Respiratory - Pneumonia

Question 1

pneumonia

Answer 1

a syndrome caused by infection
inflammation of the lung parenchyma
consolidation- new lung shadowing on cxr

Question 2

how is pneumonia classified

Answer 2

by source of infection

community acquired
hospital acquired
aspiration pneumonia

Question 3

symptoms of pneumonia

Answer 3

fever, purulent cough,SOB, pleuritic chest pain

signs: increased resp, increased HR, coarse crep and decreased air entry, hypotension

Question 4

auscultation sounds in pneumonia

a.coarse crepitations
b.fine inspiratory crackles
c.pleural rub

Answer 4

a.coarse crepitations

Question 5

new radiographic infiltrate in prescence of infection with onset at least 48 hrs after hospital admission (or within 2 weeks of discharge)

Answer 5

hospital acquired pneumonia

Question 6

aspiration pneumonia occurs at the upper airway when it is colonised with gram……..

a.positives
b.negatives

Answer 6

b.negatives

esp if prev antibitoics

enteric bacilli
pseudomonas
MRSA

Question 7

Which bacteria usually present in hopsital acquired pneumona

a.enteric bacilli, pseudomonas,MRSA

b.strep pneum, haem influenzae

Answer 7

a.enteric bacilli, pseudomonas,MRSA

Question 8

risk factors for hopsital acquired pneumonia

Answer 8

> 70
comorbidities
surgery
NG tube

Question 9

gram……… are the main cause of community acquired pneumonia

a.positives
b.negatives

Answer 9

a.positives

Question 10

which gram positive cause of community acquired pneumonia is more common in copd

a.strep pneum
b.haemophillus influenzae
c.moraxella catarrhalis
d.pseudomonas

Answer 10

c.moraxella catarrhalis

Question 11

which bacteria cause atypical pneumonia

Answer 11

legionella
mycoplasma
chlamydia

Question 12

first line investigation for community acquired pneumonia

a.o2 assessment
b.cxr
c.bloods
d.microbiology

Answer 12

a.o2 assessment

check if can go home

Question 13

second line investigation for community acquired pneumonia

a.o2 assessment
b.cxr
c.bloods
d.microbiology

Answer 13

b.cxr

shows consolidation in lower lobes (patchy changes cant make out border of diaphragm)

if consolidation is upper consider other causes …
TB, aspirated, tumour (if tumour occludes bronchus then can cause pneumonia)

Question 14

which blood test is deranged if pneumonia is caused by mycoplasma or legionella

a.wcc
b.crp
c.u and e
d.lft

Answer 14

d.lft

Question 15

poor prognosis factors

Answer 15

> 65 yrs
rr >30
confusion
hypotension
urea >7
albumin <35

Question 16

what grading system is used for pneumonia

a.GOLD
b.CURB 65
c.GRACE
d.Hinshey

Answer 16

b.CURB 65

C- NEW confusion
u- urea >7 mmol
r- resp rate >/= 30
b- systolic <90 or diastolic <= 60

65 - age 65+

each letter = 1 point
>2 = hospital admission

Question 17

first line management for pneumonia

a. antibiotics
b.oxygen
c.VTE prophylaxis
d.critical care
e.CT chest

Answer 17

a. antibiotics

within 4 hrs of hospital admission

and oxygen,fluids,analgesia,nutrition,physio,VTE prophylaxis

Question 18

pneumonia with paO2 <8kpa
tiring with CO2 increase
increasing metabolic acidosis despite antibiotics and fluids
hypotension

what should be done ?

a. antibiotics
b.oxygen
c.VTE prophylaxis
d.critical care
e.CT chest

Answer 18

d.critical care

Question 19

patient with pneumonia and improving what should be done for follow up

a.cxr
b.ct

Answer 19

DO NOT REPEAT CXR IF THINK IMPROVING

only repeat cxr if decrease or no improvement

Question 19

when should a 6XR be repeated post admisission

a.4 weeks
b.5 weeks
c.6 weeks
d.7 weeks

Answer 19

c.6 weeks

esp if persisting , higher risk of cancer (>50s/smokers)

to exclude any underlying condition

if unresolved do a CT

Question 20

what should be done if pneumonia unresolved after 6 week follow up x ray

a. ct chest
b. x ray chest
c. contrast ct

Answer 20

a. ct chest