Pneumonia

Question 1

What is pneumonia?

Answer 1

Infection involving the distal airspace’s, usually with inflammatory exudates (localised oedema).

Question 2

What causes consolidation?

Answer 2

Fluid filled spaces

Question 3

Classification

Answer 3

By clinical setting, organism and morphology.

Question 4

Clinical setting

Answer 4

Community, hospital, aspiration, legionella.

Question 5

Organisms

Answer 5

Mycoplasma pneumonia, strep pneumoia, klebsiella pneumonia.

Question 6

Mycoplasma pneumonia

Answer 6

Community acquired pneumonia

Question 7

Morphology

Answer 7

Lobar pneumonia & bronchopneumonia

Question 8

Lobar pneumonia

Answer 8

Confluent consolidation involving complete lung lobe

Question 9

Causative organism of lobar pneumonia

Answer 9

Most often streptococcus but also with klebsiella & legionella.

Question 10

Clinical setting of lobar pneumonia

Answer 10

Usually community acquired

Question 11

Affected individuals of lobar pneumonia

Answer 11

Healthy young adults

Question 12

Pathology of Lobar Pneumonia

Answer 12

Classical acute inflammatory response => exudation of fibrin rich fluid, neutrophil infiltration, macrophage infiltration => resolution.

Question 13

Immune response in Lobar Pneumonia

Answer 13

Antibodies lead to opsonisation & phagocytosis of bacteria.

Question 14

Bronchiopneumonia

Answer 14

Infection starting in the airways that spreads to adjacent alveolar lung.

Question 15

Affected individuals of Brochopneumonia

Answer 15

Patients with pre-existing disease.

Question 16

Causative organisms of bronchopneumonia

Answer 16

Streptococcus, haemophilia influenza, staphylococcus, anaerobes, coliforms.

Question 17

Why is mycoplasma pneumonia resistant to B-lactam antibiotics?

Answer 17

They have no cell wall.

Question 18

Symptoms

Answer 18

Malaise, anorexia, sweats, arthralgia, myalgia, headache, confusion, cough & haemoptysis, pleurisy, dyspnoea, preceding URTI, abdominal pain, diarrhoea.

Question 19

Signs

Answer 19

Fever, rigors, herpes labilus, tachypnoea, crackles, pleural rub, cyanosis, hypotension, diminished expansion, dull percussion.

Question 20

Investigations

Answer 20

CXR, FBC, Blood glucose, ABG, oximetry, liver function, CURB65, sputum, pleural fluid aspirate

Question 21

CXR

Answer 21

Lobar or multilobar infiltrates, cavitation, pleural effusion

Question 22

CURB65

Answer 22

• Confusion
• Urea > 7
• RR > 30
• BP: Systolic < 90, Diastolic < 61.
• Age > 65.

Question 23

Complications

Answer 23

Resp failure, hypotension, pleural effusion etc.

Question 24

General treatments

Answer 24

Oxygen, fluids, bed rest, no smoking.

Question 25

Antibiotics for mild, moderate and severe acquired

Answer 25

Mild-Moderate (0-2 CURB65): amoxicillin.

Severe (3-5 CURB65): IV Co-amoxiclav + clarithoromycin or levofloxacin. Step down to doxycycline.

Question 26

Antibiotics for hospital or aspiration acquired

Answer 26

IV amoxicillin, metronidazole & gentamicin.

Question 27

Antibiotics for legionella pneumonia

Answer 27

Levofloxacin

Question 28

Prevention of pneumonia

Answer 28

Influenza and pneumococcal vaccines.