Pneumonia

Question 1

Aetiology of pneumonia?

Answer 1

• common inflammatory condition affecting the alveoli
• occurs as a result of pathogens entering the lower respiratory tract and causing infection

Causative pathogens include:
- Bacteria eg streptococcus pneumonia - the most common cause of community acquired pneumonia

• virus
• fungus

Question 2

Pathophysiology of pneumonia

Answer 2

1. pathogen enters lower respiratory tract
2. inflammatory cascade beings
3. neutrophils migrate to the infected alveoli and release cytokines which activate an immune resposne and induce fever
4. accumulation of fluid and pus within the alveoli
5. imapirement of gas exchange
6. hypoxic state which is characteristic of pneumonia

Question 3

Risk factors of pneumonia

Answer 3

• under 5 year or over 65 years
• smoking
• recent viral resp tract infectoin
• chronic respiratory diseases: cystic fibrosis, COPD
• immunosppression
• IV drug users
• diabetes, cardiovascular disease

Question 4

Symptoms of pneumonia?

Answer 4

• a cough with purulent sputum (rust coloured/bloodstained)
• dyspnoea
• chest pain (may be pleuritic in nature)
• fever
• malaise

Question 5

Signs of pneumonia?

Answer 5

• systemic infection: high temp, tachycardia, hypotension, confusion
• tachypnoea
• low oxygen sats
• reduced breath sounds, bronchial breathing, crepitations/crackles on auscultation
• dullness on percussion (fluid)

Question 6

NICE recommends that patients should be initally assessed in primary care using which criteria?

Answer 6

CRB65

C = confusion (abbreviated mental test score <=8/10)

R = respiration rate = >30 /min

B = Blood pressure systolic <=90 mmHg and/or diastolic <= 60 mmHg

65 = aged >=65 years

Question 7

Patients are stratified for risk of death as follows: (CRB65)

Answer 7

0: low risk (less than 1% mortality risk)

1 or 2: intermediate risk (1-10% mortality risk)

3 or 4: high risk (more than 10% mortality risk).

Question 8

Should patients be cared for at home or in hospital with pneumonia?

Answer 8

• home-based care for patients with a CRB65 score of 0
• hospital assessment for all other patients, particularly those with a CRB65 score of 2 or more.

clinical judgement should also be considered

Question 9

NICE also mention point-of-care CRP test. This is currently not widely available but they make the following recommendation with reference to the use of antibiotic therapy:

Answer 9

• CRP < 20 mg/L - do not routinely offer antibiotic therapy
• CRP 20 - 100 mg/L - consider a delayed antibiotic prescription
• CRP > 100 mg/L - offer antibiotic therapy

Question 10

What might an X-ray show?

Answer 10

• consolidation in the area of infection
• may also show effusion

Question 11

Bloods show?

Answer 11

• FBC: raised WBC
• U&E: urea from the CURB-65 score
• CRP: raised inflammation. Monitoring is recommended for admitted patients to help determine response to treatment
• blood cultures

Question 12

Sputum sample ?

Answer 12

Used to diagnose causative organisms after culture

Question 13

What antibodies are recommended in intermediate or high risk patients?

Answer 13

Legionella antibodies

Question 14

Treatment of pneumonia

Answer 14

• Amoxicillin is the 1st line antibiotic for low severity community acquired pneumonia
• Clarithromycin anddoxycycline
  are both used in the treatment of pneumonia, particularly those caused by atypical organisms
• Co-amoxiclavor Co-amoxiclav and clarithromycin → high severity CAP

Question 15

Appropriate drug treatment for a women presenting with green sputum, 95% sats, normal bp, normal repiratory rate and temperature of 37.8?

Answer 15

Amoxicillin

Question 16

What is aspiration pneumonia?

Answer 16

pneumonia that develops as a result of foreign materials gaining entry to the bronchial tree, usually oral or gastric contents such as food and saliva.

Aspiration pneumonia often results from an incompetent swallowing mechanism, such as those that occur in neurological disease or injury such as stroke, multiple sclerosis and intoxication. Iatrogenic causes, such as intubation, can also result in aspiration pneumonia developing.

Question 17

Risk factors for the development of aspiration pneumonia include:

Answer 17

• Poor dental hygiene
• Swallowing difficulties
• Prolonged hospitalization or surgical procedures
• Impaired consciousness
• Impaired mucociliary clearance

Question 18

The bacteria often implicated in aspiration pneumonia are aerobic, and often include:

Answer 18

• Streptococcus pneumoniae
• Staphylococcus aureus
• Haemophilus influenzae
• Pseudomonas aeruginosa

Question 19

In a patient with pneumonia,recent influenza infection is most associated with which organism?

Answer 19

staphylococcus aureus

Question 20

In a patient with pneumonia,dry cough and atypical chest signs, autoimmune haemolytic anaemia and erythema multiformeis most associated with which organism?

Answer 20

mycoplasma pneumoniae

Question 21

In a patient with pneumonia,a past history of alcohol excess
is most associated with which organism?

Answer 21

Klebisella pneumoniae

Question 22

A history of HIV, dry cough, exercise-induced desaturations and the absence of chest signs

Answer 22

Pneumocystis jiroveci