Pneumonia

Question 1

Define pneumonia.

Answer 1

Pneumonia is inflammation of the lungs with consolidation or interstitial lung infiltrates, most often categorised according to the causative organism.

Question 2

Explain the aetiology/risk factors of pneumonia.

Answer 2

Age >65 years
Residence in a healthcare setting
COPD
Exposure to cigarette smoke
Alcohol abuse
Poor oral hygiene
Use of acid-reducing drugs, inhaled corticosteroids, antipsychotics, antidiabetic drugs
Contact with children
HIV infection
Aspiration risk

Question 3

Summarise the epidemiology of pneumonia.

Answer 3

The global burden of diseases, injuries, and risk factors (GDB) study showed that lower respiratory tract infections affected over 336 million people all over the world. HAP and ventilator-associated pneumonia (VAP) are now the most common nosocomial infections (accounting for 22% of the total). In the UK, between 0.5% and 1% of adults will have CAP every year.

Question 4

Recognise the presenting symptoms of pneumonia. Recognise the signs of pneumonia on physical examination.

Answer 4

Dyspnoea
Productive cough
Fever
Chest pain
Asymmetrical expansion of the chest
Diminished resonance

Question 5

Identify appropriate investigations for pneumonia and interpret the results.

Answer 5

Chest x-ray
FBC
Serum electrolytes, urea
Liver function tests
Blood glucose
Arterial blood gases/oximetry
Blood culture
Sputum culture

Question 6

Generate a management plan for pneumonia.

Answer 6

Oral antibiotics e.g. amoxicillin, doxycycline, macrolide
Supportive care

Question 7

Identify the possible complications of pneumonia and its management.

Answer 7

Septic shock
Acute respiratory distress syndrome (ARDS)
Antibiotic-associated Clostridium difficile colitis
Heart failure
Acute coronary syndrome
Cardiac arrhythmias
Necrotising pneumonia
Pleural effusion
Lung abscess

Question 8

Summarise the prognosis for patients with pneumonia.

Answer 8

Prognosis is determined by 3 major factors: age of the patient, general state of health (presence of comorbidities), and the setting where antibiotic treatment is given.

The all-cause mortality for HAP is 30% to 70%, while the attributable mortality is approximately 10%. Many people with HAP die of their underlying cause. Readmission rates in patients with CAP range from 7% to 12%.