Pneumonia

Question 1

what is pneumonia?

Answer 1

inflammation of lung parenchyma

Question 2

causes of pneumonia

Answer 2

bacteria 
viruses
fungi
parasites
aspiration

Question 3

what are the types of pneumonia?

Answer 3

hospital or community acquired
typical or atypical
immunocompromised
aspiration

Question 4

CAP

Answer 4

contracted in community

divided into typical and atypical

Question 5

typical

Answer 5

classical symptoms
productive cough
fever
pleuritic chest pain

Question 6

most common cause of typical pneumonia?

Answer 6

strept. pneumoniae
haemophilus influenzae
moraxella catarrhalis

Question 7

atypical

Answer 7

more gradual onset
subacute onset
present with pulmonary and extrapulmonary symptoms
zoonotic and non-zoonotic causes

Question 8

zoonotic causes of atypical pneumonia

Answer 8

chlamydophia psittaci
coxiella burnetiid
francisella tularensis

Question 9

non-zoonotic causes of atypical pneumonia

Answer 9

mycoplasma pneumoniae
legionella pneumophilia
chlamydophila pneumoniae

Question 10

HAP

Answer 10

contracted >48 hours after hospital admission that was not incubating at time of admission

Question 11

causative organisms of HAP

Answer 11

gram negative bacilli - pseudomonas aeruginosa, staph aureus, legionella pneumophilia

Question 12

aspiration pneumonia pathogenesis

Answer 12

caused by inhalation of oropharyngeal or gastric contents

brings bacteria into the lungs

Question 13

who gets aspiration pneumonia?

Answer 13

patients who are unable to protect their airway - reduced consciousness, neuromuscular disorders, oesophageal conditions, mechanical interventions
PPIs increased risk

Question 14

what are the causative organisms of aspiration pneumonia?

Answer 14

strep. pneumoniae 
staph aureus 
haemophilus influenzae 
enterobacteriaceae 
hospital gram-negative bacilli

Question 15

immunocompromised pneumonia

Answer 15

risk of infective organisms not usually seen in other patient groups
wider range of causative organisms

Question 16

immunocompromised causative organisms

Answer 16

mycobacterium complex
non-TB mycobacterium 
pneumocystis jirovecii 
aspergillus fumigatus 
cryptococcus neoformans 
varicella zoster 
CMV 
parasites

Question 17

clinical features of pneumonia

Answer 17

cough
SOB
signs of consolidation 
malaise
purulent sputum 
dysnpoea 
pleuritic pain 
dull percussion 
reduced breath sounds 
bronchial breathing 
coarse crepitations 
increased vocal fremitus 
tachycardia 
hypotension 
confusion 
cyanosis

Question 18

complications

Answer 18

parapneumonic effusion 
pneumothorax 
abscess
empyema 
sepsis
AF

Question 19

investigations

Answer 19

observations
sputum sample
urinary sample
ECG
FBC
U&Es 
CRP
blood cultures
CXR 
don't delay antibiotics with tests

Question 20

what are the pneumonia scoring systems?

Answer 20

CRB-65 and CURB-65
used to stratify patients risk of mortality
determines best place of care

Question 21

CRB-65

Answer 21

used in primary care 
confusion 
respiratory rate >30 
BP <90 or <60 
over 65 years old

Question 22

interpreting CRB-65

Answer 22

score 0 = outpatient, low risk of mortality <1%
score 1-2 = secondary care, intermediate risk mortality - 1-10%
score of 3+ = urgent admission - high risk mortality (>10%)

Question 23

CURB-65

Answer 23

used when patient presents to hospital 
confusion 
urea >7mmol/L
respiratory rate >30 
BP <90 or <60 
aged over 65

Question 24

interpreting CURB-65

Answer 24

score 0-1 = outpatient, low risk of mortality - <3%
score 2 = secondary care, intermediate risk mortality (3-15%)
score of 3-5 = ICU, high risk of mortality >15%

Question 25

definition of confusion

Answer 25

AMT <8 or new onset of disorientation in time, place or person

Question 26

management

Answer 26

ABC approach
oxygen titrated
IV fluids - maintenance
appropriate analgesia - paracetamol, NSAIDs or opiates