Pneumonia

Question 1

Define pneumonia

Answer 1

acute infection of lung parenchyma

Question 2

Pneumonia risk factors

Answer 2

smoking
chronic lung disease (eg. asthma, COPD)
chronic heart disease
alcohol excess
immunosuppression

Question 3

4 broad classifications of pneumonia

Answer 3

community acquired pneumonia (CAP)
hospital acquired pneumonia (HAP)
aspiration pneumonia
pneumonia in immunocompromised patients

Question 4

Clinical features of pneumonia

Answer 4

shortness of breath (SOB)
cough
sputum production
pleuritic chest pain
fever
confusion (especially in elderly)

Question 5

Examination features of pneumonia

Answer 5

pyrexia
tachycardia
tachypnoea
reduced lung expansion
signs of consolidation found
coarse crackles may be heard as infection resolves

Question 6

Patients at risk of CAP

Answer 6

primary (healthy adults)
secondary (underlying lung disease):
- COPD
- Interstitial lung disease
- Bronchial cancer

Question 7

Common organisms that cause CAP

Answer 7

Streptococcus pneumoniae
Haemophilus influenzae
Mycoplasma pneumoniae

Question 8

Patients at risk of HAP

Answer 8

elderly
immobile
pain (causes basal atelectasis)
immunosuppression
immunocompromise

Question 9

Common organisms that cause HAP

Answer 9

Staphylococcus aureus
Gram-negative enterobacteria
Pseudomonas
Klebsiella

Question 10

Patients at risk of aspiration pneumonia

Answer 10

alcohol excess
impaired consciousness
swallowing problems (eg. stroke)

Question 11

Common organisms that cause aspiration pneumonia

Answer 11

anaerobes
Gram-negative enterobacteria
Staphylococcus aureus

Question 12

Patients at risk of pneumonia in immunocompromised patients

Answer 12

HIV
transplant patients
chemotherapy
leukaemia/lymphoma

Question 13

Common organisms that cause pneumonia in immunocompromised patients

Answer 13

CAP organisms (Streptococcus pneumonia, Haemophilus influenzae, Mycoplasma pneumoniae)
HAP organisms (Staphylococcus aureus, Gram-negative enterobacteria, Pseudomonas, Klebsiella)
Viruses (CMV, VZV)
Fungi (Aspergillus)
Mycobacteria

Question 14

What investigations can be used to diagnose pneumonia?

Answer 14

sputum culture - identify causative organism

FBC - raised WBC, neutrophilia, raised inflammatory markers

U+E - dehydration common (raised urea and creatinine)

LFT - can be deranged in atypical pneumonia (eg. Legionella)

Cultures (only if pyrexial) - identify organism

ABG - identify respiratory failure

CXR - consolidation or effusion

Electrocardiograph - AF common in pneumonia, rule out cardiac causes of chest pain

Question 15

When would you do an atypical pneumonia screen?

Answer 15

atypical presentation
severe pneumonia
pneumonia that is not responding to antibiotics

Question 16

What is in an atypical pneumonia screen?

Answer 16

Urinary legionella antigen
Cold agglutinins (present in mycoplasma)
Mycoplasma, chlamydia serology
Pneumococcal antigen

Question 17

What is the CURB-65 score?

Answer 17

objective assessment of pneumonia severity

C (confusion) - abbreviated mental test score <8

U (urea) - urea >7mmol/L

R (respiratory rate) - >30 breaths/min

B (BP) - systolic BP <90 mmHg

65 (age) - >65 years

Question 18

Describe interpretation of CURB-65 score

Answer 18

0-1 = mild = consider treatment at home with oral antibiotics

2 = moderate = treatment in hospital

3+ = severe = consider HDU, high mortality rate

Question 19

Pneumonia general management

Answer 19

Oxygen (maintain sats >94%)

IV fluids to correct dehydration (cautious with heart failure patients)

Antibiotics (oral or IV depending on severity)

Question 20

Complications of pneumonia

Answer 20

respiratory failure
parapneumonic effusions (pleural effusion that forms in the pleural space adjacent to a pneumonia)
empyema
lung abscess
atrial fibrillation

Question 21

Pathophysiology of pneumonia

Answer 21

Infection to lung
Inflammatory response initiated alveolar oedema + exudate formation
Alveolar and respiratory bronchioles fill with serous exudate, blood cells, fibrin, bacteria
Consolidation of lung tissues

Question 22

When does HAP typically present?

Answer 22

3 days after admission

Question 23

3 types of pneumonia (pathogenesis wise)

Answer 23

Bronchopneumonia
Lobar pneumonia
Interstitial pneumonia

Question 24

Streptococcus pneumonia sputum colour

Answer 24

Rust-coloured

Question 25

Pseudomonas aeruginosa sputum colour

Answer 25

Green

Question 26

Klebsiella sputum colour

Answer 26

Redcurrant jelly sputum

Question 27

Sputum with anaerobes

Answer 27

Bad-smelling or bad-tasting

Question 28

What can lobular pneumonia progress to if treated insufficiently?

Answer 28

Empyema of pleural effusions

Question 29

CAP moderate and severe treatment

Answer 29

Penicillin and macrolide (eg. Amoxicillin/tazobactam + clarithromycin)

Question 30

CAP prevention

Answer 30

Smoking cessation
Vaccines

Question 31

4 types of HAP

Answer 31

Ventilator associated pneumonia
Aspiration pneumonia
Environmental source (Legionella pneumophila)
Hospital transmission

Question 32

TB symptoms

Answer 32

Productive cough
Fever
Night sweats
Weight loss

Question 33

TB CXR findings

Answer 33

Upper love consolidation
Nodular

Question 34

TB treatment

Answer 34

Isoniazid
Rifampicin
Pyrazinamid
Ethambutol

Question 35

Which 2 organisms can be detected on urinary antigen dipstick?

Answer 35

Legionella
Pneumococcus

Question 36

Primary infection prevention

Answer 36

Prevent or reduce exposure
Immunisation (pneumococcus, influenza)

Question 37

Secondary infection prevention (TB)

Answer 37

Chemoprophylaxis
Contact tracing

Question 38

Tertiary infection prevention

Answer 38

Minimise disability arising from infection
Effective treatment
Physiotherapist