Pneumonia - LSRC

Question 1

Investigations

Answer 1

blood gas
FBC
blood cultures
U&Es 
CRP
LFTs
CXR
urine dipstick
ECG

Question 2

typical blood results

Answer 2

raised creatinine 
raised urea
raised CRP
raised WCC
raised neutrophils 
raised lactate

Question 3

CXR

Answer 3

patchy opacification
air bronchograms
sparing of the costophrenic angle suggests middle lobar pneumonia

Question 4

what are air bronchograms?

Answer 4

area of consolidation

suggest pneumonia

Question 5

risk factors

Answer 5

elderly 
young children 
underlying respiratory disease -asthma, COPD 
immunosuppression/HIV 
co-morbidities - heart disease

Question 6

clinical features

Answer 6

fever
productive cough
discoloured sputum
shortness of breath
pleuritic chest pain 
high respiratory rate 
low O2 sats
crackles
bronchial breathing

Question 7

atypical pneumonia

Answer 7

more constitutional symptoms
low grade fever
malaise 
headaches
myalgia 
cough

Question 8

management

Answer 8

supportive
fluids
supplemental oxygen
antibiotics

Question 9

what is pneumonia?

Answer 9

severe form of acute LRTI causing inflammation of lung in which the alveoli become filled with inflammatory cells

Question 10

what are the stages of pneumonia?

Answer 10

consolidation
red hepatisation
grey hepatisation
resolution

Question 11

consolidation timing

Answer 11

first 24 hours

Question 12

consolidation

Answer 12

cellular exudates containing neutrophils, lymphocytes and fibrin replaces the alveolar air
capillaries surrounding the alveolar walls become congested
infection spreads to hilum and pleura causing pleurisy

Question 13

timing of red hepatisation

Answer 13

2-3 days after consolidation

Question 14

red hepatisation

Answer 14

lungs become hyperaemic
alveolar capillaries are engorged with blood
fibrinous exudates fill the alveoli
many erythrocytes, neutrophils, desquamated epithelial cells and fibrin within the alveoli

Question 15

timing of grey hepatisation

Answer 15

2-3 days after red hepatisation

Question 16

grey hepatisation

Answer 16

avascular stage
lung is grey-brown because of fibrinopurulent exudates
disintegration of RBCs and hemosiderin
pressure of alveolar exudates causes compression of capillaries
leukocytes migrate into congested alveoli

Question 17

resolution

Answer 17

resorption and restoration of pulmonary architecture
large number of macrophages enter alveolar spaces
phagocytosis of bacteria laden leucocytes occurs
consolidation tissue re-aerates and fluid infiltrate causes sputum
fibrinous inflammation may extend to and across the pleural space - causing pleural rub
can lead to pleural adhesions