Respiratory - Pneumonia

Question 1

What is pneumonia?

Answer 1

Infection of lung tissue causing inflammation in the alveolar space

Question 2

What is acute bronchitis?

Answer 2

Inflammation in the bronchi and bronchioles

Pneumonia and acute bronchitis both classed as lower respiratory tract infections

The lower down higher chance of bacterial infection

Question 3

How is pneumonia classified?

Answer 3

Community-acquired pneumonia
Hospital-acquired pneumonia (more than 48 hours in a hospital)
Ventilator-acquired pneumonia (intubated patients ICU)

Question 4

What is aspiration pneumonia?

Answer 4

When infection develops due to aspiration of foods or fluids

Patients with impaired swallowing

Anaerobic bacteria

Question 5

How does pneumonia present?

Answer 5

Cough
Sputum production
SOB
Fever
Haemoptysis
Pleuritic chest pain

Question 6

What are the characteristic chest signs of pneumonia?

Answer 6

Bronchial breath sounds (consolidation around the airways)
Focal coarse crackles (air passing through sputum in airways)
Dullness to percussion (lung tissue filled with sputum or collapsed)

Question 7

What does CURB-65 stand for?

Answer 7

Confusion
Urea over 7mmol
Respiratory rate over 30
Blood pressure < 90 systolic or 60 disatolic
65over 65

Question 8

What do different CURB-65 scores mean?

Answer 8

0/1 treatment at home
>2 Hospital admission
>3 consider ICU

Question 9

What are the most common causes of bacterial pneumonia?

Answer 9

Streptococcus pneumoniae
Haemophilus influenzae

Less common:
- Moraxella catarrhalis (immunocompromised or COPD)
- Pseudomonas aeruginosa (CF)
- Staphylococcus aureus (CF)
- MRSA (hospital acquired infections)

Question 10

What is an atypical pneumonia?

Answer 10

Caused by organisms that cannot be cultured normally or detected using gram stain

Treated with macrolides e.g. clarithromycin
Fluoroquinolones e.g. levofloxacin

Question 11

How do you remember the 5 atypical pneumonia causes?

Answer 11

Legions of Psittaci MCQs
Legionella pneumophilia
Psittaci Chlamydia psittaci
Mycoplasma pneumoniae
Clamydia pneumoniae
Qs Q fever (coxiella burnetii)

Question 12

What is legionella pneumophilia?

Answer 12

Legionnaire’s disease
Inhaling water from infected water systems

Can cause SIADH resulting in hyponatraemia

Urine antigen to test

Cheap hotel and illness after

Question 13

What is mycoplasma pneumoniae?

Answer 13

Milder pneumonia and a rash erythema multiforme, varying sized target lesions formed by pink rings with pale centres

Neurological symptoms in younger patients

Question 14

What is Chlamydophila pneumoniae?

Answer 14

Mild to moderate chronic pneumonia and wheezing in school-age children

Common presentation without Chlamydophila pneumoniae

Question 15

What is Coxiella burnetti or Q fever?

Answer 15

Exposure to bodily fluids of animals

Farmer with flu-like illness

Question 16

What investigations are done for pneumonia?

Answer 16

CXR
FBC
Renal profile (CURB 65 and AKI)
CRP
Sputum culture
Blood cultures
Pneumococcal and legionella urinary antigen tests

Question 17

What is important to consider when looking at CRP?

Answer 17

Starts rising 6 hours after inflammation

Peaks after 24-48 hours

Question 18

What antibiotics are given for mild community-acquired pneumonia?

Answer 18

5 days of oral
Amoxicillin or
Doxycycline or
Clarithromycin

Question 19

How is moderate or severe pneumonia treated?

Answer 19

IV antibiotics then stepped down to oral as condition improves

Respiratory support also used