Pneumonia (Respiratory)

Question 1

What is it called when people with bad pneumonia get exudate into their alveoli which makes it look like liver?.

Answer 1

Red hepatisation.

Question 2

What are the symptoms of pneumonia?

Answer 2

Malaise, anorexia, sweats, rigors, myalgia, arthralgia, headache, confusion, cough, pleurisy (pain when you breathe in and out), haemoptysis, dyspnoea, preceding URTI, abdominal pain (referred), diarrhoea.

Question 3

What are the clinical signs of pneumonia?

Answer 3

Fever, rigors, herpes labialis (cold sores), tachypnoea, crackles, rub, cyanosis, hypotension.

Question 4

On examination, what will you find with pneumonia?

Answer 4

Reduced chest expansion, dull percussion note, bronchial breath sounds, crackles, increased vocal resonance (whispering pectoriloquy).

Question 5

What types of pneumonia causes rusty coloured sputum to be produced?

Answer 5

Pneumococcal pneumonia.

Question 6

What investigations should you carry out if pneumonia is suspected?

Answer 6

Blood culture, serology, ABG, full blood count, urea, liver function, CXR.

Question 7

Describe each part of the CURB 65 score.

Answer 7

C - new onset of confusion, U - urea >7, R - respiratory rate >30/min, B - blood pressure systolic <90 or diastolic <61, 65 - age 65 or older.

Question 8

What is the CURB65 score actually assessing?

Answer 8

Signs of sepsis.

Question 9

What are some other severity markers of pneumonia?

Answer 9

Temp <35 or >40, PaO2 <8kPa, WBC <4 or >30, multi-lobar involvement.

Question 10

How would you treat community acquired pneumonia?

Answer 10

Antibiotics (amoxicillin, doxycycline), oxygen to maintain SaO2 to required level, fluids, bed rest, no smoking.

Question 11

Why does sputum culture not matter so much in pneumonia?

Answer 11

Resistant bugs in pneumonia uncommon, most are amoxicillin resistant.

Question 12

What type of pathologies does mycoplasma pneumonia cause?

Answer 12

Pneumonia, hepatitis, immune thomobocytopenic purpura, autoimmune haemolytic anaemia, arthritis.

Question 13

Why is mycoplasma pneumonia resistant to beta-lactam antibiotics?

Answer 13

It has no cells wall.

Question 14

Why does mycoplasma pneumonia cause a protracted paroxysmal cough?

Answer 14

Cilial dysfunction, H2O2 production damages respiratory membranes and alveoli.

Question 15

What are other special cases of pneumonia?

Answer 15

Hospital acquired - need extended gram negative cover. Aspiration pneumonia - need anaerobic cover. Legionella - chest symptoms minimal, GI disturbance common, confusion common.

Question 16

When predicting what organism is causing a pneumonia, what factors should you take into account?

Answer 16

Young vs old (old more likely to get simple things, young people get mycoplasma)? Severity? Immuno-competent vs immuno-compromised? Chronic illness? Lifestyle?

Question 17

Using the CURB65 score, show how young people compensate well for being unwell.

Answer 17

C - good cerebral vasculature, U - good kidneys, R - can increase tidal volume, B - inotropic, chronotropic and vasculature responses good.

Question 18

Why should you try and not use IV antibiotics in pneumonia?

Answer 18

Modern oral drugs are highly bioavailable, IV access risks infections.

Question 19

When should you use IV antibiotics?

Answer 19

When oral route unavailable, if there are drug resistant organisms, if there are deep seated infections e.g. abscesses, bone, endocarditis, meningitis, or if it is the first dose to rapidly increase plasma concentrations.

Question 20

When should you use sputum cultures?

Answer 20

When: resistant organisms suspected, TB or NTM (nontuberculous mycobacteria) suspected, failure to improve on standard therapies, high risk individuals.

Question 21

What types of pneumonia are people who have HIV, people who inject drugs, alcoholic/homeless people, frequently hospitalised people, returning travellers, people who have visited India or eastern europe more likely to have?

Answer 21

HIV - PCP; PWID - staph aureus; alcohol/homeless - TB, klebsiella; frequently hospitalised (pseudomonas); returning traveller - legionella, TB; indian sub-continent - TB; eastern europe - multi resistant and extended resistant TB.

Question 22

What are the complications of pneumonia?

Answer 22

Respiratory failure, pleural effusion, empyema (infection of pleural space), death.

Question 23

Who should the influenzal and pneumococcal vaccines, involved in the prevention of pneumonia, be given to?

Answer 23

People over 65, chronic chest or cardiac disease, diabetes, immunocompromised e.g. splenectomy, healthcare workers.