Pneumonia

Question 1

What is pneumonia?

Answer 1

Infection of the lung parenchyma

Question 2

RFx for pneumonia?

Answer 2

1. Impaired defences
   - poor gag reflex
   - impaired mucociliary escalator (smoking, CF)
   - immunosuppression (steroids, chemo, AIDS/HIV, DM)
2. Increased risk of aspiration
   - impaired swallowing (dec GCS, neurologic illness causing dysphagia, mechanical obstruction)

Question 3

Where are aspiration pneumonias more commonly seen?

Answer 3

Infiltrates in R middle or lower lobes due to larger calibre and more vertical orientation of the right bronchus.

Question 4

Typical bacteria of community acquired pneumonia?

Answer 4

• Strep pneumoniae
• Moraxella catarrhalis
• H. influenzae
• Staph aureus

Question 5

Atypical bacteria causing community acquired pneumonia?

Answer 5

• Mycoplasma pneumoniae
• Chlamydophila pneumoniae
• Legionella pneumoniae

Question 6

Viral causes of community acquired pneumonia?

Answer 6

• Influenza virus

- Adenovirus

Question 7

Causes of nosocomial pneumonia?

Answer 7

• Enteric GNB (E.coli)
• Pseudomonas aeruginosa
• S. aureus (inc MRSA)

Question 8

Organisms of aspiration pneumonia?

Answer 8

• Oral anaerobes (e.g. bacteroides)
• Enteric GNB (e.g. E.coli)
• S. aureus
• Gastric contents (chemical pneumonitis)

Question 9

Organisms of HIV associated pneumonia?

Answer 9

• Pneumocystis jirovecii
• Fungi (cryptococcus)
• Nocardia
• CMV
• HSV
• TB

Question 10

Signs and symptoms of pneumonia?

Answer 10

• Fatigue
• Productive cough
• Pleuritic chest pain
• Dyspnea / tachypnoea
• Tachycardia
• Evidence of consolidation
• features of parapneumonic effusion

Question 11

What are the signs of consolidation?

Answer 11

• Dullness to percussion
• Bronchial breath sounds
• Crackles
• Increased fremitus
• Whisper pectoriloquy

Question 12

What are the signs of parapneumonic effusions?

Answer 12

• Decreased air entry
• Dullness to percussion
• Decreased fremitus

Question 13

Complications of pneumonia?

Answer 13

• ARDS
• Lung abscess
• Parapneumonic effusion /empyema
• Pleuritis +/- haemorrhage

Question 14

Ix in pneumonia?

Answer 14

• CXR
• Obs inc pulse ox
• FBE
• UEC
• ABG (if resp distress)
• Troponin
• LFTs
• Urinalysis
• Sputum MCS
• Pleural tap w/ MCS (effusion >5cm or resp distress)

Question 15

When are bronchoscopy and washings indicated in pneumonia Ix?

Answer 15

• Severely ill patients refractory to treatment

- Immunocompromised pts

Question 16

Mx pneumonia?

Answer 16

• ABC
• O2
• IV fluids
• ?Salbutamol
• Determine prognosis and need to ABx (IV / oral)

Question 17

Pneumonia clinical prediction tool?

Answer 17

CURB65:
Confusion
Urea >7
Resp rate >30bpm
BP (SBP

Question 18

ABx for OP Rx previously well pt w/ pneumonia?

Answer 18

-Macrolide (clarithromycin, erythromycin,azithromycin)
OR
-Doxycycline

Question 19

ABx for OP Rx pt with pneumonia w/ comorbidities?

Answer 19

-Respiratory fluoroquinolone (moxifloxacin, levofloxacin)
OR
-B-lactam + macrolide

Question 20

ABx for ward Mx pt w/ pneumonia?

Answer 20

-Respiratory fluoroquinolone (moxifloxacin, levofloxacin)
OR
-B-lactam + macrolide

Question 21

Pneumonia prevention?

Answer 21

• Yearly Fluvax

- Pneumococcal vax adults 65+, high risk pts

Question 22

Klebsiella pneumonia?

Answer 22

Red currant jelly sputum

Question 23

What are the 3As of klebsiella?

Answer 23

• Aspiration pneumonia
• Alcoholics and diabetics
• Abscess in lungs

Question 24

Signs of consolidation on CXR?

Answer 24

• Air bronchogram
• Silhouette sign
• Less visible blood vessels