Pneumonia

Question 1

Definition

Answer 1

acute lower respiratory tract illness with fever

Inflammatory condition of lung affecting primarily the alveoli

Question 2

Epidemiology

Answer 2

common

highest in very young and very old

Question 3

Pathogenesis

Answer 3

Note below level of carina lungs sterile

Three mechanisms

• Host defence defect (immuno-compromised)
• Large inoculum (inhale large amounts of organism in 1 go)
• increased virulence (baterium and virus are equipped to dampen pneumonia

Question 4

Causes

Answer 4

typical

• strep pnemumonia
• haemophillus influenza

Atypical

• Legionella
• mycoplasma pneumonia

Question 5

History signs and symptoms

Answer 5

fever
cough 
chest pain 
abrupt onset 
non respiratory symptoms 

PMH

• underlying lung disease
• immunosuppression

Travel history

Question 6

Investigations

Answer 6

Blood tests
-FBC - WC increasd
Uand e- urea for CURB
ABGs/ox - lung function

Investigations
CXR- consolidation
ECG- no cardiac compromise

Microbiology 
Blood cultures 
sputum culture 
throat swab- atypicals 
urine - legionella antigen

Question 7

Management

Answer 7

Airways (conscious level)
Breathing (oxygen, ITU)
Circulation (BP, pulse, fluids)

Second
CURB65 - mortality increases with score of >2
SIRS - 2 or more = sepsis
Hypoxia - ON AIR

Question 8

CURB 65 score

Answer 8

Confusion (new disorenitation to place, person and time)
Urea (blood urea) >7mm
RR >30 bpm
B- Diastolic BP (65

0-1- outpatient treatment
2- admitted for treatment
2+ hypoxaemia - severe CAP - iv ABX

CURB65 assesses mortality higher number higher mortality

Question 9

strep pneumonia risk factors

Answer 9

smoking
alcoholism
HIV

Question 10

Presentaiton of strep pnemonia

Answer 10

abrupt onset
-cough, fever, pleuritic chest pain, mucky spit

consolidation on CXR

Question 11

Abx of strep pneumonia

Answer 11

penicillin

Question 12

Haemophillus influzenza pneumonia risk factors

Answer 12

older people

underlying lung disease

Question 13

Haemophillus influzenza pneumonia presentation

Answer 13

Type B is vacinnated against

Non typeable causes - ears, eyes, brain infection

Question 14

Treatment of haemophills influenzae

Answer 14

Amoxicillin (risk of b-lactamases) could use co-amoxiclav to fix

Question 15

Mycoplasma pneumonia risk factors

Answer 15

cough
young people
seasonality

Question 16

Mycoplasma pneumonia presentation

Answer 16

non specific illnes
-fever, malaise, sore head, achy joints

On examination CXR xonsolidation

Question 17

Abx in Mycoplasma pneumonia

Answer 17

lack of cell wall
1macrolides
2tetracylines
3quinolones

Question 18

Legionella pneumophillia risk factors

Answer 18

lives in env

soil, showers

Question 19

Legionella pneumophillia presentation

Answer 19

non specific illnes
-fever, malaise, sore head, achy joints

On examination CXR xonsolidation

Question 20

Abx of legionella pneumophillia

Answer 20

lack of cell wall

NOTE USE

1. macrolides
2. quinolone
3. tetracyclines

im comparison to mycoplasma

Question 21

What can mycoplasma cause

Answer 21

haemolyisis (cold aggluitination)
Guillian barre - ascending parylsis
Erthema multiforme - skin rash
arthritis

Question 22

Psudeomonas aeruginosa

Answer 22

• immunocompromised and cystic fibrosis

- Ceftazidine, ciprofloxaciin, tobramycin

Question 23

Chlamydia psittaci

Answer 23

• history of contact with birds, particularly parrots
• fever, malaise, cough and muscular pains
• erythromycin or tetracycline

Question 24

Pneumocystitis carinii

Answer 24

Most common in AIDS patients
- insidious obnset of breathlessness, a non productive cough, fever and malaise
co-trimoxazole, intravenous pentaqmidine

Question 25

Streptococcus pneumonia

Answer 25

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