Pneumonia

Question 1

Define Pneumonia

Answer 1

Swelling (inflammation) of the tissue in one or both lungs. Usually bacterial infection. Alveoli may swell with fluid or pus.

Question 2

Pneumonia - Main Causative Agent

Answer 2

Streptococci Pneumoniae

Question 3

Pneumonia Types & Agents:

Answer 3

Community Acquired: Streptococcus pneumoniae
Hospital Acquired: Staphylococcus aureus
Aspiration: Streptococcus pneumoniae
Atypical, Immunocompromised Pneumonia, Recurrent

Question 4

Pneumonia Patterns:

Answer 4

Bronchopneumonia, Segmental
Lobar
Hypostatic
Aspiration
Obstructive Retention and Endogenous Lipid

Question 5

Pneumonia Complications

Answer 5

Septicaemia 
Lung Abscess
Atrial Fibrillation
Pleurisy
Pleural Effusion 
Pericarditis
Myocarditis
Hypotension 
Empyema 
Respiratory failure 
Bronchiectasis

Question 6

Pneumonia Symptoms

Answer 6

Fever
Breathlessness
Cough 
Sputum - yellowish/blood = Rusty
Chest Pain 
Shaking Chills

Question 7

Pneumonia Signs: DIICC PPBRTT

Answer 7

Dullness on percussion (consolidation)
Increased Vocal Resonance (consolidation)
Inspiratory Crepitations
Central Cyanosis (Bluish Discolouration of the Tongue & Lips)
Confusion (sometimes only sign in elderly)
Pyrexia (raised body temp)
Pleural Rub
Bronchial breath sounds (consolidation)
Reduced Chest Expansion
Tachypnoea (rapid breathing)
Tachycardia

Question 8

Pneumonia Investigations:

Answer 8

CXR
Blood Tests: FBC, U&E, LFT, Blood Culture
Throat Swab
Pleural Fluid (aspirated & cultured)
Sputum Culture
Urinary Legionella Antigen 
Serum Biochemistry 
*If the patient is immunocompromised or on ITU, consider Bronchoscopy & Bronchoalveolar Lavage

Question 9

Pneumonia Severity Scoring System: CURB 65

Answer 9

Confusion - Abbreviated mental test equal to or < 8
Urea = Blood Urea < 7 mmol/L
Respiratory Rate = equal to or > 30
Blood Pressure (diastolic) < 60 &amp;/or (systolic) <90
65 = Age 65 &amp; +

Question 10

Pneumonia Treatment

Answer 10

Oxygen
IV fluids
CPAP
Intubation
Ventilation
CURB 0-1: Amoxycillin OR Clarithromycin/Deoxycycline
CURB 2: Amoxycillin & Clarithromycin (or Leurofloxacin if allergic to Penicillin) - Consider Hospital Treatment
CURB 3-5: Co-Amoxiclav & Clarithromycin (or Leurofloxacin if allergic to Penicillin) - Manage in hospital as severe pneumona (mortality is 15-40%, cosnider ITU)

Question 11

Pneumonia Other Management:

Answer 11

Oxygen (to keep PaO2 > 8.0 & or sat > 94%
Intravenous Fluids
Analgesia (if pleurisy)
Follow up after 6 weeks - also possibly with CXR.

Question 12

NICE Recommendations:

Answer 12

1 week - fever should have stopped
4 weeks - chest pain and sputum production should have substantially reduced
6 weeks - cough and breathlessness should have substantially reduced
3 months - most symptoms should have resolved, but fatigue may still be present
6 months - most people feel back to normal