Pneumonia

Question 1

What is pneumonia?

Answer 1

Infection of the lung tissue, where the alveoli in the lungs become filled with microorganisms, fluid and inflammatory cells that affect function of lung.

Question 2

Difference between CAP and HAP?

Answer 2

Community acquired pneumonia develops outside of hospital.

Hospital acquired pneumonia develops more than 48h after hospital admission.

Question 3

Typical symptoms of pneumonia?

Answer 3

Cough, dyspnoea, purulent sputum, pleuritic chest pain (sudden and intense pain), fever >38.

Question 4

Typical signs of pneumonia ?

Answer 4

Tachypnoea

Auscultation: Bronchial breathing from consolidation

Added sounds: Coarse crackles on one lobe

Percussion: Dullness on percussion on one lobe

Vocal resonance: increased vocal resonance (when 99 whispered)

Question 5

Top two common causative organism of CAP?

Answer 5

S. pneumoniae 50%

H. influenzae 20%

Question 6

Most common causative organism of HAP?

Answer 6

S. aureus

Question 7

What are the risk factors for pneumonia?

Answer 7

Old age
Smoking
COPD
Previous lung infection 
Residence in healthcare setting

Question 8

What investigations are needed to confirm diagnosis?

Answer 8

CXR: lobar consolidation

FBC: leukocytosis, WBC count > 15 x109/L indicates a bacterial aetiology

CRP: raised

U+E’s - deranged renal function

Question 9

What is the severity assessment used in general practice?

Answer 9

CRB-65 estimates mortality and guides whether to admit patient to hospital

C – Confusion (mental test score ≤ 8 or disorientation in person, place or time
R – Respiratory rate ≥ 30/min
B – Blood pressure < 90 systolic or ≤ 60 diastolic.
65 – Age ≥ 65
(no urea)

1 point for each marker

Question 10

What is the severity assessment used in hospital?

Answer 10

CURB-65 estimates mortality to determine outpatient vs inpatient treatment

C – Confusion (mental test score ≤ 8 or disorientation in person, place or time
U – Urea > 7
R – Respiratory rate ≥ 30
B – Blood pressure < 90 systolic or ≤ 60 diastolic.
65 – Age ≥ 65

1 point for each marker

Question 11

What do scores mean for CURB-65

Answer 11

Score 0-1 Treatment at home
Score 2 Outpatient treatment
Score ≥3 Inpatient treatment with ITU admission

Question 12

What do scores mean for CRB-65?

Answer 12

Score 0-1 Treat at home
Score 2 Hospital admission can be considered
Score ≥3 Urgent hospital admission

Question 13

Differentiate between acute bronchitis and CAP?

CXR, examination

Answer 13

CXR:

• abnormal in CAP
• normal in acute bronchitis

Examination:

• wheeze in acute bronchitis
• Focal coarse crackles, bronchial breathing, dullness percussion, asymmetric sounds

Question 14

Whats the Mx for non-severe HAP?

Answer 14

co-amoxiclav, if penicillin allergy give doxycycline , cefalexin

Question 15

What is the Mx for MRSA resistant S. Aureus HAP?

Answer 15

Vancomycin

Question 16

What is the Mx for mild CAP?

Answer 16

amoxicillin, if allergic to penicillin clarithromycin

Question 17

What is the Mx for severe CAP?

Answer 17

amoxicillin + clarithromycin

Question 18

What is atypical pneumonia?

Answer 18

Caused by atypical organisms not detected on gram stain and cannot be cultured.

Question 19

What is is an example of causative organism for atypical pneumoniae?

Answer 19

M. pneumoniae

Question 20

What is an example of causative organism for viral pneumonia?

Answer 20

Respiratory syncytial virus

Influenza virus

Question 21

What is the Mx for viral pneumonia?

Answer 21

Flu vaccine available in NHS for at risk groups (elderly, children)

Antiviral: oseltamivir for influenza

Question 22

What is aspirational pneumonia?

Answer 22

Aspiration pneumonia occurs when food, saliva, liquids, or vomit is breathed into the lungs or airways leading to the lungs, instead of being swallowed into the esophagus and stomach.