Pneumonia

Question 1

define pneumonia

Answer 1

inflammation of the lungs caused usually by bacteria

Question 2

what age group is community acquired pneumonia most common in?

Answer 2

extremes of age

Question 3

main cause of community acquired pneumonia

Answer 3

strep pneumonia
haemophilus influenza (5%)
staph aureus (4%)

Question 4

how is pneumonia spread?

Answer 4

respiratory droplets

Question 5

clinical features of all pneumonias

Answer 5

• cough (dry or productive)
• breathlessness
• coarse crackles
• fever
• pleuritic chest pain
• confusion/recurrent falls

Question 6

what colour is the sputum in pneumococcal pneumonia

Answer 6

rust coloured

Question 7

why are coarse crackles heard in pneumonia

Answer 7

consolidation of parenchyma

Question 8

what does swinging fever indicate?

Answer 8

empyema

Question 9

broad investigations

Answer 9

• CURB65 score
• CXR
• sputum culture and gram stain

Question 10

describe CURB65 score

Answer 10

Confusion
Urea >7mM
Resp rate >30/min
BP <90/60
65

Question 11

timings of CXR

Answer 11

• when admitted to hospital

- 6 weeks after discharge to rule out malignancy

Question 12

specific investigation for strep pneumonia

Answer 12

counter-immunoelectrophoresis of sputum

Question 13

specific investigation for legionella

Answer 13

urinary antigen tests

Question 14

specific investigation for mycoplasma

Answer 14

PCR

Question 15

clinical features of pneumococcus/strep pneumonia

Answer 15

• rust coloured sputum
• preceded by flu-like symptoms
• high fevers
• pleuritic chest pain

Question 16

clinical features of mycoplasma pneumonia

Answer 16

• mild disease in young patients

- extra pulmonary symptoms such as headache, malaise and myalgia

Question 17

clinical features of legionella pneumonia

Answer 17

• usually travel/water

- neurological symptoms

Question 18

causes of staph aureus pneumonia

Answer 18

• recent influenza

- intravenous drug user

Question 19

causes of haemophilus influenza

Answer 19

• pre-exisiting lung disease such as CF, bronchiectasis and COPD

Question 20

cause of chlamydia psittaci

Answer 20

birds

Question 21

causes of klebsiella pneumonia

Answer 21

• excess alcohol use

- poor dental hygiene

Question 22

pathology of pseudomonas

Answer 22

cavitation and abscess formation

Question 23

when is it consider hospital acquired pneumonia

Answer 23

been in hospital for more than 2 days

Question 24

most common pathogens for HAP

Answer 24

• gram negatives (pseudomonas, E. coli)
• anaerobic (enterobacter)
• staph aureus (incl. MRSA)

Question 25

complications of pneumonia

Answer 25

• empyema (pus in the pleural cavity)

Question 26

treatment of empyema

Answer 26

ultrasound guided chest drain and antibiotics