T4 - Clinical consequence of respiratory infection

Question 1

what are the three main anatomical classifications of pneumonia?

Answer 1

Lobar, broncho and diffuse

Question 2

what are the three main classifications of pneumonia by setting?

Answer 2

CAP, HAP and ventilator related

Question 3

what are the 5 main signs of pneumonia? (enough for a diagnosis in GP setting)

Answer 3

• reduced air entry
• dull percussion
• bronchial breathing
• increased vocal resonance
• crackles

Question 4

what is used to define the severity of pneumonia?

Answer 4

CURB 65 (or CRB65 in GP setting)

Question 5

what does the CURB 65 score assess?

Answer 5

C - confusion 
U - raised blood urea (>7mmol/L)
R - increased respiratory rate (>30/min)
B - low blood press (below 95/60)
65 - aged over 65 years

Question 6

what is the significance of a CURB 65 score of

i) 0-1
ii) >1

Answer 6

0-1 - low chance of mortality, no need to admit

>1 - significant chance of mortality - admit to hospital

Question 7

what are the main diagnostic tests used in pneumonia?

Answer 7

• FBC (especially CRP and WBCs)
• renal function
• liver function
• blood cultures
• HIV test
• Sputum
• viral throat swab for mycoplasma
• urine test for legionelle
• ABGs
• CXR

Question 8

what may be seen on a CXR for a patient with pneumonia?

Answer 8

• lobar changes
• hazy
• opacity (infection)
• consolidation

Question 9

what type of pneumonia may be seen in frail patients with significant co-morbidities?

Answer 9

broncho pneumonia

Question 10

what does opacity on a CXR indicate?

Answer 10

infection

Question 11

what should be done for a patient with pneumonia with a CURB score of 0 that has shown no improvement in 48hrs?

Answer 11

refer for admission

Question 12

at how many weeks should a CXR be done to see if pneumonia has cleared?

Answer 12

6 weeks

Question 13

what the predominate bacterial cause of pneumonia?

Answer 13

Strep pneumoniae

Question 14

name four bacterial causes of pneumonia apart from strep pneumoniae?

Answer 14

• chalmidya pneumoniae
• mycoplasma pneumoniae
• haemophilus influenzae
• staph aureus

Question 15

how is HAP managed?

Answer 15

• oxygen if required
• fluid replacement if metabolic need is high or there is acute kidney injury
• antibiotics
• critical care management if needed

Question 16

what does the type of antibiotic prescribed for pneumonia depend on?

Answer 16

setting, co-morbidities, local infection trends (epidemiology) and allergies

Question 17

what are the main class of antibiotics given for CAP?

Answer 17

beta lactase (amoxicillin, doxycycline, clarithromycin)

Question 18

what are the main antibiotics prescribed for

i) non severe HAP
ii) severe HAP

Answer 18

non severe HAP - amoxicillin (if a strep) or doxycyclin (myocplas or legionella)

severe HAP - amoxicillin and doxycycline or ceftriaxone or levofloxacin (if IgE mediated)

Question 19

what are the general complications of pneumonia?

Answer 19

respiratory failure and sepsis

Question 20

what are the CV system associated complications of pneumonia?

Answer 20

CV failure due to low blood pressure and kidney failure

Question 21

what are the local complications associated with pneumonia?

Answer 21

pleural effusion, empyema and lung abceses

Question 22

name five possible reasons why a patient with pneumonia may not respond to treatment?

Answer 22

1) pleural parapneumonic effusion
2) differential diagnosis of TB
3) empyema
4) lung abscess
5) underlying bronchial obstruction

Question 23

what is the main bacteria that causes a pleural parapneumonic effusion?

Answer 23

pneumococcus

Question 24

what are the three types of parapneumonic effusions?

Answer 24

1) simple
2) complicated
3) empyema

Question 25

what are the three indications to drain an empyema?

Answer 25

1) visibly purulent effusion
2) radiologically located effusions
3) positive microbial culture from effusion

Question 26

what action should be taken to a non responsive empyema?

Answer 26

refer to cardiothoracics for thoracotomy and draining

Question 27

what investigations should be done if a lung abscess is suspected?

Answer 27

• lavage
• bronchoscopy
• wash out then look at microbiology to exclude differentials eg TB