Pneumonia

Question 1

Clinical presentation

Answer 1

Following URTI, patient gets worsening fever, cough and breathlessness.
Tachypnoea
Signs of consolidation (dullness, decreased breath sounds, bronchial breathing) may be present but difficult to detect in infants
Crackles may be present
In bacterial pneumonia. pleural inflammation causing chest/abdo pain and effusion common

Question 2

Causative organisms in neonates

Answer 2

Group B strep
E. coli
Chlamydia trachomatis
Listeria monocytogenes

Question 3

Causative organisms in infants

Answer 3

Resp viruses eg RSV and adenoviruses
Strep pneumoniae
Hib
Bordetella pertussis

Question 4

Causative organisms in children

Answer 4

Strep pneumoniae
Hib
Group A strep
Mycoplasma pneumoniae (>5)

Question 5

Causative organisms in those with underlying respiratory disease

Answer 5

Pseudomonas aeruginosa

Staph aureus

Question 6

Predisposing factors

Answer 6

Congenital anomaly of bronchi
Inhaled foreign body
Immunosupression
Recurrent aspiration
CF

Question 7

Investigations

Answer 7

Diagnosis largely clinical
CXR only if failure to respond to tx or complications suspected
BC, CRP, blood cultures
nasopharyngeal aspirate
Mycoplasma: acute and convalescent serology/demonstration of cold agglutinins

Question 8

Features suggesting bacterial pneumonia

Answer 8

Temp >38.5
RR >50 with recession
CXR consolidation
(Polymorphonuclear leucocytosis, pleural effusion)

Question 9

Management

Answer 9

Amoxicillin first line
Cefuroxime and flucloxacillin in severe illness
Erythromycin (macrolide) if mycoplasma suspected
Oxygen if sats <92%
Antipyretics/analgesia
Fluids

Question 10

Features suggesting viral pneumonia

Answer 10

Temp <38.5
Wheeze
CXR hyperinflation

Question 11

Indicators for hospital admission in infants

Answer 11

Sats 70
Difficulty breathing
Intermittent apnoea/grunting
Not feeding
Family not able to provide appropriate observation/supervision

Question 12

Indicators for hospital admission in older children

Answer 12

Sats 50
Difficulty breathing
Grunting
Signs of dehydration
Family not able to provide appropriate observation/supervision