Pneumonia

Question 1

What is pneumonia?

Answer 1

Infection, inflammation and consolidation of the lungs

Question 2

How does pneumonia present on history?

Answer 2

• Dyspnoea
  
  • Fever
  • Malaise
  • Lethargy
  • Cough - dry or moist, not always present
    
    • Pleuritic chest pain, abdo, shoulder, or neck pain

Question 3

How does pneumonia present on examination?

Answer 3

• Tachypnoea
  
  • Respiratory distress
  • Dullness to percussion
  • Localised crackles and bronchial breathing
    
    • Low sats
  • Reduced movement of chest wall on affected side

Question 4

How do you Ix pneumonia?

Answer 4

CXR
Blood cultures
Nasal aspirate 
Sputum
Immune function

Question 5

What can be concluded from a CXR?

Answer 5

○ Pneumonia can be reasonably excluded with a clear CXR
○ Patchy or peripheral is more indicative of viral
○ Lobar is bacterial

Question 6

How is pneumonia mx?

Answer 6

• Mild: PO Amoxycillin 25mg/kg and PO roxithromycin if considering mycoplasma
• Moderate: IV Benzylpenicillin 50mg/kg and PO roxithromycin if considering mycoplasma
• Severe: IV Flucloxacillin 50mg/kg and IV Gent and consider IV azithromycin

Question 7

What are the unique characteristics of staphylococcal pneumonia?

Answer 7

○ More rapid onset, more severe 
○ High fever, marked tachypnoea 
○ Serious complications are common 
		§ Encysted pleural effusions with thick walls
		§ Empyema 
		§ Abscesses 
-  Longer treatment required

Question 8

What are the unique characteristics of mycoplasma pneumonia?

Answer 8

○ Most common in school age
○ Gradual development, non-productive initially
○ Can be wheeze, especially in asthmatics
- Require macrolides for treatment though they may not effect the clinical course of the illness unless started early

Question 9

Who gets viral pneumonia?

Answer 9

Under 5 year olds

Pre-existing chronic problems