Pneumonia

Question 1

COMMS: Pneumonia

Answer 1

• Pneumonia is swellng (known as inflammation) of one or both of lungs usually caused by bacteria although sometimes other organisms such as viruses can cause it.
• At the end of breathing tubes are tiny air sacs called alveoli which are crucial in exchanging oxygen into the blood and removing carbon dioxide from the blood
• These air sacs are the components of the lungs that can become inflamed in pneumonia and filled with fluid makign the exchange of these gases poor and resulting in symptoms such as breathlessness and overproduction of mucus which causes you to cough.

Question 2

What is the most common organisms involved in community-acquired pneumonia?

Answer 2

-Strep. Pneumoniae (80%)

Question 3

What organism commonly involved in CAP in alcoholics?

Answer 3

Kleibsella

Question 4

What is a common organism involved in CAP in COPD patients?

Answer 4

Haemophilia influenza

Question 5

What is a common organism involved in CAP following influenza infection?

Answer 5

Staphylococcus aureus

Question 6

How does atypical pneumonia caused by Mycoplasma pneumonia often present?

Answer 6

-Dry cough and atypical chest signs -Complication may include autoimmune haemolytic anaemia and erythema multiforme.

Question 7

What is the atypical organism Legionella pneumophilia often linked to?

Answer 7

-Air-conditioning systems -Hyponeutropenia and lymphopenia common

Question 8

In CAP what type of patient can be infected with pneumocystis jiroveci?

Answer 8

Immunocompromised HIV Transplant patients Presents with dry cough, exercise induced desaturation, absent chest signs

Question 9

Define hospital-acquired pneumonia

Answer 9

Onset of symptoms 48h after hospital admission Also up to 2 weeks after discharge

Question 10

What are the typical clinical features of pneumonia?

Answer 10

Symptoms -Productive cough -SOB -Chills then fever -Chest Pain Signs -Increased RR/HR -Crackles on aus. -Dullness on percussion

Question 11

What are the typical investigations for pneumonia

Answer 11

• Culture*
• Blood
• Sputum (early morning collection x3)

Bloods

• FBC = increased WCC
• U&E = dehydration/cUrb-65
• CRP = infection
• ABG/oximetry = hypoxia, respiratory acidosis

Imaging

-CXR

Question 12

What are the pneumonia signs on a CXR? (Hint: x4)

Answer 12

-infiltration -consolidation -effusions -cavitations

Question 13

What scoring system is used for pneumonia management?

Answer 13

1 MARK FOR EACH

C = Confusion (AMTS < 8/10)

U = Urea ( > 7 mmol)

R = RR ( > 30 / min)

B = BP (systolic < 90 / diastolic < 60)

65 = >65yrs

0 = manage community

1 = if O2 >92% manage in community

= if CXR bilateral/multilobar shadowing = hospital admission

2 = hospital admission

Question 14

What is the basic management of pneumonia?

Answer 14

Antibiotics - check cultures for sensitivities

Oxygen - if desaturated

Fluids - if hypotensive/signs of dehydration

Analgesia - Pain ladder

Question 15

Which groups may receive pneumococcal vaccination?

Answer 15

• Babies (2 months, 4 months, 1 year)
• >65yr (one off)
• Long term health conditions (CKD CLD, COPD, IHD) (one off or 5 yearly)
• Immunosuppression