Pneumonia

Question 1

What are the main classes of pneumonia?

Answer 1

There are:

• Community aquired pneumonias - either primary or secondary to underlying disease - strep pneumoniae, h. influenzae
• Hospital aquired penumonia - >48hrs after admission
• Aspiration - those with stroke, myasthenia, decreased consciousness
• Immunocompromised - strep pneumoniae, h. influenzae

Question 2

What are the clinical features of pneumonia?

Answer 2

Fever
Dyspnoea
Cough
purulent sputum
haemoptysis
pleuritic pain

Question 3

What are the signs of pneumonia?

Answer 3

Pyrexia
Cyanosis
Confusion
tachycarida
tachycardia
Signs of consolodation (reduced air entry, expansion, dull percussion, increased vocal resonance)

Question 4

What tests should be done if pneumonia is suspected?

Answer 4

Oxygen saturation, ABG in severe cases and BP
Bloods - FBC, U and E, LFT, CRP
CXR - will show consolidation or effusion
Sputum for microscopy and culture
Urine - check for legionella/pneumoccocal antigens

Question 5

What is the scorign system for pneumonia and what are the points for?

Answer 5

CURB65
Confusioin (abreviated mental test <8)
Urea >7mmol/L
Respiration rate >30/min
BP less than 90 systolic
>65 age

Question 6

What treatments do different curb scores indicate?

Answer 6

0-1 - PO antibiotics and home treatment
2- hospital treatment
3 and above - severe pneumonia, consider ITU

Question 7

How do you manage pneumonia? For CAP, hospital aquired and aspiration?

Answer 7

A-E assessment
High flow oxygen if hypoxic
Start at 24-28% if history of COPD
Treat hypotension
Giave antibiotics based on CURB score:
CAP
-Mild 0-1 - oral amoxicillin 500mg/8hr
-Moderate 2 - Oral amoxicillin 500mg/8hr + doxycycline 100mg/12hrs
-Severe 3+ - Co amoxiclav 1.2g/hr IV
For hospital aquired:
-Antipsuedomonal penicillin IV + aminoglycoside IV
For Aspiration:
-Cephlasporin IV + Metronidazole IV

Question 8

What does pneumocytis jirovecii pneumonia suggest?

Answer 8

HIV infection

Question 9

how can pneumonia cause hypotension?

Answer 9

From a combination of dehydration and vasodilation from sepsis

Question 10

How does pneumonia cause a pleural effusion?

Answer 10

Inflammation of the pleura next to the infection causes exudation in the pleural space

Question 11

What is an empyema?

Answer 11

This is pus in the pleural space