Pneumonia

Question 1

What is the definition of community-acquired pneumonia

Answer 1

NOT hospitalized within 14 days of onset of symptoms OR hospitalized less than 4 days prior to the onset of symptoms

Question 2

Epidemiology of CA-Pneumonia

Answer 2

<1% mortality
14% inpatient
>65 = 50% of occurrence

Question 3

What are the risk factors of community acquired pneumonia

Answer 3

Elderly
Smoking
Asthma RR: 4.2
Smoking
Lung CA
COPD
DM
Alcoholism (RR 9)
CRF
Liver Failure
CHF
Chronic steroids
Malnutrition
HIV (OR 41)
Recent < 3month ATB history
Hospitalization < 3 months

Question 4

What is the etiology of pneumonia?

Answer 4

No comorbidity: S.pneumonia, M.pneumonia, C.pneumonia

comorbidity: same + H. Influenza, S.Aureus, M.Catarrhalis, Enterobacteriaceae

Hospitalized: Same + Strep Group A, Legionella

> 50 less likely to be M.Pneumonia (therefore can use amox)

PEDS: S.Pneumonia

Question 5

Symptoms of pneumonia

Answer 5

At least 2 of the following:

Fever
New cough +/- sputum production (sensitivity 50%/chronic cough with change in colour of sputum)
Hemoptysis (Necrotizing pneumonia/TB/Gram neg)
Pleuritic chest pain
Dyspnea (sensitivity 70%)
Sweats
Weight loss

AND

Auscultatory findings consistent with pneumonia (localized crackles, bronchial breath sounds)

AND

Presence of new opacity on Chest X-Ray

Decreased likelihood –> Sore throat/Rhinorrhea, Asthma

PEDS: Fever, cough, Increased WOB, decreased feeding, vomiting, chest/Abdo pain

Question 6

What do we see on Physical examination

Answer 6

Fever
Tachypnea
Signs of consolidation:
- Diminishes chest expansion
- Increased tactile vocal fremitus
- Dullness to percussion
- Diminished air entry
- Bronchial breath sounds
- Whispering pectoriloquy
- Localized crakles
- Pleural rub
- Egophony

PEDS:
increased RR, indrawing, tracheal tug
Nasal flare, Crackles
Grunting

Question 7

Clinical decision rule diagnosis of pneumonia

Answer 7

1 point for each:
1- Temperature > 37.8 OC
2- HR> 100 bpm
3- Crackles/rales
4- Decreased breath sounds
5- No asthma

1: 1%
2: 4%
3: 8%
4: 27%
5: 47%

Alternative: if temp<37.8, HR<100, RR<20 -LR 0.09 <0.4%

Question 8

Investigations

Answer 8

AXR PA and Lateral
Hospitalized: CBC, glucose, Lytes, Cr, ALT, ABG
If severe: Sputum + blood cultures

Question 9

What score to use

Answer 9

Pneumonia Severity Index preferred over CURB 65

Question 10

How much time should we give till response to treatment in pneumonia?

Answer 10

72 hours