Pneumonia

Question 1

What is Pneumonia, and what does it look like on a chest X-ray?

Answer 1

• infection of the lung tissue, causing inflammation in the alveolar space.
• on a CXR, it can be seen as a consolidation

Question 2

How can pneumonia be classified; what are the 4 classifications of penumonia?

Answer 2

1) community-acquired pneumonia (CAP)
2) Hospital-acquired pneumonia (HAP)- develops after more than 48 hours in a hospital
3) Ventilator-acquired pneumonia (VAP)- develops in intubated patients in the ICU
4) Aspiration pneumonia- wen infection develops due to aspiration of food or fluids, usually in patients with impaired swallowing.

Question 3

What are the presenting symptoms of pneumonia?

Answer 3

• cough
• sputum production- usually green
• SOB
• fever
• malaise
• hemoptysis
• pleuritic chest pain (sharp chest pain, worse on inspiration)
• delirium (acute confusion)

Question 4

What are the characteristic chest signs of pneumonia? (3)

Answer 4

1) bronchial breath sounds
2) focal coarse crackles caused by air passing through sputum in the airways
3) dullness to percussion- due to lung tissue filled with sputum or collapsed

Question 5

Signs that could indicate sepsis secondary to pneumonia:

Answer 5

• tachypnoae
• tachycardia
• hypoxia
• hypotension (shock)
• fever
• confusion

Question 6

Which tool do you use to assess the severity of the pneumonia? What do the results mean?

Answer 6

CURB65

C- confusion
U- urea > 7mmol/L
R- RR>/30
B- BP <90 systolic or </60 diastolic
65- age >/65

• Score 0/1- low risk- treat at home
• score >/2- consider hospital admission
• score >/3- consider intensive care

Question 7

Which infective organisms are the top two causes of pneumonia? what are other causes of it, and which patients are likely to acquire it?

Answer 7

1) streptococcus pneumoniae
2) haemophilus influenzae

• moraxella catarrhalis- in immunocompromised patients or those with chronic pulmonary disease
• pseudomonas aeruginosa- patients with CF or bronchiectasis
• staphylococcus aureus- in patients with CF
• MRSA- HCAIs

Question 8

Atypical pneumonia and Other causes

Answer 8

Still have to make flashcards on this!!

Question 9

What investigations would you do on a patient with CURB score of more than 1?

Answer 9

1) CXR
2) FBC- raised WBCs
3) Renal profile- urea level for CURB-65 score and acute kidney injury
4) CRP- raised in inflammation and infection
5) sputum cultures
6) blood cultures
7) pneumococcal and legionella urinary antigen tests

Question 10

What antibiotics are used in patients with mild CAP? How is more severe pneumonia treated?

Answer 10

• treated with 5 days of oral antibiotics, including:

1) amoxicillin
2) doxycycline
3) clarithromycin

• more severe pneumonia is treated with IV AB and respiratory support

Question 11

What are some complications of pneumonia?

Answer 11

1) sepsis
2) acute respiratory distress syndrome
3) Pleural effusion
4) empyema
5) lung abscess
6) Death