Pneumonia

Question 1

What are the 2 lower resp tract infections?

Answer 1

Pneumonia and TB

Question 2

What is pneumonia?

Answer 2

Fluid exudation into alveoli due to inflammation; from INFECTION

Question 3

What causes pneumonia?

Answer 3

Typically bacterial, can be viral
Can be CAP (Community acquired pneumonia) or
HAP (Hospital acquired pneumonia)

Question 4

CAP is found where?

Answer 4

In community or <48 hours in hospital

Question 5

What can cause CAP?
overall

Answer 5

Bacteria
viral
Fungi

Question 6

Which Bacteria cause CAP?
3 main ones

Answer 6

S.Pneumoniae - (MC Cause)
H. Influenzae
Mycoplasma pneumonae - (causes atypical pneumonia)

Question 7

What other bacteria also cause CAP?

Answer 7

S. aureus
Legionella (typically comes from SPAIN or associated with air conditioning)
Moraxella
Chlamydia Pneumoniae (atypical pneumonia)

Question 8

2 Viral causes of CAP?

Answer 8

H.Flu
CMV

Question 9

What is the fungal cause of CAP?
Who is it specifically found in?

Answer 9

P. Jirovecii
(in immunocompromised only - HIV)
PCP is AIDS defying illness

Question 10

HAP is found where?

Answer 10

> 48 hours of hospital admission

Question 11

What causes HAP?
General

Answer 11

Bacteria

Question 12

Bacteria that cause HAP?

Answer 12

P. auruginosa
E. coli
Klebsiella
(these 3 all gram -ve aerobic bacilli)
MRSA

Question 13

Are HAP bacteria more or less severe and why?

Answer 13

HAP are more severe as many of these are drug resistant (MDR)

Question 14

How do these pathogens enter the Px?

Answer 14

Typically from inhaled pathogens, also can be from aspiration

Question 15

RF for pneumonia?

Answer 15

Immunocompromised (HIV, long term steroids)
IV DU (S.aureus)
Resp, pre existing disease
very old/young

Question 16

Pathology of typical pneumonia

Answer 16

Bacteria invades + exudate forms inside alveoli lumen + sputum

Question 17

Pathology of atypical pneumonia?

Answer 17

Bacteria invade + exudate forms In interstitial of alveoli + dry cough (mycoplasma pneumoneae)

Question 18

Sx of pneumonia

Answer 18

Productie cough with rusty coloured sputum (purulent = pus)

Pyrexic (high temp) - due to infection

Pleuritic chest pain - worse when breathing and coughing

Tachypnoea and dyspnoea (tachy + hypo)

Confusion in elderly

Question 19

If atypical, what Sx seen?

Answer 19

Dry cough and low grade fever

Question 20

Dx for pneumonia ?
1st line?
diagnostic?

Answer 20

1st line + diagnostic = Chest X ray shows consolidation - ‘airbronchogram’ - fluid filled surrounding alveoli
Diagnostic sign - Airfield bronchi made visible by pacified fluid filled surrounding alveoli

Sputum sample + culture 10 organisms (gram stain, Ziehl Neelsen stain)

Question 21

On chest x ray for pneumonic lesions, what would be seen in diff organisms?

Answer 21

Multilobar = S. pneumoniae, S.aureus, Legionella
Multiple abscesses = s.aureus
upper lobe = Klebsiella but exclude TB FIRST

Question 22

For CAP to assess the severity, what acronym is used and what does it stand for?

Answer 22

CURB 65
Confusion
Urea nitrogen >7mmol/L
RR >30
BP <90/60mmHg (<90 sys or <60 dias)
65+ y/o

Question 23

Scored out of?
what is the Tx for each score?

Answer 23

5
1. 3% mortality, out Px, oral Abx + discharge
2. Consider short hospital stay + Abx
>3. 15% mortality, HOSPITAL (ICU) + IV Abx

Question 24

General Tx for pneumonia

Answer 24

O2 (sats 94-98%) unless COPD
Broad spec Abx
Analgesia (NSAIDS) for pleuritic chest pain

Question 25

Abx for CAP :
CURB 0-2
CURB 3-5
Except which bacteria, what is the 1st line for and what else about the bacteria?

Answer 25

CURB 0-2 = Amoxicillin

CURB 3-5 = Coamoxiclav + clarythromycin

Except legionella
1st line = clarythromycin
Notifiable disease to Public Health England

Question 26

Aspiration pneumonia?
seen in Px with?
what is it?

Answer 26

seen in Px with stroke, bulbar palsy, MG

Aspiration of gastric contents into lungs, can be fatal due to destructiveness of gastric acid