Pneumonia

Question 1

What are the RF of pneumonia?

Answer 1

• impaired lung defenses:
- ƒ poor cough/gag reflex (e.g. illness, drug-induced)
ƒ- impaired mucociliary transport (e.g. smoking, cystic fibrosis)
- ƒ immunosuppression (e.g. steroids, chemotherapy, AIDS/HIV, DM, transplant, cancer)

• increased risk of aspiration
- ƒ impaired swallowing mechanism (e.g. impaired consciousness, neurologic illness causing
dysphagia, mechanical obstruction)

Question 2

What are the 3 most common causative agents of pneumonia in COPD patient?

Answer 2

• Strep pneumo
• Klebsiella
- Hib

Question 3

Where are aspiration pneumonias normally occur?

Answer 3

Aspiration pneumonias more commonly manifest as infiltrates in the right middle or lower lobes due to the larger caliber and more vertical orientation of the right bronchus.

Question 4

What are the typical bacteria causing CAP?

Answer 4

Streptococcus pneumoniae Moraxella catarrhalis Haemophilus influenzae Staphylococcus aureus
GAS

Question 5

What are the atypical bacteria causing CAP?

Answer 5

• Mycoplasma pneumoniae

• Chlamydophila pneumoniae
• Legionella pneumophila

Question 6

What are the common bacteria that cause nosocomial pneumonia?

Answer 6

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

Question 7

What is the most common bacteria of HIV associated pneumonia?

Answer 7

• Pneumocystis jiroveci

- Fungi: cryptococcus

Question 8

Symptoms of pneumonia

Answer 8

• cough (± sputum), fever, pleuritic chest pain, dyspnea,

Question 9

Signs of consolidation

Answer 9

tachypnea, tachycardia
• elderly often present atypically; altered LOC is sometimes the only sign
• evidence of consolidation (dullness to percussion, bronchial breath sounds, crackles, increased
fremitus, whisper pectoriloquy)

Question 10

Signs of parapneumonic effusion

Answer 10

• decreased air entry
• dullness to percussion
• decreased fremitus

Question 11

Ix for pneumonia

Answer 11

Bedside:
• pulse oximetry to assess severeity of respiratory distress
Bloods:
• CBC and differential, electrolytes, urea, Cr, ABG (if respiratory distress), troponin/CK, LFTs

Imaging
• CXR±CT chest shows distribution (lobar consolidation or interstitial pattern), extent of
infiltrate ± cavitation

Pathology:
• sputum Gram stain/C&S, blood C&S, ± serology/viral detection, ± pleural fluid C&S (if effusion
>5 cm or respiratory distress)

Question 12

Mx for pneumonia

Answer 12

• ABC, O2, IV fluids, consider salbutamol (nebulized or MDI)

Mild (Home)
	• Amoxy
	• Doxy
Mod
	•  Ben pen
	• Doxy

Severe (Hospitilization)
• IV ceftriaxone 1 g daily
Azithromycin 500mg BD

Question 13

Complications of pneumonia

Answer 13

complications:
- ARDS
- Lung abscess
- parapneumonic effusion/empyema
- pleuritis ± hemorrhage