Pneumonia

Question 1

What are the clinical features associated with pleural effusion?

Answer 1

Stony dullness to percussion
Reduced breath sounds
Reduced vocal resonance
Reduced chest expansion
Bronchial breath sounds above the effusion

Question 2

What are the different types of pneumonia?

Answer 2

Bronchopneumonia:
Community Acquired
Hospital Acquired
Ventilator Associated
Aspiration

Lobar Pneumonia:
Atypical
Eosinophilic

Interstitial Pneumonia

Question 3

What are the stages in the pathophysiology of lobar pneumonia?

Answer 3

Congestion/Consolidation: First 24 hours, intravascular edema.
Red Hepatisation: 2-3 days post-infection, red-pink appearance.
Grey Hepatisation: 3-4 days post-phase 2, grey appearance, fibrinopurulent exudate.
Resolution: Begins by the 8th day, enzymes digest exudate components.

Question 4

What are the risk factors for pneumonia?

Answer 4

Smoking
Pre-existing airway disease
Chronic alcohol use
Diabetes
Chronic medical conditions
Immunocompromised/steroid use
Nursing home residents

Question 5

What are the common clinical features of pneumonia?

Answer 5

Symptoms:

Fever, pyrexia, rigors, cyanosis, malaise, tachypnea
Vocal Resonance:

Increased in consolidation, collapse, fibrosis
Decreased in pneumothorax, pleural effusion
Breath Sounds:

Vesicular/Normal, Bronchial, Crackles, Wheeze, Stridor, Pleural Rub

Question 6

What are the key investigations for pneumonia?

Answer 6

FBC, U&Es, CRP
WCC (White Cell Count): <20 or <4 indicates severe infection
CXR (Chest X-ray)
Sputum culture, Blood culture
Viral throat swab, Urine legionella

Question 7

What are the management steps for pneumonia based on CURB-65 severity score?

Answer 7

Low Severity (0-1):

Supportive care, discharge based on patient’s wishes
Moderate Severity (2):

Order microbiology testing
IV antibiotics if severe
High Severity (3-5):

Urgent senior review, consider ICU transfer
Dual antibiotic therapy (Amoxicillin + Broad-spectrum, Clarithromycin)

Question 8

What are the complications of pneumonia?

Answer 8

Respiratory failure (common in elderly)
Hypotension (due to dehydration or sepsis)
Atrial fibrillation (common in elderly)
Pleural effusion (inflammation and exudation)
Empyema (pus in pleural space)
Lung abscess (localized infection)

Question 9

What are the risk factors that require a follow-up CXR after pneumonia?

Answer 9

Elderly
Immobility
Smoking
Diabetes
COPD

Question 10

What are the key features of COVID-19 in terms of clinical presentation and management?

Answer 10

Incubation period: 4-5 days

Presentation spectrum: Asymptomatic to pneumonia, ARDS, multi-organ failure

Imaging findings: Normal CXR or multiple bilateral opacities

CT thorax: Bilateral ground-glass opacities

Lab findings: Lymphopenia, raised CRP, high PT

Management:
Awake proning, thromboprophylaxis, oxygen therapies

Medications: Corticosteroids, antivirals (Remdesivir), monoclonal antibodies (Tocilizumab)

Question 11

How is the CURB-65 score calculated and what does it assess?

Answer 11

The CURB-65 score is used to assess the severity of pneumonia and help determine whether a patient requires hospitalization or intensive care. It includes the following criteria:

C - Confusion (new onset): 1 point
U - Urea > 7 mmol/L (more than): 1 point
R - Respiratory rate ≥ 30 breaths/min: 1 point
B - Blood pressure:
Systolic BP < 90 mmHg or Diastolic BP ≤ 60 mmHg: 1 point
65 - Age ≥ 65 years: 1 point