Pneumonia

Question 1

What is it?

Answer 1

1. Infection of lung parenchyma

Question 2

Common organisms:

Answer 2

1. Streptococcus pneumoniae is the commonest cause (60–75%)
2. Haemophilus influenzae
3. Mycoplasma pneumoniae
4. Staphylococcus aureus found more commonly in ICU patients
5. Legionella species
6. Chlamydia psittaci
7. Gram-negative bacilli, often hospital-acquired or immunocompromised - Pseudomonas
   8.

Question 3

Sx:

Answer 3

1. Fever
2. Rigors
3. Malaise
4. Anorexia
5. Dyspnoea
6. Cough
7. Purulent sputum (classically
   ‘rusty’ with pneumococcus)
8. Haemoptysis
9. Pleuritic chest pain

Question 4

Signs:

Answer 4

1. Fever
2. Cyanosis
3. Confusion
4. Tachypnoea
5. Tachycardia
6. Hypotension
7. Signs of consolidation

Question 5

Investigations:

Answer 5

1. O2 sats
2. Bloods - ABG, FBC, U&E, LFT, CRP, atypical serology
3. CXR
4. Urine pneumococcal (and legionella) antigen
5. Viral throat swabs if appropriate
6. Blood cultures if pyrexial
7. Pleural fluid may be aspirated for culture
8. Bronchoscopy and bronchoalveolar lavage if the patient is immunocompromised or on ICU

Question 6

Criteria for CURB-65:

Answer 6

1. Confusion (abbreviated mental test ≤8)
2. Urea >7mmol/L
3. RR ≥30/min
4. BP <90/60mmHg
5. Age ≥ 65

Question 7

Scoring CURB-65:

Answer 7

0–1 = Home treatment if possible
2 = Hospital therapy
≥ 3 = Severe pneumonia & consider ICU referral

Question 8

Cx:

Answer 8

1. Pleural effusion
2. Empyema
3. Lung abscess
4. Respiratory failure
5. Septicaemia
6. Pericarditis
7. Myocarditis
8. Cholestatic jaundice
9. Acute kidney injury