Pneumonia

Question 1

What if pneumonia?

Answer 1

Acute LRTI associated with fever, chest symptoms and CXR abnormalities.

Question 2

What typical organisms cause pneumonia in CAP?

Answer 2

• Haemophilus influenzae
• Moraxella catarrhalis
Streptococcus pneumoniae

Question 3

What atypical organism cause pneumonia in CAP?

Answer 3

• Mycoplasma
	• SA
	• Legionella
Chlamydia
Klebsiella

Can get fungal e.g. PCP in HIV

Question 4

What organisms tend to cause HAP?

Answer 4

• Gram negative enterobacteria

Staph aureus

Question 5

What kind of patients can get aspiration pneumonia

Answer 5

patients with strokes, myasthenia, bulbar palsies, decreased consciousness, oesopophageal disease. Usually causes a right sided middle lobe pneumonia.

Question 6

What are symptoms of pneumonia?

Answer 6

• Fever
  
  • Rigors
  • Malaise
  • Anorexia
  • SOB
  • Cough
  • Purulent sputum
  • Pleuritic pain

Question 7

What are signs of pneumonia?

Answer 7

• Pyrexia
	• Cyanosis
	• Confusion
	• Tachypnoea 
	• Tachycardia
Hypotension

Question 8

What are signs of consolidation in respiratory exam?

Answer 8

Reduced expansion, dull percussion, ↑tactile vocal fremitus/vocal resonance, bronchial breathing), and a pleural rub.

Question 9

What investigations in pneumonia?

Answer 9

O2 sats

ABG (is sats <92)

Bloods: CRP, WCC, urea, and cultures

Sputum cultures + microscopy

Urine if legionella suspected

Pleural fluid sample if effusion

Question 10

What is scoring system for pneumonia?

Answer 10

CURB 65
• Confusion (abbreviated mental test ≤8)

* Urea >7mmol/L
* Respiratory rate ≥30/min
* BP <90 systolic and/or 60mmHg diastolic)
* Age ≥65.

0–1, PO antibiotic or home treatment

2, hospital therapy

≥3, severe pneumonia indicates mortality 15–40%—consider ITU. Other features increasing the risk of death are: comorbidity; bilateral/multilobar; PaO2 <8kPa.

Question 11

What is antibiotic treatment for pneumonia? (typical organisms)

Answer 11

Usually oral amoxicillin or clari or doxy (CURB 0-1) 5 days

Oral or IV amoxicillin + clari or doxy 7 days (CURB 2)

CO-amoxiclav or cephalosporin and clari if CURB >3

Question 12

What other treatments for pneumonia?

Answer 12

O2
IV fluids
VTE prophylaxis
Analgesia if pleurisy

Question 13

What are complications of pneumonia?

Answer 13

Respiratory failure
Hypotension (sepsis)
AF
Pleural effusion and empyema (Suspect in patients with a resolving pneumonia but recurrent fever. Pleural fluid is yellow and turbid with pH <7.2, low glucose, raised LDH

Lung abscess

Septicaemia