Pneumonia

Question 1

What is Pneumonia?

Answer 1

• Pneumonia is an infection of the lung tissue, it causes inflammation of the lung tissue and sputum filling the airways and alveoli.
• Pneumonia can be seen as consolidation on a Chest X-Ray.
• It can be caused by a bacteria, virus or atypical bacteria such as mycoplasma

Question 2

How does Pneumonia Present?

Answer 2

• Cough
• High Fever >38.5
• Tachycardia
• Tachypnoea
• Increased work of breathing
• Lethargy
• Delirium

Question 3

What are the Signs of Pneumonia?

Answer 3

• Tachypnoea (Raised RR)
• Tachycardia (Raised HR)
• Hypoxia (low oxygen)
• Fever
• Confusion

Question 4

What is the definition of Bronchial Breath Sounds in Pneumonia?

Answer 4

• Bronchial Breath Sounds: Harsh breath sounds that are equally loud on inspiration and expiration. These are caused by consolidation of the lung tissue around the airway.

Question 5

What is the definition of Focal Coarse Crackles in Pneumonia?

Answer 5

• Focal Coarse Crackles: Caused by air passing through sputum similar to using a straw to blow into a drink

Question 6

Why do you have dullness to percussion in Pneumonia?

Answer 6

• Due to lung tissue collapse and consolidation

Question 7

What are some of the Viral Causes of Pneumonia?

Answer 7

• RSV (Respiratory Syncytial Virus)
• Parainfluenza Virus
• Influenza Virus

Question 8

What are some of the Bacterial Causes of Pneumonia?

Answer 8

• Streptococcus Pneumonia
• Group A strep (Streptococcus Pyogenes)
• Group B strep - occurs in pre-vaccinated infants, typically through birth e.g. vaginally
• Staphylococcus Aureus - causes x-ray findings of pneumatocoeles (round air filled cavities) and consolidations in multiple lobes
• Haemophilus Influenza - pre/ unvaccinated children
• Mycoplasma Pneumonia, atypical bacteria with extra-pulmonary manifestations

Question 9

What Investigations would you do for Pneumonia?

Answer 9

• Chest X-ray ( not routinely required but can be useful for diagnosis)
• Causative Organism and to guide treatment: Sputum cultures and throat swabs for bacterial cultures and viral PCR
• Suspected sepsis = Blood cultures
• Capillary Blood gas Analysis can be helpful in assessing/ monitoring respiratory/metabolic acidosis and blood lactate levels

Question 10

What is the Managment for Pneumonia?

Answer 10

• Abx via the local guidelines
• 1. Amoxicillin, 2. Adding a Macrolide (erythromycin, clarithromycin or azithromycin) = atypical pneumonia
• IV ABx can be used when there is sepsis or a problem with intestinal absorbtion

Question 11

What should you do for Recurrent Lower Respiratory Tract Infections?

Answer 11

• When a child is having recurrent admissions requiring Abx for a lower respiratory tract infections
• Investigations:
  1.FBC (White blood cells)
  2.CXR (structural abnormalities/ scarring from infections)
  3.Serum Immunoglobulins (to test for low levels of antibody classes = antibody deficiency)
  4. Immunoglobulin Class-switch recombination deficiency (unable to convert IgM to IgG)
  5. Sweat test for cystic fibrosis
  6. HIV text