Pneumonia

Question 1

What is pneumonia?

Answer 1

An infection of the alveoli

Infection -> Inflammation & Infected Fluid -> Pus/Damage/Fibrosisetc

Question 2

What are the common aetiological types of pneumonia?

Answer 2

Community Acquired
Hospital acquired or Nosocomial
Aspiration

Atypical - Recurrent - Immunocompromised

Question 3

What are the common organisms behind pneumonia?

Answer 3

Strep Pneumoniae
Haemophilus Influenzae
Viruses

Legionella - Mycoplasma Pneumoniae - Staph Aureus - MRSA

Question 4

What radiological types of pneumonia are there?

Answer 4

Lobar/Segmental - Pneumonia restricted to a specific Lobe or branch
Bronchopneumonia - Diffuse pneumonia over the entire lung

Question 5

What are the symptoms of pneumonia?

Answer 5

Malaise
Fever
Pleuritic Pain
Dyspnoea
Cough
Purulent Sputum

Question 6

What are the signs of pneumonia?

Answer 6

Affected Area:
Reduced Breath sounds 
Bronchial Breathing
Increased Vocal Resonance
Stony Dullness to Percussion
Reduced Chest Expansion
Inspiratory Crackles

Tachypnoea/Tachycardia
Central Cyanosis
~ Low BP

Question 7

What investigations can we do for pneumonia?

Answer 7

ABG - FBC - U+E - CRP - LFT
CXR
CT
Bronchoscopy/Bronchoalveolar Lavage
Sputum Culture & Blood Culture
Throat Swab for atypical pathogens
Urine Legionella antigen

Question 8

What is the differential for pneumonia?

Answer 8

TB
Lung Cancer
Cardiac Failure
PE
Pulmonary Vasculitis

Question 9

What are the complications of pnemonia?

Answer 9

ARDS
Effusion
Lung Abscess
Empyema
Septicaemia

Question 10

What are the non-antibiotic treatments for pneumonia?

Answer 10

O2 -> CPAP -> Intubate/Ventilate
IV fluids
Analgesia if pleuritic pain is bad

Question 11

How do we grade pneumonia?

Answer 11

CURB65
Confusion - Urea>7mmol/L - Resp>30 - BP D<60 or S<90 - Age>65

0 = treat in community
1-2 = hospitalise
3-5 = ITU the fuck out of them

Question 12

Explain the antibiotic treatment for pneumonia?

Answer 12

CURB65 again!!
0-1 = Amoxicillin or Clarithromyicn or Doxycyclin
2 = Amoxillin/Levofloxacin AND Clarithromycin
3-5 = Co-Amoxiclav/Levofloxacin AND clarithromycin
(Levofloxacin if penicillin allergic)

Add Vancomycin if MRSA
Add Flucloxacillin if Staph

Question 13

What are the possible outcomes of penumonia?

Answer 13

Resolution
Complication (mainly abscess or emphysema)
Permanent bronchiectasis
Scarring (Crytogenic Organising Pneumonia)