Pneumonia

Question 1

Typical vs Atypical pneumonia

Answer 1

Typical pneumonia is sudden onset with productive cough which is usually caused by streptococcus pneumoniae whereas atypical is less severe with a dry cough which is usually caused by mycoplasma pneumoniae, chlamydia pneumoniae, legionella

Question 2

How is lobar pneumonia characterised

Answer 2

It is characterised by a predominantly intra-
alveolar exudate and may involve an entire lobe
of the lung.

Question 3

What are the 4 pathological stages of lobar pneumonia

Answer 3

1. Congestion—outpouring of protein-rich exudate into the alveolae 2. Red hepatization—massive accumulation of red cells and polymorphs in the alveolar spaces, giving a liver-like consistency (hence ‘hepatization’)
2. Grey hepatization—accumulation of fibrin in the lung spaces with red-cell disintegration
3. Resolution—most patients recover with their lungs returning to normal structure and function

Question 4

What is the pneumonic curb 65 and when is it used

Answer 4

It is used for assessing community acquired pneumonia

• Confusion
• Urea > 7 mmol/L
• Respiratory Rate > 30
• Blood Pressure Sys BP < 90 or Diastolic < 60 mmHg
• Age > 65

Question 5

How is bronchopneumonia characterised

Answer 5

A patchy distribution involving one or more lobes, with an inflammatory infiltrate extending from the bronchioles into the adjacent alveoli.

It is common in
(a) as a terminal event in a chronic debilitating disease
(b) in infancy
(c) in old age
(d) as a manifestation of secondary infection in viral conditions, e.g. influenza, measles.

Question 6

What is nosocomial pneumonia

Answer 6

Hospital acquired pneumonia

Question 7

What is aspiration pneumonia

Answer 7

Aspiration pneumonia occurs when fluid or food is aspirated into the lung, resulting in secondary inflammation and consolidation.

Question 8

What are the complications of pneumonia

Answer 8

• Lung fibrosis—inflammatory exudate is often not completely absorbed but is organized with residual fibrous scarring and permanent lung dysfunction.
• Bacteraemia—bacterial dissemination of organisms can lead to
septicaemia with meningitis, arthritis, endocarditis or pyemic abscesses.
• Lung abscesses—single or multiple areas of suppuration.
• Empyema—pus in the pleural cavity as a result of extension of infection into the pleural cavity.
• Pleural effusion—non-infected effusion is common. •
Death.