Pneumonia

Question 1

What is pneumonia?

Answer 1

A blanket term for LRTIs, causing alveolar damage and inflammation.

Question 2

What is the difference between lobar and bronchopneumonia?

Answer 2

• Lobar pneumonia affects a single lobe

- Bronchopneumonia affects multiple lobes

Question 4

What are the two classes of pneumonia?

Answer 4

CAP and HAP

Question 5

What are the patient risk factors of pneumonia?

Answer 5

Modifiable- smoking, alcohol.

Non-Modifiable- age 65+, chronic respiratory diseases, other comorbidities.

Question 6

What are the most common organisms for CAP?

Answer 6

IPA

• Influenzae (Haemophilus)
• Pneumoniae (Streptococcus)
• Aureus (Staphylococcus)

Question 7

When is each organism of CAP most likely?

Answer 7

• Influenzae (Haemophilus)- COPD
• Pneumoniae (Streptococcus)- Aspiration pneumonia
• Aureus (Staphylococcus)- Very common

Question 8

Which organisms are most common in HAP?

Answer 8

KAP

• Klebsiella pneumoniae
• Aureus
• Pseudomonas aureginosa

Question 9

When is each organism of HAP most common?

Answer 9

-Klebsiella pneumoniae - alcoholics

• Aureus - very common
• Pseudomonas aureginosa - very common

Question 10

What are the atypical organisms for pneumonia?

Answer 10

Legionella and mycoplasma

Question 11

What symptoms may pneumonia present with?

Answer 11

• Dyspnoea
• Productive cough
• Fever
• Pleuritic chest pain

Question 12

What is Pneumocystis Jirovechi?

Answer 12

Type of pneumonia found in HIV patients.

Question 13

How does Pneumocystis jirovechi present?

Answer 13

Dry cough and reduced exercise tolerance on B/G of HIV.

Question 14

What blood tests should be done?

Answer 14

• ABG
• Inflammatory markers- CRP, ESR
• WBC with differential
• Blood cultures (if patient is immunocompromised or pregnant)
• Urea (for CURB-65)

Question 15

What signs may be found on examination?

Answer 15

• Crackles
• Bronchial breathing
• Tachypnoea
• Tachycardia
• Hypoxia

Question 16

What might a CXR show?

Answer 16

Consolidation

Question 17

What orifice tests are important?

Answer 17

Sputum cultures and sensitivities

Question 18

What are the parameters of CURB-65?

Answer 18

Confusion
Urea 7mmol/L+
Resp rate 30+
BP less than 90/60
65+ age

Question 19

What are the ranges of CURB-65?

Answer 19

• 0-1= Low risk (2% mortality)
• 2= moderate risk (9% mortality)
• 3+= high risk (22% mortality)

Question 20

What do you do with a patient at low risk?

Answer 20

Outpatient care

Follow up in 6 weeks, chest clinic with CXR

Question 21

What do you do if a patient is moderate risk?

Answer 21

Weigh up OP vs IP care

Follow-up chest clinic in 6 weeks with a CXR

Question 22

What do you do if a patient is high risk?

Answer 22

Admit urgently for treatment

Follow up when discharged in 6 weeks

Question 23

What are the discharge criteria for pneumonia?

Answer 23

Cannot discharge if:

• NEWS 2 or higher in last 24 hours
• Confused
• Cannot eat

Question 24

What is the conservative treatment of pneumonia?

Answer 24

• Smoking cessation
• Diet and exercise
• MDT if complex case
• Optimise comorbidities

Question 25

What drug is used for CAP?

Answer 25

• Amoxicillin PO, TDS for 5 days
• Doxycycline if pen allergic

(See local guidelines)

Question 26

What drugs are used for HAP?

Answer 26

• Amoxicillin and Clarithromycin for 7-10 days

- Doxy and Clarythromycin if pen allergic

Question 27

What are the complications of pneumonia?

Answer 27

RAPSS

• Resp failure
• Abscess
• Pleural effusion
• Sepsis
• Spread (local) e.g. pericarditis