25.26. Pneumonia

Question 1

What is pneumonia?

Answer 1

Inflammation of the distal small airways, alveoli, and the interstitium associated with exudate accumulation in the alveolar space.

Question 2

What is pneumonitis?

Answer 2

Pneumonia induced by irradiation or chemical agents.

Question 3

What is interstitial pneumonia?

Answer 3

Inflammation affecting primarily the interstitium.

Question 4

What is community-acquired pneumonia (CAP)?

Answer 4

A type of pneumonia that is acquired outside of a hospital or healthcare setting.

Question 5

What are the typical pathogens that cause typical pneumonia?

Answer 5

Streptococcus pneumoniae, Hemophilus influenzae, and Staphylococcus aureus.

Question 6

What are the atypical pathogens that cause atypical pneumonia?

Answer 6

Mycoplasma pneumoniae, Chlamydophila pneumoniae, and viruses.

Question 7

What is hospital-acquired pneumonia (HAP)?

Answer 7

A type of pneumonia that is acquired in a hospital or healthcare setting.

Question 8

What is ventilator-associated pneumonia (VAP)?

Answer 8

Pneumonia occurring in patients on mechanical ventilation breathing machines in hospitals, typically in the ICU.

Question 9

What are the gram-negative pathogens that cause HAP?

Answer 9

Pseudomonas aeruginosa, Enterobacteriaceae (E.coli), and Acinetobacter spp.

Question 10

What are the symptoms and clinical signs of pneumonia?

Answer 10

-Symptoms : Fever, cough, sputum, dyspnea, chest pain,
- Clinical signs : shortened sound with percussion, fine crepitation, rales, X-ray shadow.

Question 11

What are the laboratory test results in pneumonia?

Answer 11

• Increased CRP, neutrophil granulocytes, ESR, LDH, GOT,
• increased procalcitonin in severe sepsis (may increase in lung cancer),
• decreased renal function.

Question 12

What are the blood gas test results in pneumonia?

Answer 12

Hypoxemia, hypocapnia, and respiratory alkalosis.

Question 13

What is the ECG finding in pneumonia?

Answer 13

Sinus tachycardia (fever).

Question 14

What are the diagnostic methods for pneumonia?

Answer 14

-Clinical diagnosis based on history, physical examination, laboratory findings, and CXR finding.
- Consider microbiological studies and advanced diagnostics based on patient history, comorbidities, severity, and entity of pneumonia.

Question 15

What are the methods to collect sputum from lower airways?

Answer 15

• Bronchofibroscopy,
• protected brush specimen,
• bronchoalveolar lavage.

Question 16

Why do we need to do a urine test for pneumonia?

Answer 16

For streptococcus pneumoniae and Legionella pneumophila antigen detection.

Question 17

What are the different findings observed in chest X-ray for different types of pneumonia?

Answer 17

• Lobar pneumonia shows opacity of one or more lobes with air bronchograms,
• bronchopneumonia shows poorly defined patchy infiltrates,
• atypical/interstitial pneumonia shows diffuse reticular opacity.

Question 18

What are the different findings observed in chest CT for pneumonia?

Answer 18

Localized areas of consolidation (hyperdense), air bronchograms, and ground-glass opacities

Question 19

What is the PORT score?

Answer 19

The PORT (pneumonia outcome research team) score is a clinical prediction rule used to calculate the probability of morbidity and mortality among patients with community-acquired pneumonia.

Question 20

What is the classification of the PORT score?

Answer 20

The PORT score is classified into four categories:
- PORT I (at home, per os ABs),
- PORT II-III (at home, per os ABs, some will later need hospitalization),
- PORT III-IV (i.v. AB, hospitalization),
- PORT IV-V (i.v. AB, respirator).

Question 21

Which viruses cause viral pneumonia in adults?

Answer 21

Influenza virus, COVID.

Question 22

Which virus causes viral pneumonia in children?

Answer 22

Respiratory syncytial virus (RSV).

Question 23

What are the typical manifestations of viral pneumonia?

Answer 23

Fever, dyspnea, cough.

Question 24

What is influenza?

Answer 24

A highly contagious viral infection that typically occurs during winter months.

Question 25

What causes influenza?

Answer 25

Influenza A, B, and C viruses.

Question 26

What are the two proteins found on the surface of the influenza virus?

Answer 26

Hemagglutinin (H) and neuraminidase (N).

Question 27

What is the usual presentation of symptomatic patients with influenza?

Answer 27

- Sudden onset of high fever, - nonproductive cough (atypical pneumonia!!) - headache, - malaise.

Question 28

What are the usual levels of inflammatory markers in patients with influenza?

Answer 28

They are usually normal or slightly elevated.

Question 29

What is the diagnostic test used to confirm the diagnosis of influenza?

Answer 29

PCR testing.

Question 30

What is the recommended management for patients with early or severe influenza?

Answer 30

Antiviral therapy with neuraminidase inhibitors such as oseltamivir or zanamivir.

Question 31

What is primary influenza pneumonia?

Answer 31

It is caused by direct infection of the lung parenchyma by the influenza virus and is less common than pneumonia or secondary bacterial bronchitis.

Question 32

What are some of the symptoms of primary influenza pneumonia?

Answer 32

Dyspnea, hypoxemia, cyanosis, and acute deterioration 2-5 days after onset of flu-like symptoms.

Question 33

What are some of the blood test and radiographic findings in patients with primary influenza pneumonia?

Answer 33

Blood tests may show leukocytosis or leukopenia, and CXR may show perihilar congestion with diffuse/multifocal infiltrates.

Question 34

What is the recommended management for primary influenza pneumonia?

Answer 34

Antiviral therapy for influenza with oseltamivir or zanamivir.

Question 35

What is COVID-19?

Answer 35

COVID-19 is an infectious disease caused by the coronavirus SARS-CoV2.

Question 36

What is the mechanism of entry of SARS-CoV2 into host cells?

Answer 36

The Spike protein of SARS-CoV2 facilitates entry by attaching to the ACE2 receptor of the host cell.

Question 37

How is SARS-CoV2 transmitted?

Answer 37

SARS-CoV2 is transmitted via inhalation of droplets, aerosol particles, or mucous membrane contact with respiratory particles.

Question 38

What are the clinical features of COVID-19?

Answer 38

Fever, cough, dyspnea, fatigue, loss of smell/taste, sore throat.

Question 39

What are the diagnostic tests for COVID-19?

Answer 39

PCR test or antigen testing.

Question 40

What is the mechanism of action of Ritonavir-boosted Nirmatrelvir?

Answer 40

Ritonavir inhibits packaging and assembly of viruses, while Nirmatrelvir inhibits the activity of protease.

Question 41

What is the mechanism of action of Remdesivir?

Answer 41

It is a nucleotide analog that inhibits RNA synthesis.

Question 42

What is the recommended route of administration for Ritonavir-boosted Nirmatrelvir?

Answer 42

Oral.