Pneumonia

Question 1

What is pneumonia and it’s common associations?

Answer 1

• An acute lower respiratory tract illness associated with fever, symptoms and signs in the chest, and abnormalities on the CXR.

Question 2

What is the mortality rate of patients in hospital with pneumonia?

Answer 2

• Approx. 21%

Question 3

What are the 4 classifications of pneumonia?

Answer 3

• Community-acquired pneumonia (CAP)
• Hospital-acquired
• Aspiration
• Immunocompromised patient

Question 4

What is the commonest cause of CAP? What are the next 2 most common?

Answer 4

• Streptococcus pneumoniae

* Haemophilus influenzae / Mycoplasma pneumoniae

Question 5

What are the two commonest causes of hospital-acquired pneumonia?

Answer 5

• Gram negative enterobacteria

* Staphylococcus aureus

Question 6

What percentage of CAP cases do viruses account for?

Answer 6

•15%

Question 7

What diseases can lead to aspiration acquired pneumonia? (4)

Answer 7

• Stroke / myasthenia / bulbar palsies / oesophageal disease

Question 8

Give two infectious agents that cause pneumonia in immunocompromised patients.

Answer 8

• Strep. pneumoniae

* H. influenzae

Question 9

What are the clinical symptoms of pneumonia? (9)

Answer 9

• Fever
• Rigors
• Malaise
• Anorexia
• Dyspnoea
• Cough
• Purulent sputum
• Haemoptysis
• Pleuritic pain

Question 10

What are the clinical signs of pneumonia? (8)

Answer 10

• Pyrexia / cyanosis / confusion / tachypnoea / tachycardia / hypotension / signs of consolidation / pleural rub

Question 11

What are the signs of consolidation? (5)

Answer 11

• Diminished expansion / dull percussion / tactile vocal fremitus / vocal resonance / bronchial breathing.

Question 12

What are the three important steps that need to be established when testing a patient with suspected pneumonia? (3)

Answer 12

• Establish diagnosis
• Identify pathogen
• Assess severity

Question 13

What tests would you carry out on a patient with suspected pneumonia? (6)

Answer 13

• CXR - lobar or multi lobar infiltrates, cavitation or pleural effusion.
• Assess oxygenation - oxygen saturation (ABG) and BP •Blood tests
• Sputum microscopy and culture
• Pleural fluid aspiration
• Bronchoscopy and bronchoalveolar lavage - if patient is immunocompromised or in ITU

Question 14

How is severity measured in a patient with pneumonia?

Answer 14

• Establishing their CURB-65 score

Question 15

What is assessed in the CURB-65 test? (4)

Answer 15

• Confusion
• Urea >7mmol/L
• Respiratory rate _>30/min 
• BP 
One point for each factor.

Question 16

What is the scoring system of CURB-65?

Answer 16

• 0-1 = home treatment possible
• 2 hospital therapy
• _>3 severe pneumonia indicates mortality 15-40% - consider ITU

Question 17

What complications may arise from pneumonia?

Answer 17

Pleural effusion / empyema / lung abscess / respiratory failure / septicaemia / brain abscess / pericarditis / myocarditis / cholestatic jaundice

Question 18

How is pneumonia treated? (6) What should be done if there is failure to improve or CRP remains high? How many weeks later should the follow up be?

Answer 18

• Antibiotics (orally or IV (if severe))
• Oxygen (keep PaO2 >8.0 and/or saturation _>94%)
• IV fluids (anorexia, dehydration, shock)
• VTE prophylaxis
• Analgesia if pleurisy
• Consider ITU if shock, hypercapnia, or uncorrected hypoxia
• Repeat CXR and look
• 6 weeks

Question 19

What would be checked via a blood test?

Answer 19

• FBC
• U&E
• LFT
• CRP
• Blood cultures

Question 20

What groups are at risk and should receive the pneumococcal vaccine? (4)

Answer 20

• _>65 yrs old
• Chronic heart, liver (eg cirrhosis), renal (eg renal failure, nephrosis, post-transplant) or lung conditions.
• Diabetes mellitus
• Immunosuppression, e.g. decreased spleen function (splenectomy, asplenia, sickle cell or coeliac disease), AIDS, or on chemotherapy or prednisolone

Question 21

What is a contraindication of the pneumococcal vaccine?

Answer 21

•Pregnancy, lactation

Question 22

What is the antibiotic treatment of pneumonia?

Answer 22

….