Session 8: Pneumonia

Question 2

Define pneumonia

Answer 2

A general term to describe the inflammation of parenchyma of the lung due to infection.

Question 3

What is inflammation of the lung parenchyma called in the absence of infection?

Answer 3

Pneumonitis

Question 4

Give examples of lower respiratory tract infections.

Answer 4

Pneumonia Bronchitis Bronchiolitis Empyema Bronchiectasis Lung abscess

Question 5

Causes of pneumonitis

Answer 5

Chemical or physical damage for example

Question 6

What is a common feature of pneumonia?

Answer 6

Cellular exudate in the alveolar spaces.

Question 7

Pneumonia can be divided into classifications. Which?

Answer 7

Lobar pneumonia Broncho pneumonia

Question 8

What is the difference between lobar pneumonia and bronchopneumonia?

Answer 8

Lobar pneumonia is when the pneumonia is restricted to a particular lobe/s of the lung. Bronchopneumonia is more diffuse and patchier. (Not restricted to lobes)

Question 9

Pneumonia is also classified due to its source of infection. State the different classifications.

Answer 9

Community acquired pneumonia Nosocomial/Hospital acquired pneumonia Aspiration pneumonia Immuno-compromised pneumonia

Question 10

Most common causative organisms of community acquired pneumonia.

Answer 10

Streptococcus pneumonia (most common) followed by Haemophilus influenzae, Moraxella catarrhalis, Klebsiella pneumoniae, Staphylococcus aureus

Question 11

What is atypical pneumonia?

Answer 11

A form of community acquired pneumonia caused by atypical organisms.

Question 12

Give the most common causative organism of atypical pneumonia + some other

Answer 12

They are atypical because they lack a cell wall. Mycoplasma pneumoniae is the most common. Chlamydia pneumoniae and Legionella pneumophila also occurs.

Question 13

How to diagnose CAP.

Answer 13

Clinical presentation - sputum sample, dyspnoea, fever, tachycardia, crackles. Imaging - consolidations, infiltrates and cavitation.

Question 14

Antibiotic treatment of CAP.

Answer 14

Since it is mainly pneumococcal it is treated with amoxicillin. However it depends on the severity.

Question 15

Antibiotic treatment of atypical pneumonia.

Answer 15

As they don’t have a cell wall and can survive intracellularly penicillins will not work. Instead antibiotics that act on protein synthesis such as macrolides (erythromycin/clarithromycin) or tetracyclines like doxycycline can be used. Doxycyclin or a macrolide can also be used in mild-moderate CAP.

Question 16

What is the definition of nosocomial pneumonia?

Answer 16

Symptoms that arise 48 hours after hospital admission and was not incubating at the time of admission.

Question 17

What are nosocomial pneumonia more associated with?

Answer 17

Impaired defence

Question 18

Give examples of defences of the respiratory tract.

Answer 18

Muco-ciliary escalator Coughing Sneezing Respiratory mucosal immune system. Alveolar microbiota

Question 19

Briefly explain the Respiratory mucosal immune system.

Answer 19

Lymphoid follicles of the pharynx and tonsils. Alveolar macrophages. Secretion of IgA and IgG.

Question 20

Common causative organisms of nosocomial pneumonia.

Answer 20

Gram-negative bacteria but also Staph aureus and MRSA.

Question 21

Antibiotic treatment of nosocomial pneumonia.

Answer 21

As it is most commonly gram-negative Co-amoxiclav is used.

Question 22

In case of MRSA nosocomial pneumonia, what antibiotic should be used?

Answer 22

Vancomycin

Question 23

What is aspiration pneumonia?

Answer 23

Aspiration of food, drink, saliva, vomit or any other foreign body can lead to pneumonia.

Question 24

Give risk factors for aspiration pneumonia.

Answer 24

Patients with altered consciousness such as anaesthesia, alcohol, drug abuse. Neuromuscular problems or oesophageal disease as well.

Question 25

Common causative organisms in aspiration pneumonia.

Answer 25

Oral flora and anaerobes. It is usually treated with Co-amoxiclav

Question 26

Causative organisms of pneumonia in immunocompromised patients.

Answer 26

Pneumocystis jiroveci, Aspergillus spp., Cytomegalovirus

Question 27

The presentation of pneumonia can be somewhat variable however there is almost always a triad of signs that arise, which?

Answer 27

Malaise Fever Productive cough (sputum)

Question 28

Variations of sputum in pneumonia.

Answer 28

Purulent, rusty coloured (evidence of blood) or frankly blood stained.

Question 29

Give other common signs and symptoms of pneumonia.

Answer 29

Pleuritic chest pain Dyspnoea

Question 30

How is the severity of pneumonia assessed?

Answer 30

CURB 65 score. If there is a presence of 2 or more of the features there is an indication for admission and hospital treatment.

Question 31

Explain what the CURB 65 score is.

Answer 31

A mnemonic for: C - New mental confusion U - Urea 7 >mmol/l R - RR > 30/min B - BP (sBP <90 and dBP <60 mmHg) 65 - Over 65 y old

Question 32

How will a CXR usually present in pneumonia?

Answer 32

As a shadowing in at least one section of the lung field.

Question 33

Other investigations.

Answer 33

FBC U & Es CRP ABGs Sputum sample for gram stain Blood cultures

Question 34

A normal prognosis of a pneumococcal pneumonia is 5% mortality. What might cause a higher mortality rate?

Answer 34

High CURB65 Very high or very low white cell count Absence of fever Extensive X-ray shadowing Significant hypoxia Hyperureamia Also causative organism

Question 35

Management of pneumonia (general measure)

Answer 35

Anything to manage the symptoms. Good oral fluid intake Avoid dehydration Anti-pyretics for the fever and malaise Stronger analgesics for pleuritic pain In severe cases IV fluids and O2 might be required.

Question 36

Complications of pneumonia.

Answer 36

Pleural effusion Empyema Lung abscess formation

Question 37

Prevention of pneumonia

Answer 37

Immunisation via flu vaccine and pneumococcal vaccine. Chemoprophylaxis Smoking advice

Question 38

Risk factors of pneumonia

Answer 38

Age Smoking/Alcohol/Drugs Chronic lung disease like bronchiectasis, CF or COPD. Immunocompromised like DM/HIV etc… Malnutrition Co-infection