Typical pneumonia

Question 1

Define pneumonia

Answer 1

Infection of lung parenchyma

Question 2

Anatomical classification of pneumonia

Answer 2

Lobar

Bronchopneumonia

Question 3

Aetiology of pneumonia (x4)

Answer 3

Community acquired
Hospital acquired
Immunosuppression
Aspiration

Question 4

Strep pneumonia

Common or uncommon cause of pneumonia?

Answer 4

Common

Question 5

Strep pyogenes

Common or uncommon cause of pneumonia?

Answer 5

Uncommon

Question 6

H influenzae

Common or uncommon cause of pneumonia?

Answer 6

Common

Question 7

Mycoplasma pneumoniae

Common or uncommon cause of pneumonia?

Answer 7

Common

Question 8

Staph aureus

Common or uncommon cause of pneumonia?

Answer 8

Middle!

Question 9

Main cause of anaerobic bacterial pneumonia

Answer 9

Aspiration

Question 10

Gram negative rod pneumonia

Common or uncommon cause of pneumonia?

Answer 10

Uncommon

Question 11

Moraxella catarrhalis

Common or uncommon cause of pneumonia?

Answer 11

Uncommon (except COPD and CCF)

Question 12

Yersinia

Common or uncommon cause of pneumonia?

Answer 12

Uncommon (plague)

Question 13

Bacillus anthracis

Common or uncommon cause of pneumonia?

Answer 13

Uncommon

Question 14

Brucella

Common or uncommon cause of pneumonia?

Answer 14

Uncommon

Question 15

Pneumonia due to Strep pneumomoniae

Answer 15

Saprophyte of respiratory tract activated in old/young/sick
Fever, rigors, pleuritic pain, cough, haemoptysis
Crackles and lobar consolidation
Complications: empyema, meningitis, septicaemia, ruptured bullae
Look at urine antigen!

Question 16

Pneumonia due to Strep pyogenes

Answer 16

Uncommon
Usually in young following viral infection
(Measles, mumps, influenza)
Complications: effusion, empyema, pneumothorax, pericarditis, fistula

Question 17

Pneumonia due to H. influenzae

Answer 17

Usually follows URTI

Less invasive than Strep pneumoniae

Question 18

Features of typical pneumonia

Answer 18

Cough, haemoptysis, tachycardia, tachypnoea, fever, rigors, pain
Early crackles
Later consolidation and bronchial breathing

Question 19

Investigation results of typical pneumonia

Answer 19

Obs: fever, tachycardia, tachypnoea, low O2%
Bloods: Neutrophilia, high WCC, CRP and ESR
Sputum culture: +ve
CXR: lobar involvement, air bronchograms, central/segmental consolidation, nodules with fluid level,

Question 20

Normal location of anaerobic infection

Answer 20

Lower lobes, typically RHS

Main cause: aspiration

Question 21

Gram negative rods

Common or uncommon cause of pneumonia?

Answer 21

Uncommon

Question 22

Klebsiella

Common or uncommon cause of pneumonia?

Answer 22

Uncommon

Question 23

E. coli

Common or uncommon cause of pneumonia?

Answer 23

Uncommon

Question 24

Pseudomonas aeruginosa

Common or uncommon cause of pneumonia?

Answer 24

Uncommon

Question 25

Acinetobacter | Common or uncommon cause of pneumonia?

Answer 25

Uncommon

Question 26

Pseudomonas pseudomallei | Common or uncommon cause of pneumonia?

Answer 26

Uncommon

Question 27

Nocardia asteroides/brasiliensis | Common or uncommon cause of pneumonia?

Answer 27

Uncommon

Question 28

Acinetomyces israeli | Common or uncommon cause of pneumonia?

Answer 28

Uncommon

Question 29

Moraxella catarrhalis | Common or uncommon cause of pneumonia?

Answer 29

Uncommon (except COPD and CCF)

Question 30

Pneumonia infection with Klebsiella

Answer 30

Elderly men with comorbidities Typically affects upper lobes Thick, bloody sputum CXR: Consolidation of upper lobes, bulging fissures, cavitation

Question 31

Pneumonia infection by E. coli, Pseudomonas aeruginosa, Acinetobacter

Answer 31

Affects chronically ill patients Rarely is there haemoptysis Affects lower lobes Frequently with abscess and empyema

Question 32

Pneumonia infection with Nocardia asteroides/brasilensis

Answer 32

Aerobic gram negative soil bacteria Spontaneous infection in the immunosuppressed Fever, lethargy, wt loss, anorexia, productive cough, pleuritic skin abscesses Focal neurology CXR: Cavitation, consolidation, nodules, abscesses

Question 33

Pseudomonas pseudomallei

Answer 33

Linked with myeloidosis Gram negative aerobe found in soil and water Causes skin infection

Question 34

Actinomyces israeli Pneumonia infection

Answer 34

anaerobic branching bacilli, often mistaken for fungi Commensal in pharynx Linked with poor dentition, COPD and bronchiectasis M>F Subacute onset Cavitating chest wall pustules

Question 35

Moraxella pneumonia infection

Answer 35

gram negative aerobic coccus Commensal in pharynx Common in COPD and CCF

Question 36

Yersinia | Common or uncommon cause of pneumonia?

Answer 36

Very uncommon

Question 37

Pasteurella | Common or uncommon cause of pneumonia?

Answer 37

Very uncommon

Question 38

Francisella tularensis | Common or uncommon cause of pneumonia?

Answer 38

Very uncommon

Question 39

Baciluus anthracis | Common or uncommon cause of pneumonia?

Answer 39

Very uncommon

Question 40

Brucella | Common or uncommon cause of pneumonia?

Answer 40

Very uncommon

Question 41

Pneumonia via Yersinia infection

Answer 41

Plague! Gram negativa aerobic rod, non fermenting Very infectious URTI Bubonic: suppurating lymph nodes Pneumonic: CP, SoB, haemoptysis, lower lobe infiltrates, effusion

Question 42

Pasteurella multocida pneumonia infection

Answer 42

Gram negative rod Commensal in mamalian oropharynx Cutaneous infection from mammalian bite

Question 43

Francisella tularensis pneumonia infection

Answer 43

Gram negative rod in animals and insects of N hemisphere | Insect bite causes abrupt pneumonia and purulent bite with lymphadenopathy

Question 44

Bacillus anthracis pneumonia infection

Answer 44

Gram negative aerobic rod with soil spores Infection via contaminated milk/dung Skin: Black, encrusted pustules GI: bowel upset Chest: cough, CO, stridor, oedema of neck and chest wall

Question 45

Brucella pneumonia infection

Answer 45

Gram negative coccobacillus In GI tract of cows, goats, dogs and pigs Infection via unpasteurised milk Fever, malaise, HSM CXR: Nodules, miliary infiltration, mediastinal lymphadenopathy

Question 46

Chlamydia

Answer 46

4-13% of CAP C. pistachio may have had contact with birds (parrots) Can be low-grade symptoms over months Can have meningitis, prostration, photophobia, neckstifness Dx with increased complement-fixing-Ab Tx- Macrolides (e.g. Erythromycin) or Tetracyclines (e.g. Doxycycline)