PNEUMONIA

Question 1

WHAT IS THE PATHOPHYSIOLOGY OF PNEUMONIA?

Answer 1

• lung inflammation with consolidation or interstitial lung infiltrate (macrophage and neutrophils)
• caused by a causative organism

Question 2

WHAT ARE THE SYMPTOMS OF PNEUMONIA?

Answer 2

• pleuritic chest pain
• dyspnoea
• fever
• cough with sputum production - purulent (bacterial)
• rigors- sudden feeling of cold with shivers

Question 3

WHAT ARE THE SIGNS OF PNEUMONIA?

Answer 3

• Auscultation - increase bronchial breath sounds, coarse crackles
• Percussion - dull
• Vocal resonance - increased in affected areas
• Reduced chest expansion
• Pyrexia
• Tachycardia
• Hypotension
• Tachypnoea
• Cyanosis

Question 4

WHAT INVESTIGATIONS ARE CARRIED OUT FOR PNEUMONIA?

Answer 4

1) CXR - consolidation
2) Pulse oximetry - <94% oxygen therapy
3) ABG
4) Blood test - FBC, U+E, CRP (look for improvement before and after treatment), LFT
5) Sputum culture - identify pathogen

Question 5

WHAT IS THE CRITERIA FOR ASSESSING PNEUMONIA SEVERITY AND ITS INDICATIONS?

Answer 5

CURB-65
Confusion
Urea > 7mmol/L
Respiratory rate > 30 bpm
BP < 90 systolic
65 - age >65

high score means increase mortality and ITU referral

Question 6

WHAT IS COMMUNITY ACQUIRED PNEUMONIA?

Answer 6

• acquired outside the hospital

Question 7

WHAT ARE THE 3 COMMON CAUSATIVE ORGANISMS FOR COMMUNITY ACQUIRED PNEUMONIA?

Answer 7

1) Streptoccocus pneumoniae
2) Haemophilus influenzae
3) Mycoplasm pneumoniae

Question 8

WHAT IS THE MANAGMENT OF COMMUNITY ACQURED PNEUMONIA ( LOW, MODERATE AND HIGH SEVERITY)?

Answer 8

1) Low severity - oral amoxicillin
2) Moderate severity - oral amoxicillin and clarithromycin
3) High severity - IV co-amoxiclav and clarithromycin

Question 9

WHAT SUPPORTIVE TREATMENT IS AVAIBLE FOR PNEUMONIA?

Answer 9

1) IV fluid resuscitation
2) oxygen therapy
3) vasopressors
4) analgesia

Question 10

WHAT ANTIBIOTIC IS GIVEN FOR PREGNANT WOMEN?

Answer 10

erythromycin

Question 11

WHAT ANTIBIOTIC IS GIVEN IN PENCILLIN ALLERGY?

Answer 11

doxycycline or clarithromycin

Question 12

WHAT IS HOSPITAL ACQUIRED PNEUMONIA?

Answer 12

pneumonia >48 hours after hospital admission

Question 13

WHAT ARE THE 2 CAUSATIVE ORGANISMS OF HOPSITAL ACQUIRED PNEUMONIA?

Answer 13

1) Pseudomonas aeruginosa

2) Escherichia coli

Question 14

WHAT IS THE MANAGMENT OF HOSPITAL ACQUIRED PNEUMONIA?

Answer 14

guided by microbiology results

Question 15

WHAT ARE THE DIFFERENTIAL DIAGNOSIS OF PNEUMONIA?

Answer 15

• pulmonary embolism
• pleural effusion
• TB
• lung cancer

Question 16

WHAT IS IMPORTANT TO CONSIDER WHEN ASSESSING PNEUMONIA?

Answer 16

• sepsis