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A. MLA Map Acute and Emergency > Pneumonia > Flashcards

Pneumonia Flashcards

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1
Q

Pneumonia is an infection of the lungs, which can lead to fluid and other components being draw into the lungs and filling the alveoli. What is the incidence of pneumonia?

1 - 50,000 / 100,000
2 - 5000 / 100,000
3 - 500 / 100,000
4 - 50 / 100,000

A

3 - 500 / 100,000

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2
Q

Pneumonia is an infection of the lungs, which can lead to fluid and other components being draw into the lungs. What age does the cases of pneumonia at its peak?

1 - >35
2 - >45
3 - >60
4 - >75

A

4 - >75

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3
Q

Pneumonia in children is the single largest contributor to childhood mortality worldwide, account for how many deaths per year in <5 year old children?

1 - 1000
2 - 10,000
3 - 100,000
4 - 1,000,000

A

4 - 1,000,000

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4
Q

Pneumonia is an infection of the lungs, which can lead to fluid and other components being draw into the lungs. Are men or women affected more by pneumonia?

A
  • equally affected
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5
Q

The bodies innate immune system aims to reduce the risk of infection in a number of ways. Which of the following does this include?

1 - mucociliary escalator
2 - cough reflex
3 - macrophages
4 - all of the above

A

4 - all of the above

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6
Q

Which of the following is NOT a risk factor for developing pneumonia?

1 - aged <5 or >65-years-old
2 - smoking
3 - recent viral RTI
4 - chronic respiratory diseases
5 - immunosuppressed (diabetes)
6 - gender
7 - neurological impairment
8 - IV drug users
9 - co-morbidities
10 - prolonged hospital stay

A

6 - gender

  • patients at risk of aspiration include those with neurological diseases such as Parkinson’s disease or those with oesophageal obstruction
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7
Q

Pneumonia can be caused by viruses, bacteria and fungi, but which is most common?

A
  • bacteria
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8
Q

The are a myriad of bacteria that can cause pneumonia, but which is most common?

1 - streptococcus pneumoniae
2 - haemophilus influenzae
3 - staphylococcus aureus
4 - legionella pneumophila

A

1 - streptococcus pneumoniae

All of these can cause pneumonia though

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9
Q

The are a myriad of viruses that can cause pneumonia, but which is most common?

1 - Covid-19
2 - SARS
3 - influenza
4 - respiratory syncytial virus

A

3 - influenza

  • respiratory syncytial virus is the most common cause of pneumonia in children
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10
Q

Match the most common causes of pneumonia with the age of the child:

Newborn – organisms maternal genital tract: Group B strept, Gram neg orgs

Age
- Newborn
- Infants and young children
- >5 years old

Cause
- Viruses e.g RSV
- organisms maternal genital tract: Group B strept, Gram neg organisms
- Mycoplasma pn, Strept pn, Chlamydia pneumoniae

A
  • Newborn = organisms maternal genital tract: Group B strept, Gram neg organisms
  • Infants and young children = Viruses e.g RSV
  • > 5 years old = Mycoplasma pn, Strept pn, Chlamydia pneumoniae
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11
Q

Is pneumonia typically caused by an infection that begins in the upper (URT) or lower respiratory tract (LRT)?

A
  • begins in the URT and then moves to the LRT
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12
Q

Once an infection reaches the lower respiratory tract which of the following occurs?

1 - immune cells initiate and immune response
2 - immune cells secrete cytokines and an inflammatory response and induce fever
3 - fluid leaks into inflamed tissue and can cause pus accumulation
4 - gas exchange at the alveoli is impaired causing hypoxia
5 - all of the above, typically in this order

A

5 - all of the above, typically in this order

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13
Q

Pneumonia can be classified on where it is acquired. Which of the following is the most common?

1 - community -acquired pneumonia
2 - hospital-acquired pneumonia
3 - ventilator associated pneumonia
4 - all equal

A

1 - community -acquired pneumonia
- patient becomes sick outside of a hospital setting

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14
Q

Pneumonia can be classified on where it is acquired. Which of the following is the most aggressive and dangerous pneumonia?

1 - community -acquired pneumonia
2 - hospital-acquired pneumonia
3 - ventilator associated pneumonia
4 - all equal

A

2 - hospital-acquired pneumonia
- patient gets sick in whilst in hospital being treated for something else

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15
Q

Are bacteria and viruses the only way patients can acquire pneumonia?

A
  • no
  • may acquire pneumonia by aspiration
  • such as food, gastric contents
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16
Q

Aspiration pneumonia can be caused by a myriad of things. Which of the following can increase the risk of an aspiration pneumonia?

1 - alcohol and drug abuse
2 - brain injuries
3 - swallowing dysfunction
4 - all of the above

A

4 - all of the above

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17
Q

Pneumonia can be categorised based on where in the lungs the infection affects. One of these is bronchopneumonia. Which part of the lung is affected in bronchopneumonia?

1 - whole lobe only
2 - alveoli only
3 - bronchi only
4 - alveoli and bronchi

A

4 - alveoli and bronchi

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18
Q

Pneumonia can be categorised based on where in the lungs the infection affects. One of these is lobar pneumonia. Which part of the lung is affected in lobar pneumonia?

1 - whole lobe only
2 - alveoli only
3 - bronchi only
4 - alveoli and bronchi

A

1 - whole lobe only
- commonly caused by streptococcus pneumoniae

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19
Q

Pneumonia can be categorised based on where in the lungs the infection affects. One of these is atypical/interstitial pneumonia. Which part of the lung is affected in atypical/interstitial pneumonia?

1 - whole lobe only
2 - alveoli only
3 - interstitium around alveoli
4 - alveoli and bronchi

A

3 - interstitium around alveoli
- can typically cause less severe or sub acute pneumonia, termed ‘walking pneumonia’
- absence of lobar consolidation on chest x-ray
- not detectable on Gram stain
- lack of response to penicillin antibiotics

20
Q

When comparing a bacterial vs a viral cause of pneumonia, which is more likely to affect the whole of one lung or both lungs?

A
  • viral

Bacterial causes of pneumonia are typically confined into one or 2 lobes

21
Q

Which is the most likely class of organism responsible for this acute presentation?

1 - Bacterial
2 - Fungal
3 - Rickettsial
4 - Tuberculous
5 - Viral

A

5 - Viral

Rickettsial and Tuberculous are typically more chronic conditions

22
Q

Does bacterial or viral pneumonia cause purulent sputum?

A
  • bacterial
23
Q

Pneumonia can typically be broken down into 4 stages. What occurs at stage 1?

1 - resolution = exudate gets digested by enzymes, ingested by macrophages, or coughed up
2 - red hepatization = exudate, RBCs, neutrophils and fibrin fill airspace and lungs appear more solid
3 - congestion = blood vessels and alveoli start filling with excess fluid
4 - gray hepatization = lungs are firm but RBCs begin to break down

A

3 - congestion = blood vessels and alveoli start filling with excess fluid

  • happens between 1 and 2 days
24
Q

Pneumonia can typically be broken down into 4 stages. What occurs at stage 2?

1 - resolution = exudate gets digested by enzymes, ingested by macrophages, or coughed up
2 - red hepatization = exudate, RBCs, neutrophils and fibrin fill airspace and lungs appear more solid
3 - congestion = blood vessels and alveoli start filling with excess fluid
4 - gray hepatization = lungs are firm but RBCs begin to break down

A

2 - red hepatization = exudate, RBCs, neutrophils and fibrin fill airspace and lungs appear more solid

  • happens between 3 and 4 days
25
Q

Pneumonia can typically be broken down into 4 stages. What occurs at stage 3?

1 - resolution = exudate gets digested by enzymes, ingested by macrophages, or coughed up
2 - red hepatization = exudate, RBCs, neutrophils and fibrin fill airspace and lungs appear more solid
3 - congestion = blood vessels and alveoli start filling with excess fluid
4 - gray hepatization = lungs are firm but RBCs begin to break down

A

4 - gray hepatization = lungs are firm but RBCs begin to break down

  • happens between 5 and 7 days
26
Q

Pneumonia can typically be broken down into 4 stages. What occurs at stage 4?

1 - resolution = exudate gets digested by enzymes, ingested by macrophages, or coughed up
2 - red hepatization = exudate, RBCs, neutrophils and fibrin fill airspace and lungs appear more solid
3 - congestion = blood vessels and alveoli start filling with excess fluid
4 - gray hepatization = lungs are firm but RBCs begin to break down

A

1 - resolution = exudate gets digested by enzymes, ingested by macrophages, or coughed up

  • happens between 8 days to 3 weeks
27
Q

Pneumonia can cause respiratory and systemic symptoms. Which of the following is NOT a respiratory symptoms?

1 - Cough
2 - Dyspnoea
3 - Malaise
4 - Pleuritic chest pain

A

3 - Malaise

  • cough = productive or non-productive, with purulent sputum in bacterial pneumonia.
  • dyspnoea = mild to severe
  • pleuritic chest pain = sharp, localised pain, exacerbated by coughing or deep breathing, suggestive of pleural involvement
28
Q

Pneumonia can cause respiratory and systemic symptoms. Which of the following is NOT a systemic symptoms?

1 - fever and chills
2 - dyspnoea
3 - malaise
4 - anorexia and weight loss

A

2 - dyspnoea

  • fever and chills = high-grade (bacteria) or low grade (viral) fever
  • malaise, fatigue, and myalgias = common in both bacterial and viral pneumonia.
  • anorexia and weight loss = may occur due to decreased appetite and increased metabolic demands
29
Q

If examining a patient with pneumonia, which of the following are we likely to detect?

1 - tachypnoea
2 - tachycardia
3 - hypoxia: Indicative of respiratory compromise.
4 - basal crackles
5 - all of the above

A

5 - all of the above

30
Q

To diagnose a patient with pneumonia we can use a chest X-ray. Match the findings with the type of pneumonia:

  • lobar pneumonia, atypical/interstitial pneumonia and bronchopneumonia
  • lobular infiltrates with fluid
  • peri-hilar infiltrates
  • patchy areas of infiltration throughout
A
  • lobar pneumonia = lobular infiltrates with fluid
  • atypical/interstitial pneumonia = peri-hilar infiltrates
  • bronchopneumonia = patchy areas of infiltration throughout
31
Q

In a patient with pneumonia, when we percuss the chest, would we expect there to be increased resonance or a decreased resonance with dullness with a consolidation, which is fluid in the lung tissue, that DOES NOT move with gravity?

A
  • reduced resonance with dullness
32
Q

In a patient with pneumonia, would we expect to feel more or less tactile fremitus than in a normal lung?

A
  • more

Vibrations travel through fluid better so we feel them more than in a healthy lung

33
Q

In a patient with pneumonia, would we expect to hear vocal fremitus more or less than in a normal lung?

A
  • more
  • vibrations travel through fluid better sop we feel them more than in a healthy lung
34
Q

In a patient with pneumonia, would we expect to hear late inspiratory crackles and bronchial breath sounds?

A
  • yes
35
Q

Patients with suspected pneumonia are expected to be seen by their GPs. Which scoring system us used to assess the severity of patients pneumonia and mortality risk?

1 - Wells score
2 - Lights criteria
3 - Dukes criteria
4 - CURB65 score

A

4 - CURB65 score

  • C = new onset confusion (<8 on MMS)
  • U = urea (>7 mmol/L) (typically used in hospital only)
  • R = respiratory rate (>30/min)
  • B = BP (SBP <90 and DBP >60 mmHg)
  • 65 = patients aged >65
36
Q

The CURB65 score ranges from 0-4, increasing upon severity.

  • 0: low risk (less than 1% mortality risk)
  • 1 or 2: intermediate risk (1-10% mortality risk)
  • 3 or 4: high risk (more than 10% mortality risk)

Patients that do not need hospital admission and are safe to be treated at home according to NICE typically have what score?

1 - 3-4
2 - 2-3
3 - 1-2
4 - 0-1

A

4 - 0-1
- also based on clinical insight

Patients scoring >2 should be assessed in hospital
Patients scoring >3 should be admitted to ICU

37
Q

In addition to a CRB65 score in primary care to assess the severity of patients pneumonia and risk of mortality, what other test is used to assess if a patient should be started on antibiotics according to NICE guidelines?

1 - WBC
2 - ESR
3 - CRP
4 - LFTs

A

3 - CRP

All the others may also be performed though

Blood and sputum cultures should also be performed

38
Q

CRP can be used to identify patients who may require antibiotics. What CRP level would mean that antibiotics should be started straight away?

1 - <20mg/mL
2 - 20-50mg/mL
3 - 20-100mg/mL
4 - >100mg/mL

A

4 - >100mg/mL

CRP < 20 mg/L - do not routinely offer antibiotic therapy
CRP 20 - 100 mg/L - consider a delayed antibiotic prescription
CRP > 100 mg/L - offer antibiotic therapy

39
Q

It can be hard to differentiate between viral and bacterial causes of pneumonia. But typically, which is associated with the following:

  • high temperatures
  • high inflammatory markers (CRP)
  • systemically unwell child
A
  • bacterial is more likely

BUT diagnosis can only be confirmed using a blood and/or sputum culture

40
Q

In a patient with NKDA, which antibiotic should be the 1st line treatment for patients with low severity pneumonia?

1 - amoxicillin (penicillin)
2 - clarithromycin (macrolide)
3 - doxycycline (tetracycline)
4 - vancomyosin (glycopeptide)

A

1 - amoxicillin (penicillin)
- 5 day course TDS

  • amoxicillin = penicillin binding protein that inhibits wall synthesis
41
Q

In a patient with an allergy to penicillin, which 2 of the following antibiotics should be the 1st line treatment for patients with low severity pneumonia?

1 - gentamicin (aminoglycosides)
2 - clarithromycin (macrolide)
3 - doxycycline (tetracycline)
4 - vancomyosin (glycopeptide)

A

2 - clarithromycin (macrolide)
- binds 50s and inhibits protein synthesis

3 - doxycycline (tetracycline)
- binds 30s and inhibits protein synthesis

  • 5 day course
42
Q

In patients with NKDA, and moderate to severe pneumonia (CURB65 score >3), they require dual antibiotic therapy for 7-10 days. Which 2 of the following should they be prescribed?

1 - co-amoxiclav (penicillin)
2 - clarithromycin (macrolide)
3 - doxycycline (tetracycline)
4 - vancomyosin (glycopeptide)

A

1 - co-amoxiclav (penicillin)
2 - clarithromycin (macrolide)

43
Q

Which of the following are pulmonary complications that can be caused by pneumonia?

1 - empyema (pus in pleural space)
2 - lung abscess (pus collection in lung parenchyme)
3 - pneumothorax
4 - acute respiratory distress syndrome
5 - pleural effusions
6 - all of the above

A

6 - all of the above

44
Q

Which of the following are extra-pulmonary complications that can be caused by pneumonia?

1 - bacteremia and sepsis
2 - metastatic infections
3 - pericarditis
4 - AKI
5 - all of the above

A

5 - all of the above

45
Q

NICE recommends that patients with pneumonia should NOT be discharged if they have certain criteria. Which of the following is NOT one of these?

1 - temperature >37.5°C
2 - RR >24
3 - HR >65
4 - SBP <90mmHg
5 - sats <90% on room air
6 - abnormal mental status
7 - inability to eat without assistance

A

3 - HR >65
heart rate over 100 beats per minute is part of the criteria

46
Q

A 72 year old man with background history of multiple myeloma presents to the emergency department with shortness of breath, sore throat runny node and a cough. He had chemotherapy 4 days previously.
Observations: HR 118 bpm, BP 90/60 mmHg, temperature 38.2°C, respiratory rate 25 /min, O2 saturation 75% on air..
Blood results:
Hb 96 g/L
WBC 0.9 x109/L
CRP 115 mg/L
U&E: normal
Urinalysis: 1+ blood and 1+ protein, nitrite -ve
Chest X-ray shown in image. What is the most likely diagnosis?

1 - Aspiration pneumonia
2 - Neutropenic sepsis
3 - Lobar pneumonia
4 - Urinary tract infection
5 - Upper respiratory tract infection

A

2 - Neutropenic sepsis

A. MLA Map Acute and Emergency (42 decks)

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