Pneumonia

Question 1

what is pneumonia

Answer 1

inflammatory condition of the lungs caused by infection. the inflammation leads to fluid and blood leaking into the alveoli, spreading the infection. this causes consolidation of the lung tissue, impairing gas exchange due to reduced ventilation

Question 2

what is the most common cause/ type of pneumonia

Answer 2

community acquired pneumonia (most common)

Question 3

types of pneumonia

Answer 3

community-acquired

hospital-acquired

aspiration pneumonia

pneumonia in immunocompromised patients

typical pneumonia

atypical pneumonia

Question 4

main causative agent of community acquired pneumonia (most common type)

Answer 4

streptococcus pneumoniae

haemophilus influenzae can also be a causative organism

Question 5

main causative agent of hospital acquired pneumonia

Answer 5

usually gram-negative enterococci; pseudomonas and Klebsiella. Staphylococcus aureus.

Question 6

main causative agent of aspiration pneumonia

Answer 6

anaerobes

Question 7

risk factors for pneumonia

Answer 7

age, smoking, alcohol, lung diseases such as COPD, immunodeficiency

Question 8

epidemiology in UK

Answer 8

Community-acquired pneumonia is responsible for > 60,000 deaths per year in the UK

Question 9

symptoms

Answer 9

fever, malaise, shortness of breath, rigors, sweating, cough, purulent sputum, pleuritic chest pain, haemoptysis

Question 10

atypical pneumonia symptoms

Answer 10

headache, myalgia, diarrhoea,

DRY cough (no sputum)

Question 11

signs of pneumonia on physical examination

Answer 11

pyrexia,

tachypnoea,

tachycardia,

hypotension,

cyanosis,

decreased chest expansion,

percussion is DULL amd increased vocal tactile fremitus over affected area

coarse crepitations at affected side of lung

CLUBBING

bronchial breathing over affected area

Question 12

investigations to do for pneumonia

Answer 12

bloods- raised WCC on FBC, u&e’s, LFT, blood cultures, ABG (resp failure?)

CXR

sputum sent for microbiology, culture and sensitivity

urinalysis for pneumococcus

Question 13

what will be seen on a CXR of a patient with pneumonia

Answer 13

Lobar or patchy shadowing

Pleural effusion

May detect complications (e.g. lung abscess)

Question 14

what does klebsiella mainly affect (hospital-acquired)

Answer 14

upper lobes

Question 15

summarise investigations for pneumonia

Answer 15

ABG

Bloods – FBC, U&E, LFT, ESR, CRP

Blood culture

Sputum for microscopy & culture

Polymerase chain reaction: for mycoplasma pneumonia

Urine antigen: for legionella and pneumococcal pneumonia

Chest X-ray: identify lobar, multi-lobar, cavitation and signs of pleural effusion

Question 16

what scoring system is used to classify severity of pneumonia which aids treatment options etc

Answer 16

CURB-65

C – confusion: An abbreviated mental test of ≤8
U – urea: >7mmol/L
R - Respiratory rate: ≥30/ min
B - blood pressure <90 systolic and/ or <60mmHg diastolic
65 - age: >65year old

CURB-65 score of 0-1 requires home treatment, 2 requires consideration for hospital treatment, however 3-5 would need hospital admission alongside consideration for ITU referral

Question 17

management of pneumonia

Answer 17

Oxygen to keep O2 saturations above 94%

Fluid management

Analgesia if patients have pleuritic chest pain.
Paracetamol 1g/6 hours (Max. 4g 24hours)

Antibiotics can be given orally for patients who are not nil by mouth and are managed in the community. However, for severe pneumonia Intravenous route is required.

Follow up appointments are organized for 6 weeks and CXR could be repeated at this time if there are complications or symptoms have not resolved.

Question 18

what vaccine can be done to prevent pneumonia

Answer 18

pneumococcal vaccine

protects against streptococcus pneumoniae

Question 19

Causative agents of atypical pneumonia

Answer 19

L. pneumophilia