Pneumonia

Question 1

what are the classifications of pneumonia?

Answer 1

community acquired
hospital acquired
atypical
aspiration pneumonia
recurrent pneumonia
pneumonia in the immunocompromised

Question 2

what are the different patterns of pneumonia

Answer 2

bronchopneumonia
segmental pneumonia
lobar pneumonia
aspiration pneumonia
hypostatic pneumonia
obstructive
retention
endogenous lipid

Question 3

what organism is the most common cause of pneumonia?

Answer 3

streptococcus pneumoniae

Question 4

describe the difference in bronchopneumonia and lobar pneumonia.

Answer 4

bronchopnuemonia has a focal nature of consolidation with bilateral opacification.
lobar pneumonia is the consolidation of the entire lung

Question 5

describe what opacification of the lung is.

Answer 5

opacification is a decrease in the gas to lung tissue ratio. this represents that there an increase in the density of the lung. this is usually due to infiltrate of fluid.

Question 6

list some of the complications of pneumonia.

Answer 6

pleurisy
pleural effusion
empyema
lung abcess
bronchiectasis
organisation (mass lesion, Cryptogenic organising pneumonia or constructive bronchiolitis). 
Acute kidney injury
ARDS
Haemolytic anaemia
Septicaemia

Question 7

how can a lung abcess develop as a complication of pneumonia?

Answer 7

bronchial obstruction by an endoluminal tumour
apiration pnuemonia complication
partial organisation i.e. staph aureus, pneumococci and klebsiella
transdiaphragmatic spread of liver abcess
necrotic lung
Metastatic empyema

Question 8

what is bronchiectasis (complication of pneumonia)

Answer 8

dilation of the bronchi which have been ripped and pulled apart

Question 9

what causes bronchiectasis as a complication of pneumonia?

Answer 9

severe infection
recurrent infection
proximal bronchial obstruction
lung parenchymal destruction

Question 10

what is the treatment for bronchiectasis?

Answer 10

Antibiotics, Physiotherapy to get rid of trapped mucous, Surgery, Postural drainage
May need inhaled therapy I.e. b2 agonist + corticosteroid

Question 11

what is hypoxaemia due to?

Answer 11

ventillation/perfusion mismatch
shun
diffusion impatiemment
hypoventillation

Question 12

how can hypoxaemia occur with pneumonia?

Answer 12

ventillation perfusion mismatch -
caused by bronchiectasis / bronchopneumonia
low ventilation/perfusion V/Q ratio
due to hypoventillation

shunt-
caused by severe bronchopneumonia
lobar pattern of a large area of consolidation

Question 13

in pneumonia with hypoxaemia, does V/Q mismatch and shunt respond well to an increase in FL02?

Answer 13

V/Q mismatch responds well to even a small increase

shunt doesn’t respond

Question 14

what are the symptoms of pneumonia?

Answer 14

symptoms varied with the immune state of the patient and the organism it is caused by.
cough (productive or dry, rust coloured sputum is caused by pneumococcus)
breathlessness
Fever
chest pain

Question 15

apart from the common clinical presentation of pneumonia, what other symptoms may be experienced by the patient?

Answer 15

Haemolysis (mycoplasma pneumonia)
thombocytopenia (low platelet count)
Community acquired pneumonia (CAP) in the elderly can present with confusion or non specific recurrent symptoms such as falls.

Question 16

What are the clinical signs of pneumonia?

Answer 16

Tachycardia , tachypnoea, Pyrexia, cyanosis
Increased vocal resonance
Band of bronchial breathing over area of consolidation on auscultation
Crackles over area of consolidation on auscultation
Dullness on percussion
Decreased chest expansion

Question 17

What is the initial treatment for a patient who has pneumonia?

Answer 17

Oxygen
IV fluids
Antibiotics (beta lactam and macrolide)
Analgesia
Anti-pyretics 
May need intubation and ventilation 
May need continuous positive airway pressure

Question 18

How is pneumonia severity assessed?

Answer 18

Using CURB 65 score:
C - confusion
U - blood urea (<7.2)
R - respiratory rate (>30)
B - blood pressure diastolic (<60)
65 - age >65

0 = low risk and community treatment
1-2 = higher risk therefore hospital treatment is required
3-5 = risk of death therefore require ITU

Question 19

What would be the treatment for a patient who has scored a 3 in the CURB65 score?

Answer 19

Co-amoxiclav + clarithromycin (or levoflaxin if they are penicillin allergic)

Question 20

What would the treatment be if a patient scored 1 on the CURB 65 score?

Answer 20

Amoxicillin or clarithromycin (doxycycline if allergic)

Question 21

Several months after being diagnosed with pneumonia and not recovering a patient presents with a liver abscess as a complication of the pneumonia. What organism Is the likely cause?

Answer 21

Strep. Aureus
Pseudomonas
Anaerobes such as klebsiella.

Question 22

A patient presents with empyema as a complication of her previous pneumonia that hasn’t fully healed. What are the most likely organisms to cause empyema?

Answer 22

Staph. Aureus
Streptococcus
Anaerobes

Question 23

What complication can arise due to pneumonia caused by klebsiella?

Answer 23

Lung abscess

Question 24

Name a complication of pneumonia due to aspiration pneumonia.

Answer 24

Lung abcess

Question 25

What are the symptoms of pneumonia?

Answer 25

Productive cough
Haemoptysis
Pyrexia
Chest pain
Dyspnoea 
Confusion

Question 26

What are the signs of pneumonia?

Answer 26

Pyrexia
Decreased chest expansion
Decreased breath sounds on auscultation
Band of bronchial breathing on auscultation over area of consolidation
Crackles on auscultation
Increased vocal resonance
Tachycardia & tachypnoea
Cyanosis
Thrombocytopenia 
Haemolysis

Question 27

What are the investigations for pneumonia?

Answer 27

CXR
Sputum culture
Full blood count
Atypical serology
Mycoplasm IgG
CRP
Serum biochemistry
Urinary legionella Antigen (Ag)