Pneumonia

Question 1

Risk factors for pneumonia

Answer 1

• impaired lung defenses
- ƒƒpoor cough/gag reflex (e.g. illness, drug-induced)
ƒƒ- impaired mucociliary transport (e.g. smoking, cystic fibrosis)
ƒƒ- immunosuppression (e.g. steroids, chemotherapy, AIDS/HIV, DM, transplant, cancer)

• increased risk of aspiration
-ƒƒ impaired swallowing mechanism (e.g. impaired consciousness, neurologic illness causing dysphagia, mechanical obstruction)

• no organism identified in 75% of hospitalized cases, and >90% of ambulatory cases

Question 2

What are the 3 As of Klebsiella?

Answer 2

Aspiration pneumonia
Alcoholics and diabetics
Abscess in lungs

Question 3

Px of pneumonia

Answer 3

• cough (± sputum), fever, pleuritic chest pain, dyspnea, tachypnea, tachycardia
• elderly often present atypically; altered LOC is sometimes the only sign
• evidence of consolidation (dullness to percussion, bronchial breath sounds, crackles, increased fremitus, whisper pectoriloquy)
• features of parapneumonic effusion (decreased air entry, dullness to percussion, decreased fremitus)

Question 4

Cx of pneumonia

Answer 4

ARDS, lung abscess, parapneumonic effusion/empyema, pleuritis ± hemorrhage

Question 5

Ix of pneumonia

Answer 5

• pulse oximetry to assess severeity of respiratory distress
• CBC and differential, electrolytes, urea, Cr, ABG (if respiratory distress), troponin/CK, LFTs, urinalysis
• sputum Gram stain/C&S, blood C&S, ± serology/viral detection, ± pleural fluid C&S (if effusion
>5 cm or respiratory distress)
• CXR±CT chest shows distribution (lobar consolidation or interstitial pattern), extent of
infiltrate ± cavitation
• bronchoscopy ± washings for
ƒƒ (1) severely ill patients refractory to treatment or (2) immunocompromised patients

Question 6

Rx of pneumonia

Answer 6

• ABC, O2, IV fluids, consider salbutamol (nebulized or MDI)

* determine prognosis and need for hospitalization and antibiotics

Question 7

What is the pneumonia clinical prediction tool?

Answer 7

CURB65 score

Confusion (altered mental status)
Urea/Bun: Urea >7mM, BUN >19
Resp rate >30
Blood pressure less than 90 systolic or less than 60 diastolic

Age >65yo

1 point for each

0-1: less than 5% mortality. Outpatient
2-3: 5-15% mortality. Hospitalisation
4-5: 15-30% mortality. ICU

Question 8

How (3) can you prevent pneumonia?

Answer 8

• Influenza A & B vaccine annually for ALL ages
• Pneumococcal polysaccharide vaccine (Pneumovax) for >65yo & >24mo at high risk for invasive pneumococcal disease (functional/anatomic asplenia, immunodeficiency)
• Pneumococcal conjugate vaccine (Prevnar-13): all children less than 5yo, 5-17yo at high risk for invasive pneumococcal disease who have not previously received Prevnar-13. Also recommended for adults at high risk.