Pneumonia

Question 1

Definition

Answer 1

Infection of the lung tissue causing inflammation in the alveoli

Question 2

Types

Answer 2

CAP, HAP, VAP, aspiration pneumonia

Question 3

Symptoms

Answer 3

SOB, fever, pleuritic chest pain, cough, sputum, confusion , haemoptysis

Question 4

Examination findings

Answer 4

Focal coarse crackles, bronchial breath sounds, dull to percuss, increased vocal resonance, reduced chest expansion

Question 5

Investigations

Answer 5

Chest X-ray
FBC, U&E, CRP
Sputum culture
Blood culture
PO2
CURB65
Renal profile

Question 6

Main causes

Answer 6

Strep pneumoniae
H. influenza

Question 7

Atypical causes

Answer 7

Mycoplasma pneumoniae - erythema multiforme
Coxiella burnetti (Q fever) - infected animals
Legionella pneumoniae - SIADH, hyponatraemia
Chlamydia psittaci - birds e.g. parrot
Chlamydia pneumoniae
Pneumocystic jiroveci - fungus with increased risk in HIV and low CD4 - SOB, dry cough and night sweets

Question 8

Treatment

Answer 8

CURB1 - oral amox (1st line), doxycycline or clarithromycin for 5 days
CURB2 or more - IV amox and clarithromycin for 7-10 days- oral when stable

Question 9

Complications

Answer 9

Pleural effusion
Empyema
Lung abscess
Sepsis
ARDS
Death

Question 10

Differential diagnosis and other investigations

Answer 10

PE
Pulmonary oedema
Neoplasm
Bronchiectasis
Other investigations: CT and bronchoscopy for unresolved cases

Question 11

Follow-up

Answer 11

Repeat CXR at 6 weeks

Question 12

Length of recovery

Answer 12

By 3 months fatigue may still present. Should be fully recovered by 6 months (passmed)