Pneumonia

Question 1

What is pneumonia?

Answer 1

Acute inflammation of the lung parenchyma distal to the terminal bronchiole, including the alveoli.

Question 2

What is the epidemiology of pneumonia in Kenya?

Answer 2

The leading cause of in-hospital death, with high mortality rates especially in ICU patients.

Question 3

What are the primary risk factors for pneumonia?

Answer 3

Extremes of age, anatomic respiratory defects, immunodeficiency, altered consciousness, and underlying lung diseases.

Question 4

Describe the lung defense mechanisms.

Answer 4

Nasopharyngeal filtering, gag and cough reflex, mucociliary action, phagocytosing alveolar macrophages, and immunoglobulins.

Question 5

What are the routes of infection for pneumonia?

Answer 5

Aspiration, inhalation of infectious aerosols, hematogenous dissemination, and direct inoculation.

Question 6

What is community-acquired pneumonia (CAP)?

Answer 6

Pneumonia acquired outside of hospitals or within 48 hours after admission, without recent healthcare facility exposure.

Question 7

What are the typical causative organisms of CAP?

Answer 7

Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Legionella, viruses like Influenza.

Question 8

What is the pathophysiology of pneumonia?

Answer 8

Impaired host defenses, microbial invasion, inflammatory response, and cytokine release leading to lung tissue consolidation.

Question 9

What are the pathophysiological causes of pneumonia?

Answer 9

Impaired defense mechanisms, virulent pathogens, and defects in host responses like reduced cough reflex and mucociliary clearance.

Question 10

What are the typical symptoms of bacterial pneumonia?

Answer 10

Productive cough with rusty sputum, fever, chills, pleuritic chest pain, and dyspnea.

Question 11

Describe the clinical presentation of pneumonia.

Answer 11

Acute cough, fever, chills, dyspnea, pleuritic chest pain, headache, altered mental status, and respiratory distress.

Question 12

What investigations are used to diagnose pneumonia?

Answer 12

Full hemogram, UECs, CRP, imaging (chest X-ray), sputum cultures, and blood tests.

Question 13

What is the role of imaging in pneumonia diagnosis?

Answer 13

To confirm the presence of infiltrates, assess the extent of lung involvement, and identify possible complications.

Question 14

How is the CURB-65 score used in pneumonia?

Answer 14

It assesses severity and guides management; includes confusion, urea level, respiratory rate, BP, and age >65.

Question 15

Why is CURB-65 important in pneumonia management?

Answer 15

It helps to stratify risk and decide whether a patient can be managed outpatient or requires hospitalization.

Question 16

What are key components of managing CAP?

Answer 16

Oxygen therapy, IV fluids, antibiotics, antipyretics, and chest physiotherapy.

Question 17

What is the treatment duration for CAP?

Answer 17

Typically 5-7 days, extended if complications like lung abscesses or empyema occur.

Question 18

What is the primary treatment for community-acquired atypical pneumonia?

Answer 18

Macrolides (azithromycin) or tetracyclines.

Question 19

What defines hospital-acquired pneumonia (HAP)?

Answer 19

Pneumonia developing 48 hours or more after hospital admission, not present at the time of admission.

Question 20

What is healthcare-associated pneumonia (HCAP)?

Answer 20

Pneumonia in non-hospitalized patients who have frequent contact with healthcare environments, such as dialysis or nursing homes.

Question 21

What is the common treatment approach for HAP?

Answer 21

Broad-spectrum antibiotics with empiric coverage, tailored after pathogen identification.

Question 22

Describe ventilator-associated pneumonia (VAP).

Answer 22

Pneumonia occurring 48 hours after intubation; treated with empirical broad-spectrum antibiotics.

Question 23

What are common causes of healthcare-associated pneumonia (HCAP)?

Answer 23

Frequent exposure to healthcare environments, recent hospitalization, long-term care, and immunosuppression.

Question 24

How does aspiration pneumonia differ from typical pneumonia?

Answer 24

It involves inhalation of gastric contents, often causing a chemical pneumonitis or infection by anaerobic bacteria.

Question 25

What is aspiration pneumonia?

Answer 25

Pneumonia caused by inhalation of oropharyngeal contents into the lungs, common in patients with impaired gag reflex.

Question 26

What are common pathogens in aspiration pneumonia?

Answer 26

Anaerobes like Bacteroides, Streptococcus pneumoniae.

Question 27

What are common pathogens in viral pneumonia?

Answer 27

Influenza, Respiratory Syncytial Virus (RSV), and SARS-CoV-2.

Question 28

What is the role of procalcitonin in pneumonia management?

Answer 28

Guides the duration of antibiotic therapy and helps in reducing unnecessary use.

Question 29

What are the benefits of using shorter antibiotic courses in pneumonia?

Answer 29

Reduces resistance, side effects, and the overall duration of therapy if the patient shows improvement within 3 days.

Question 30

How does hypostatic pneumonia develop?

Answer 30

From prolonged immobility leading to pooling of fluids in dependent lung areas, commonly seen in elderly or bedbound patients.

Question 31

What is hypostatic pneumonia?

Answer 31

Pneumonia in immobile patients due to fluid pooling in dependent lung areas, treated with mobilization and chest physiotherapy.

Question 32

What are the signs of severe pneumonia?

Answer 32

Fever, tachypnea, hypoxemia, hypotension, confusion, and decreased breath sounds on auscultation.

Question 33

What are common complications of pneumonia?

Answer 33

Para-pneumonic effusion, empyema, lung abscess, ARDS, and sepsis.

Question 34

What factors increase the risk of pneumonia in immunocompromised patients?

Answer 34

Conditions like HIV/AIDS, cancer, organ transplants, and the use of immunosuppressive drugs.

Question 35

How is pneumonia managed in patients with structural lung disease?

Answer 35

Using broader spectrum antibiotics, including carbapenems or fluoroquinolones.

Question 36

How is pneumonia prevented in high-risk groups?

Answer 36

Vaccination, good hygiene, managing chronic conditions, and avoiding crowded places during flu season.

Question 37

What are the preventive measures for pneumonia?

Answer 37

Vaccination, smoking cessation, hand hygiene, and managing chronic conditions.