pneumonia

Question 1

define pneumonia

Answer 1

inflammation of the air sacs in the lungs due to fluid exudation into the alveoli

Question 2

what causes pneumonia

Answer 2

infection
typically bacterial but can be viral

Question 3

2 types of pneumonia

Answer 3

1. community-acquired pneumonia
2. hospital-acquired pneumonia

Question 4

what is community acquired pneumonia

Answer 4

pneumonia acquired outside hospital environment or healthcare services.

Question 5

what is hospital acquired pneumonia

Answer 5

an acute lower respiratory tract infection that is by definition acquired after at least 48 hours of admission to hospital and is not incubating at the time of admission.

Question 6

what is atypical pneumonia

Answer 6

caused by atypical organisms not detectable by gram stain

Question 7

which bacteria cause CAP

Answer 7

1. Streptococcus pneumoniae
2. Haemophilus influenzae

Question 8

which bacteria cause HAP

Answer 8

1. Pseudomonas aeruginosa
2. E coli
3. klebsiella

all are gram negative aerobic bacilli

Question 9

which bacteria causes atypical phemonia

Answer 9

mycoplasma pneuominae

Question 10

viral causes of pneumonia

Answer 10

H. flu
CMV

Question 11

If question has water cooler/air conditioner what bacteria is it most likely to be

Answer 11

Legionella

Question 12

If question mentions HIV patient what is the cause of pneumonia most likely to be

Answer 12

likely pneumocystis jiroveci which is a fungal infection

Question 13

risk factors for pneumonia

Answer 13

• immunocompromised
• IVDU
• pre existing resp disease
• v young/old

Question 14

pathophysiology of typical pneumonia

Answer 14

bacteria invades and exudate forms inside alveoli lumen

results in sputum

Question 15

pathophysiology of atypical pneumonia

Answer 15

bacteria invades and exudate forms in interstitium of alveoli

results in dry cough

Question 16

symptoms of pneumonia

Answer 16

• productive Cough
• nasty coloured sputum
• SOB
• fever
• pleuritic chest pain

Question 17

symptoms of atypical pneumonia

Answer 17

dry cough
low grade fever

Question 18

signs of pneumonia

Answer 18

↑ RR + HR, ↓BP, ↓ O2 sats,
Dull to percuss, Increased tactile fremitus

Question 19

what is present on auscultation of pneumonia patient

Answer 19

• Wheezing
• Coarse crackles
• Bronchial breath sounds
• Increased vocal resonance

Question 20

3 main investigations for pneumonia

Answer 20

1. chest x ray
2. sputum culture
   3.. FBC

Question 21

what does FBC for pneumonia show

Answer 21

elevated WBC

Question 22

what does chest x ray for pneumonia show

Answer 22

• localised/widespread consolidation
• effusion
• abscesses
• empyema

Question 23

how to assess severity of CAP

Answer 23

CURB 65

1. confusion
2. urea nitrogen >7mmol/L
3. RR > 30
4. BP < 90/60
5. 65+ age

Question 24

how to score using CURB 65

Answer 24

score out of 5
1. - outpatient 3% mortality
2 - consider short hospital stay + Abx
3. -15% mortality - hospital

Question 25

how to treat CURB score of 0-1

Answer 25

Oral amoxicillin for 5d (or macrolide if penicillin allergy)

Question 26

how to treat CURB score of 2

Answer 26

Dual therapy with amoxicillin + macrolide (IV or oral) for 7-10d.

Question 27

how to treat CURB score of 3-5

Answer 27

IV co-amoxiclav + macrolide

Question 28

other treatment options for pneumonia

Answer 28

• Maintaining O2 Sats between 94-98%
• In COPD patients: maintain O2 sats between 88-92%
• Analgesia: paracetamol or NSAIDs
• IV fluids

Question 29

which patients is aspiration pneumonia seen in

Answer 29

patients with stroke, bulbar palsy and MG

Question 30

what is aspiration pneumonia

Answer 30

aspiration of gastric contents into lungs