Pneumonia

Question 1

Define Pneumonia

Answer 1

infection of distal lung parenchyma.

Question 2

How can pneumonia be categorised?

Answer 2

Community or hospital
Typical or atypical (Mycoplasma, Chlamydia, Legionella)
Aspiration or Immunocompromised

Question 3

Which 10 infections may cause CAP?

Answer 3

Streptococcus pneumoniae (70%) 
Haemophilus influenzae 
Moraxella catarrhalis (COPD) 
Chlamydia pneumonia 
Chlamydia psittaci (causes psittacosis) 
Mycoplasma pneumonia 
Legionella (A/C) 
Staphylococcus aureus 
Coxiella burnetii (causes Q fever)  
TB

Question 4

Which infections may cause HAP?

Answer 4

Gram-negative enterobacteria (Pseudomonas, Klebsiella)

Anaerobes (due to aspiration pneumonia)

Question 5

List 6 risk factors for pneumonia

Answer 5

Age  
Smoking  
Alcohol 
Pre-existing lung disease (e.g. COPD)  
Immunodeficiency 
Contact with pts with pneumonia

Question 6

List 6 Sx of pneumonia

Answer 6

Fever + Rigors  
Cough 
Sputum (yellow/ green/ rusty)
SOB 
Pleuritic chest pain  
Confusion (in severe/ elderly)

Question 7

List 4 atypical symptoms of pneumonia

Answer 7

Headache
Myalgia
Diarrhoea/ abdominal pain
DRY cough

Question 8

List 12 signs of pneumonia

Answer 8

Pyrexia  
Tachypnoea 
Tachycardia 
Hypotension 
Cyanosis  
Decreased chest expansion  
Dull to percuss over affected area  
Increased tactile vocal fremitus over affected area  
Bronchial breathing over affected area 
Pleural rub
Coarse crepitations on affected side  
Chronic suppurative lung disease (e.g. abscess)- clubbing

Question 9

Ix for pneumonia

Answer 9

CXR
Blood/ Sputum culture
Urine dip: Legionella
Bronchoscopy

Question 10

Which bloods are taken in pneumonia?

Answer 10

FBC (high WCC) 
LFT (abnormal in legionella)
U+Es (Urea high in severe)
CRP (high)
RBC (Mycoplasma agglutinates)

Question 11

What is seen on CXR of a patient with pneumonia?

Answer 11

Lobar patchy shadowing
Pleural effusion
Klebsiella often effects upper lobes
May detect abscesses.

Question 12

When in bronchoscopy performed in pneumonia cases?

Answer 12

if Pneumocystitis carinii is suspected

If Pneumonia fails to resolve

Question 13

What management does each CURB-65 score indicate?

Answer 13

0-1: Abx PO, home
2: Admit
3+: ITU

Question 14

Describe the use of antibiotics in bacterial pneumonia

Answer 14

Amoxicillin or Clarithromycin PO (0-1)
Amoxicillin + Clarithromycin PO or IV (2)
Co-amoxiclav + Clarithromycin IV (3+)
Levofloxacin IV (3+ with penicillin allergy)

Question 15

When would you add metronidazole to the baseline antibiotics being used to treat a pneumonia?

Answer 15

Aspiration
Lung abscess
Empyema

Question 16

What supportive treatment may be necessary in treating pneumonia?

Answer 16

Oxygen
IV fluids
CPAP, BiPAP or ITU care for respiratory failure
Surgical drainage for lung abscesses + empyema

Question 17

What are the clinical features of instability when discharge planning for pneumonia? How many equates to high risk of re-admission and mortality?

Answer 17

High temperature
Tachycardia
Tachypnoea
Hypotension
Low oxygen sats 
>,2

Question 18

What would you consider in a non-resolving pneumonia?

Answer 18

Other causes:
PE
PH
RHF
Drug toxicity
Unusual pathogens
Alveolar haemorrhage

Question 19

2 approaches to prevention of pneumonia

Answer 19

Pneumococcal vaccine
Haemophilus influenzae type B vaccine
Only usually to high risk groups (e.g. >65, splenectomy)

Question 20

List 5 complications of pneumonia

Answer 20

Pleural effusion  
Empyema 
Abscess
Septic shock  
ARDS

Question 21

What are the extra complications of Mycoplasma pneumonia?

Answer 21

Erythema multiforme 
Myocarditis 
Haemolytic anaemia 
Meningoencephalitis  
Transverse myelitis  
GBS

Question 22

What system is used to assess severity of pneumonia?

Answer 22

CURB-65 score:
Confusion < 8 AMTS 
Urea > 7 mmol/L 
Respiratory rate > 30/min 
BP: sys < 90 mmHg or dias < 60 mmHg  
Age > 65 yrs