Pneumonia

Question 1

What is pneumonia

Answer 1

Inflammation of alveoli due to infection

It results in cellular exudate accumulation in the alveolar spaces

Question 2

What types of pneumonia exist

Answer 2

Lobar

Broncho-

Question 3

How do we classify pneumonia

Answer 3

Source of infection:
HAP
CAP
Aspiration
In immunocompromised patients

Question 4

What is pneumonitis

Answer 4

Inflammation of alveoli not due to an infection

Question 5

Common causative organisms of CAP

Answer 5

Strep pneumoniae 
Haemophilus influenzae 
Moraxella catarrhalis 
Staph aureus 
Klebsiella pneumoniae

Question 6

Atypical causative organisms of CAP

Answer 6

Mycoplasma pneumoniae
Legionella pneumophila
Chlamydia pneumoniae

Question 7

Atypical manifestations of pneumonia

Answer 7

Autoimmune haemolysis
Rash
Hyponatraemia
Hepatitis 
Arthralgia

Question 8

Treatment for strep pneumoniae infection

Answer 8

Amoxicillin or benzylpenicillin

Question 9

Treatment for mild to moderate CAP

Answer 9

Amoxicillin or doxycycline

Question 10

Treatment for severe CAP

Answer 10

Co-amoxiclav and doxycycline

Question 11

When is HAP more likely

Answer 11

Comorbidities
Ventilator use
Previous antibiotics

Question 12

Causative organisms of HAP

Answer 12

Staph aureus 
Enterobacteriaciae 
Pseudomonas aurigonosa 
Haemophilis influenzae
Candida albicans

Question 13

Treatment for HAP

Answer 13

First line - Co-amoxiclav

Second line - pipperacillin, tazobactam or meropenem

Question 14

What is aspiration pneumonia

Answer 14

Aspiration of contaminated exogenous or endogenous material

Question 15

When is aspiration pneumonia more likely

Answer 15

Impaired consciousness

Oropharyngeal dysphasia

Question 16

Causative organisms of aspiration pneumonia

Answer 16

Oral flora e.g viridans strep

Anaerobes

Question 17

Treatment of aspiration pneumonia

Answer 17

Co-amoxiclav

Question 18

What are the causative organisms of pneumonia in immunocompromised patients

Answer 18

HIV - pneumocystis jivoreci
Neutropenia - aspergillus
Bone marrow transplant - CMV
Splenectomy - encapsulated bacteria e.g strep pneumoniae and haemophilus influenzae

Question 19

Causative organisms of viral pneumonia

Answer 19

Influenza
Parainfluenza
Respiratory syncytial virus
Adenovirus

Question 20

Complications of viral pneumonia

Answer 20

Necrosis and haemorrhage into lung parenchyma

Question 21

CXR of viral pneumonia

Answer 21

Ground glass opacity

Question 22

Symptoms of pneumonia

Answer 22

Fever
Malaise
Cough productive of sputum
Pleuritic chest pain
Dyspnoea

Question 23

Findings on examination in pneumonia

Answer 23

Pyrexia 
Tachypnoea
Tachycardia
Hypotension 
Cyanosis 
Bronchial breathing 
Crackles

Question 24

Investigations in pneumonia

Answer 24

FBC
CRP
Gram stain suitable sample
Us and Es
ABGA
CXR

Question 25

Examples of samples for analysis in pneumonia

Answer 25

``` Sputum Blood Bronchoalveolar lavage fluid Nose/throat swab Lung biopsy Urine (legionella) Serum (virus) ```

Question 26

What is a severe CURB-65 score and what is the significance

Answer 26

At least 2 | Needs hospital admission

Question 27

What is the CURB-65 score

Answer 27

``` New mental confusion Urea >7mmol/L Resp rate >30 Blood pressure <90 systolic or <60 diastolic >65 years old ```

Question 28

What factors indicate a poor prognosis

Answer 28

``` High CURB-65 score Elderly Very high or very low WBC count No fever Significant hypoxia Significant blood urea ```

Question 29

General management of pneumonia patients

Answer 29

``` Antipyretics Hydration Analgesics IV fluids O2 therapy if cyanosis (and has good respiratory drive) ```

Question 30

Complications of pneumonia

Answer 30

Lung abscess Empyema Bronchiactasis Pleural effusion

Question 31

What might have occurred if treatment makes no improvement

Answer 31

``` Empyema Obstruction Resistant pathogen Antibiotics not absorbed Immunosuppressed Wrong diagnosis (lung cancer?) ```

Question 32

Prevention of pneumonia

Answer 32

Flu vaccine every year and Pneumococcal vaccine every 5 years for high risk patients Penicillin or erythromycin prophylaxis Smoking advice