Pneumonia

Question 1

Describe the symptoms of a patient with CAP or HAP?

Answer 1

Symptoms:
Productive cough
Fever
Pleuritic pain
Dysopnea 
Malaise
Vomiting 
Haemoptysis

Question 2

Describe the CURB 65 score?

Answer 2

Confusion:
Urea: 7mmol
Resp rate: >30
BP: <90/60 (can have systolic <90 or diastolic <60)
Age: 65

Score guides treatment options as it correlates to morbidity.

0-1= treat at home
2= admit to hospital
3 or above- consider ITU

Question 3

List the common pathogens causing CAP and HAP.

Answer 3

CAP:
Typical:
Strep. Pneumoniae (often post viral inf.)
HIB
Viruses

Atypical:
Mycoplasma Pneumoniae
Chlamydophila Pneumoniae
Legionella

HAP:
Gram -ve bacteria (E.coli, klebsiella, pseudomonas)
S. Aureus

Question 4

What are the factors that predispose to pneumonia?

Answer 4

Hospitalised
Viral Infection

Bronchiectasis
COPD
Immunocompromised

Smoking
Alcoholics
IVDU

Note: Pneumonia is a LRTI with evidence of consolidation on CXR, it is a radiological finding.

Question 5

Describe the pathology of acute lobar pneumonia and bronchopneumonia?

Answer 5

Acute lobar pneumonia:

Can occur at any age.
Infection of distal air spaces rather than bronchi
Rapid spread of infection

Bronchopneumonia:

Extremes of age
Spread to adjacent alveoli which become consolidated

Question 6

Outline the investigations of a patient presenting with suspected CAP?

Answer 6

Bedside:
O2 sats and observations

Bloods/lab:
FBC. 
U&Es (urea for curb, hyponatraemia in leigonairres)
LFTs
CRP
Blood cultures.

Sputum culture if possible.

Urinary antigen testing for strep pneumoniae and leigonairres if severe.

Imaging:
CXR- consolidation

Question 7

Discuss the treatment supportive and medical for pneumonia?

Answer 7

CAP:
0-1: 500mg amoxiclav tds 7 days

2: 500mg-1g amoxiclav tds 7days +clarithromycin 500mg bd 7 days

> 3e: Co-amoxiclav IV 1.2g tds PLUS Clarithromycin IV 500mg bds 10 days (Critical care)

Lifestyle: Quit smoking, physiotherapy for bronchopneumonia, O2 if sats are low

HAP:
Mild= doxycycline
Severe= Tazocin

If concerned of aspiration then add metronidazole

6 week follow up CXR to confirm resolution.

Question 8

Describe the complications of pneumonia?

Answer 8

• Sepsis.
• Infection spreading to the blood aka septicaemia.
• Lung abscess formation associated with klebsiella and s.aureus (HAP).
• Empyema (the presence of pus in the pleural cavity)
• Pneumothaoraces (in severe infections)

Question 9

What are the signs of pneumonia?

Answer 9

Tachypnoea
Tachycardia
Decreased chest expansion
Hypoxia
Dullness to percuss over affected area
Coarse crackles and pleural rub 
Increased vocal resonance 
Can get upper abdo tenderness