Pneumonia

Question 1

An infection in the lung tissue caused by microbes and the result is an inflammation

Answer 1

Inflamation brings water to the site of infection in the lung thus it’s make it hard to breathe

Question 2

How the lungs protect it self from microbes and foreign orgasms ?

Answer 2

1- coughing
2- mucociliary escalator
3- macrophages

Question 3

What’s happen if those microbes colonizes tge bronchioles or alveoli?

Answer 3

We will have pneumonia 🌚

Question 4

What is the inflammatory response in pneumonia?

Answer 4

1- white blood cells
2- red blood cells
3- proteins
4-fluid

Question 5

Pneumonia causes?

Answer 5

Microbes like : 
1-viruses 
2-bacteria 
3-fungal 
4-parasitic

Question 6

Give examples of microbes that cause pneumonia?

Answer 6

1- viral- influenza and parainfluenza
2- bacterial- staphylococcus aureus, staphylococcus pyogenes ,streptococcus pneumonia , mycobacterium tuberculosis
3- fungi + parasites 🦠- candida albicans , histoplasm, aspergillus

Question 7

Classifications of pneumonia :

Answer 7

1 - depending on the etiological agent 
* bacterial, viral , fungal, parasitic 
2- depending on the status of the lung :
*primary pneumonia-in a healthy lung 
*secondary pneumonia-previously affected lung 🫁 
3- depending on the environment form where the infection was contracted 
* community pneumonia 
*Nosocomial pneumonia

Question 8

The difference between community acquired pneumonia and nosocomial pneumonia?

Answer 8

One gets it from the hospital which’s more serious and more resistant to drugs so we need stronger medication 💊
And one we get it from the outside of the hospital 🏥

Question 9

Pathophysiology of pneumonic process ?

Answer 9

Pneumonia activation depends on 3 major factors:
1-microbial virulence
2-microbial inoculum size
3- host response

The respiratory defense mechanisms :

1- mechanical ⚙️: removal of the microbes 🦠 with cough 😷, and muco-ciliary clearance . To the microbes that come from the nasal cavity.

2- biological ( hormones، enzymes and cells) :
* humoral- immunoglobulin (igA,igG) ,antioxidant, lysosomes

*cellular -lymphocytes, neutrophils, macrophages

Question 10

Lower respiratory tract contamination mechanisms تكمله للباثوفيزيولوجي ؟

Answer 10

1-aspiration, inhalation (micro aspiration at the level of oro-nasopharynx is the most frequent mechanism in pneumonia pathogenesis

2- hematological dissemination (نشر) : occurs from remote infections sites تناقل العدوى البعيده الي الرئتين )endocarditis,septic phlebitis

3-direct inoculation: during trauma )rare

Question 11

Pneumococcal community-aquired pneumonia: morphopathology :?

Answer 11

Alveolar labor pneumonia characterized by :
1-damage to peripheral air spaces due to the presence of an inflammatory exudate containing germs 🦠

2-homogeneous condensation ( condensation) opacities

3- condensation with out the bronchi (non-opacified bronchus
4 pneumococcal pneumonia-typical example of labor pneumonia

Question 12

Symptoms of
pneumococcal community-Acquired
pneumonia

Answer 12

1-dyspnea
2-general sings: fever 🥵,chills,asthenia,sweats
3-chest pain due to pleural inflammation, thoracic discomfort
4-cough - dry then productive with blood 🩸 sputum
5-myalgias الم بالعضلات
6-arthralgias - الم بالمفاصل
7-inappetence and wight loss

Question 13

Pneumococcal community acquired pneumonia

Physical exam:

Answer 13

1-Continuous fever 🥵 
2-Tachycardia 
3-Tachypnea
4-Cyanosis in sever cases 
5-Pulmonary condensation syndrome: limitations of respiratory movements and amplitude, local dullness, crackels, bronchial breath sound

Question 14

Paraclinical diagnosis 🫁 in pneumococcal community acquired pneumonia

Answer 14

1-inflammatory syndrome presence
2-arterial gasometry reveals 
3- bacteriologic suptum exam
4- hemocultures 
5-thoracic-xray

Question 15

Hospitalization criteria

Answer 15

All the symptoms but more severe
More intense pain , sever lung 🫁 damage , very high values PMN ,failure of first antibiotic therapy, risk factor presence

Question 16

Differential diagnosis

Answer 16

Collapse 
Sarcoidosis 
Pleural effusion 
Pulmonary edema 
Pulmonary embolism 
Other cases of acute fever 🥵

Question 17

Complications:

Answer 17

General :
toxic- nephritis , hepatitis , myocarditis

Septic- pericarditis endocarditis ,otitis septicemia with sepsis metastasis

Acute renal failure 😞

Local:parapneumonic pleural effusion
Metapneumonic pleular effusion
Abscedation :pus formation
Chronicization: bronchiectasis

Question 18

Which score can evaluate the severity of a patient ?

Answer 18

Curb-65  
C- confusion - 1point
U- urea-1p
R-respiratory rate-1p
B-blood pressure -1p
65- age above 65 years old -1p
0-1 -safely treated at home 🏠 
2- shortly period admission 
3-require hospital admission
4–5 hospital ICU

Question 19

Nosocomial pneumonia

Answer 19

is a lower respiratory infection that was not incubating at the time of hospital admission and that presents clinically 2 or more days after hospitalization

Question 20

Pneumonia with klebsielia

Answer 20

Klebsiella pneumoniae (K. pneumoniae) are bacteria that normally live in your intestines and feces.

These bacteria are harmless when they’re in your intestines. But if they spread to another part of your body, they can cause severe infections. The risk is higher if you’re sick.

Question 21

Treatment for community acquired pneumonia pharmacological :

Symptomatic treatment

Answer 21

Symptomatic treatment:
Fever- antipyretic
Thoracic pain-pain killers
Dry cough 😷- anti cough medications-codeine15mg
Productive cough-mucolytic and expectorants

Question 22

Pharmacological treatment
Antibiotics:
After sampling (sputum/blood)

Answer 22

At home 🏠:

• Ampicillin/amoxicillin for7-10days
• Patient with high severity score: amoxicillin\ Augmentin 2tb

Patient with severity score and chronic respiratory pathologis and multiple previous antibiotherapy :levofloxacin500mg + augmentin
M
Hospital 🏥 treatment :
Two Hemoculture from 2 different sites and 10 min interval
Augmentin 1 vial or cephalosporin 1g vial or ceftriaxone 1-2 g