia

Answer 35

``` 1- Sepsis 2- Pleural effusion 3- Empyema 4- Lung abscess 5- Death ```

Question 36

What's the Mild CAP antibiotics for pneumonia

Answer 36

5 day course of oral antibiotics amoxicillin or macrolide

Question 37

What's the Moderate to severe CAP antibiotics for pneumonia

Answer 37

7-10 day course of dual antibiotics amoxicillin and macrolide