Pneumonia

Question 1

What is pneumonia?

Answer 1

An infection in the lungs leading to fluid and blood cells leaking into the alveoli.
Causes inflammation and sputum.

Question 2

What is the pathophysiology of pneumonia?

Answer 2

Blood cells and fluid leak into the alveoli

This consolidates and causes reduced ventilation and gas exchange.

Question 3

What is an infection of pneumonia outside of the hospital called?

Answer 3

Community acquired pneumonia (CAP).

Question 4

what is an infection of pneumonia called if it develops more than 48hrs after hospital admission?

Answer 4

Hospital acquired pneumonia (HAP).

Question 5

What is pneumonia called if it happens after inhaling food or fluid?

Answer 5

Aspiration pneumonia.

Question 6

What is the presentation of pneumonia?

Answer 6

SOB
Cough (productive)
Sputum - brown or green
fever
haemoptysis
Pleuritic chest pain (worse on inspiration)
delirium
sepsis

Question 7

What is the presentation in the IMMUNOCOMPROMISED?

Answer 7

SOB on exertion
Cough - WITHOUT sputum
hight sweats

Question 8

What are the chest signs seen on an X-ray?

Answer 8

Consolidation of lung fields.

Question 9

What chest signs are heard?

Answer 9

Bronchial breathing
Dull percussion (consolidation)
Coarse crackles (fluid)

Question 10

What are the signs which might indicate sepsis?

Answer 10

Tachycardia
Tachypnoea
Hypotension (shock)
fever (or cold)
Hypoxia
Confusion

Question 11

What is the assessment done to indicate severity and mortality?

Answer 11

CURB 65
C-onfusion
U-rea >7
R-espiratory rate >30
B-lood pressure, systolic <90, diastolic <60
65 = over 65 yrs.

1 point for each.

Question 12

What do the different curb scores mean for where the person is treated?

Answer 12

0/1 = treated at home.
2 or more = hospital treatment
3 or more = ICU or HDU

Question 13

What do the different curb scores mean for mortality?

Answer 13

1 = <5%
3 = 15%
4/5 = >25%

Question 14

What are the main organisms causing pneumonia?

Answer 14

Streptococcus pneumonia 50%

Haemophilus influenza 20%

Question 15

What organisms are CF patients likely to develop pneumonia from?

Answer 15

Staph aureus

Pseudomonas argenosa

Question 16

What prophylaxis is offered to CF patients?

Answer 16

Flucloxacillin.

Question 17

What is fungal pneumonia called?

Answer 17

Pneumocystis jiroveci

Question 18

Who develops pneumocystis jiroveci?

Answer 18

Immunocompromised patients.

Question 19

What hospital investigations are there for pneumonia?

Answer 19

Chest x ray
FBC
U and E
CRP

Severe:
Sputum cultures
blood cultures
legionella and pneumococcal urinary antigens

Question 20

Why is WBCs and CRP good for pneumonia?

Answer 20

They are raised in relation to how bad the infection is - can measure after giving antibiotics, if they have decreased, antibiotics is working.

Question 21

Who is given IV antibiotics?

Answer 21

Moderate/severe pneumonia

sepsis

Question 22

What is the treatment for mild community acquired pneumonia?

Answer 22

5 days of amoxicillin OR macrolide

Question 23

what is the treatment for moderate to severe community acquired pneumonia?

Answer 23

7-10 days DUAL antibiotics - amoxicillin + macrolide.

Question 24

What are the main complications of pneumonia?

Answer 24

sepsis
pleural effusion
empyema
lung abscess
death