Pneumonia

Question 1

What is pneumonia?

Answer 1

Infection and inflammation of the alveoli

Pneumonia can be caused by various pathogens including bacteria, viruses, and fungi.

Question 2

What does the acronym SALAMI stand for in pneumonia risk factors?

Answer 2

• S: Smoking
• A: Advanced age (over 60)
• L: Lung diseases or cancer
• A: Alcohol
• M: Malnutrition
• I: Immunocompromised

Immunocompromised individuals may include IV drug users and those with HIV or on antibiotic and cytotoxic drug use.

Question 3

What are the most common bacterial infections associated with pneumonia?

Answer 3

• Strep pneumoniae
• Haemophilus influenzae b

These bacteria are often responsible for community-acquired pneumonia.

Question 4

Which bacteria are associated with pneumonia in immunocompromised or chronic lung disease patients?

Answer 4

Moraxella

Moraxella is particularly noted in patients with weakened immune systems.

Question 5

What bacteria are commonly found in cystic fibrosis patients with pneumonia?

Answer 5

• Pseudomonas aeruginosa
• Staphylococcus aureus

These pathogens can lead to severe lung infections in cystic fibrosis patients.

Question 6

What is the primary bacterial cause of pneumonia in bronchiectasis patients?

Answer 6

Staphylococcus aureus

Staphylococcus aureus is often implicated in pneumonia for bronchiectasis patients.

Question 7

What is the definition of hospital-acquired pneumonia?

Answer 7

Pneumonia that occurs 48 hours or more after hospital admission and is not present at the admission time

Hospital-acquired pneumonia is often more resistant to treatment due to the pathogens involved.

Question 8

Define community-acquired pneumonia.

Answer 8

Pneumonia contracted in a community setting, not hospital or healthcare facility or nursing homes

This type of pneumonia is generally more common and may be less severe than hospital-acquired pneumonia.

Question 9

What causes foreign body aspiration pneumonia?

Answer 9

Inhalation of a foreign object into the lungs

This type of pneumonia can occur in individuals of all ages, particularly in young children.

Question 10

What is pneumocystis jiveci pneumonia?

Answer 10

A fungal infection that occurs in immunocompromised patients, e.g., poorly controlled HIV

This type of pneumonia is characterized by specific symptoms and requires antifungal treatment.

Question 11

What are the three signs of pneumocystis jiveci pneumonia?

Answer 11

• Dry cough
• Shortness of breath on exertion
• Night sweats

These symptoms are indicative of the infection in immunocompromised individuals.

Question 12

What is an atypical infection that causes pneumonia associated with infected water systems?

Answer 12

Legionella pneumophila

Example: AC systems

Question 13

What is the hallmark feature of Legionella pneumophila infection?

Answer 13

Syndrome of Inappropriate ADH (SIADH) causing hyponatremia

Perform urine antigen test

Question 14

What atypical infection is associated with infected birds?

Answer 14

Chlamydia psittaci

Question 15

What is the hallmark feature of Mycoplasma pneumoniae infection?

Answer 15

Erythema multiforme and neurological symptoms

Occurs in approximately 43% of cases

Question 16

What atypical infection is common in school-age children?

Answer 16

Chlamydia pneumoniae

Question 17

What is Q fever caused by?

Answer 17

Coxiella burnetii

Transmitted through infected bodily fluids of animals, e.g., farmers

Question 18

What are common pneumonia presentations?

Answer 18

Productive cough, fever, shortness of breath (SOB), malaise, acute confusion, haemoptysis, pleuritic chest pain

Question 19

What are physical examination findings in pneumonia?

Answer 19

Bronchial breath sounds, focal coarse crackles, dullness to percussion

Question 20

What are the complications of pneumonia represented by SLAP HER?

Answer 20

S: SIADH and hyponatremia
L: Lung abscess
A: ARDS
P: Parapneumonic effusion
H: Hypotension
E: Empyema
R: Respiratory or renal failure

Question 21

What investigations are used for pneumonia?

Answer 21

CXR: Consolidation
FBC: Raised WBC count
CRP level: Raised
U&Es: Urea level and acute kidney injury
Microbiology: Sputum cultures, blood cultures

Question 22

What does CURB-65 stand for in pneumonia scoring?

Answer 22

C: Confusion
U: Urea more than 7 mmol/L
R: Respiratory rate 30 or more
B: Blood pressure: systolic less than 90 OR diastolic equal to or less than 60
65: Age 65 or over

Question 23

What is the total score range for CURB-65?

Answer 23

Ranges from 0-4

0/1: Low risk so can be treated at home
2: Moderate risk so should assess and consider hospital admission
3/4: High risk, give immediate hospital referral so should be admitted to intensive care

Question 24

What is the management for hospital-acquired pneumonia?

Answer 24

PO doxycycline 200 mg on the first day then 100 mg once a day for 4 days (total course of 5 days)

Question 25

What is the management for community-acquired pneumonia?

Answer 25

Amoxicillin PO 500 mg three times a day for 5 days

Question 26

What is the second-line treatment for pneumonia?

Answer 26

PO doxycycline 200 mg on the first day then 100 mg once a day for 4 days (total course of 5 days)

Question 27

What is the treatment for Pneumocystis jiroveci pneumonia?

Answer 27

Co-trimoxazole

Question 28

What is the management for foreign body aspiration pneumonia?

Answer 28

Bronchoscopy to remove foreign body, antibiotic course

Question 29

What are the treatments for atypical pneumonia?

Answer 29

Macrolides (e.g., clarithromycin), fluoroquinolones (e.g., levofloxacin) and tetracyclines (e.g., doxycycline)

Question 30

Why is penicillin ineffective for certain pneumonia types?

Answer 30

Can’t be cultured with gram staining, so penicillin is ineffective

Question 31

What are general measures for pneumonia management?

Answer 31

Smoking cessation, up to date vaccinations