Pneumonia

Question 1

Where in the lungs does pneumonia start?

Answer 1

Alveoli

Question 2

Complications of pneumonia

Answer 2

• parapneumonic effusion
• Empyema
• lung abscess
• necrotising pneumonia

Question 3

Symptoms found in pneumonia

Answer 3

• persistent fever
• tachypnoea at rest
• Cough +/- chest pain
○ Remember - cough not necessary - alveoli don’t have cough receptors!
• Vomiting +/- abdo pain
• increased work of breathing/respiratory distress
• lethargy/ unwell appearance / irritability
• Reduced appetite and dehydration

Question 4

Exam findings in pneumonia

Answer 4

• hypoxaemia ( <92%) on pulse oximetry
• crackles and bronchial breathing on auscultation
• elevated respiratory rate for age
• chest wall indrawing, retractions, grunting, nasal flaring
  
  • apnoea
• absent breath sounds and a dull percussion note suggest a pleural effusion

Question 5

What Ix could you do in pneumonia?

Answer 5

Ix are not recommended for routine use in Dx CAP - esp. in mild disease:

• UEC: hyponatraemia vs SIADH
• FBE
• microbio Ix
• CXR

Question 6

Severe pneumonia - criteria

Answer 6

Clinical features of pneumoniaand2 or more of the following:
	• Severe respiratory distress
	• Severe hypoxaemia or cyanosis
	• Marked tachycardia
	• Altered mental state

OR
• Empyema

Question 7

When to admit and d/c pneumonia?

Answer 7

Admit:
○ <1 yo
○ Nil by mouth + dehydration
○ Pleural effusion
○ Extensive consolidation
○ Severe breathing problems

• D/C when can maintain adequate oxygenation and oral intake

Question 8

When O2 for pneumonia?

Answer 8

<92% sat

Question 9

What abx for bacterial pneumonia?

Answer 9

○ Non-severe pneumonia: oral amoxicillin (7-10days) or IV benpen
- We don’t really use augmentin, that would be if you think staph is likely

○ Severe: ceftriaxone or cefotxaime AND flucloxacillin

- Consider addition of vancomycin for MRSA
- If mycoplasma - roxythromycin 10 days

○ Consider neuraminidase inhibitors (oseltamivir) i.e. tamiflu if suspect to be complicated by/will be by influenza e.g. IC

Question 10

Empyema:

• exam findings
• Mx

Answer 10

• stony dullness and pleuritic pain

- chest drain and fibrinolytics

Question 11

What is the most common atypical organism in pneumonia? What are some cutaneous symptoms that you might see?

Answer 11

• Mycoplasma pneumoniae
• SJS/TEN
• Erythema multiforme
• Mucositis
• Rash: non-specific erythematous exanthem, might have vesicles/bullae associated