Pneumonia

Question 1

What is pneumonia?

Answer 1

an acute lower respiratory tract infection associated with fever, symptoms and signs in the chest and abnormalities on the CXR

Question 2

What are the 3 classifications of pneumonia?

Answer 2

Community acquired
Hospital acquired >48hrs post admission
Aspiration pneumonia

Question 3

What is aspiration pneumonia?

Answer 3

results from inhalation of oropharyngeal contents into the lower airways that leads to lung injury and resultant bacterial infection. It commonly occurs in patients with altered mental status who have an impaired gag or swallowing reflex.

Question 4

What are the signs and symptoms of pneumonia?

Answer 4

Symptoms: fever, riggers, malaise, anorexia, dyspnoea, cough, purulent sputum, haemoptysis and pleuritic chest pain
Signs: pyrexia, cyanosis, confusion, tachypnoea, tachycardia, hypotension, signs of consolidation (decreased expansion, dull percussion, increased vocal resonance)

Question 5

What test would you order in pneumonia?

Answer 5

Asses PaO2, BP
Bloods: FBC, U&Es, LFT, CRP
CXR- lobar or multi lobar infiltrates, cavitation or pleural effusion
Urine- urinary antigen
Pleural tap- aspirate for culture

Question 6

What is the difference between an infective exacerbation of COPD and pneumonia?

Answer 6

IECOPD- more diffuse and bronchus involvement

Pneumonia- localised consolidation

Question 7

How would you assess the severity of community acquired pneumonia? and what are the variables involved?

Answer 7

CURB 65
Confusion (abbreviated mental test score <8)
Urea (>7mmol/L)
Resp rate (>30)
BP <90 systolic or 60 diastolic
Age 65

score 0-1= PO abx/home treatment
2-hospital treatment
3-severe pneumonia

Question 8

Explain the management pneumonia

Answer 8

Abx
O2- keep PaO2 >8kPa and sats >94%
IV fluids
VTE prophylaxis
Analgesia if pleurisy
follow up at 6 weeks +/- CXR

Question 9

suggest 3 abx for pneumococcal pneumonia

Answer 9

Amoxicillin, benzylpenicillin or cephalosporin

Question 10

suggest 3 abx for staphylococcal pneumonia

Answer 10

Flucloxacillin +/- rifampicin

Question 11

What is pneumocystis pneumonia?

Answer 11

pneumonia in immunocompromised patients e.g. HIV
causative agent= pneumocystis carinii/pneumocystis jiroveci
high dose co-trimoxazole or pentamidine by slow IV for 2-3 weeks
Steroids are also beneficial

Question 12

what is the commonest cause of community acquired pneumonia?

Answer 12

streptococcus pneumonias?

Question 13

after streptococcus pneumonia what is the next most common cause of community acquired pneumonia?

Answer 13

Haemophilus influenza.

Question 14

what type of organism causes pneumonia commonly after an influenza virus infection?

Answer 14

staphylococcus aureus

Question 15

what organism causing pneumonia is the culprit in alcoholics?

Answer 15

Klebsiella pneumoniae