Pneumonia

Question 1

What is the definition of pneumonia?

Answer 1

An acute lower respiratory tract infection associated with recently developed radiological signs

Question 2

What is community acquired pneumonia?

Answer 2

It is picked up from home, rather than in a hospital

Question 3

What is pneumonia?

Answer 3

An infection that inflames the alveoli

They may fill with fluid or purulent material (pus)

Question 4

What is a pulmonary consolidation and how does it appear on a chest X-ray?

Answer 4

a region of lung tissue that has filled with fluid, rather than air

Areas of consolidation appear cloudy on X-ray

Question 5

What are the 5 main symptoms of pneumonia?

Answer 5

1. Progressive breathlessness
2. Fever with shivering attacks (rigor)
3. Sharp chest pain
4. General malaise/lethargy
5. Hypotension

Question 6

What causes the sharp chest pain in pneumonia patients?

Answer 6

The pain is due to pleurisy which is inflammation of the pleura

The pain becomes worse on inspiration

Question 7

Why is hypotension a symptom of pneumonia?

Answer 7

Due to an inflammatory stimulus

This decreases peripheral arterial resistance - dilation

Cardiac output increases to compensate, leading to tachycardia

Question 8

What are the 4 main clinical signs of pneumonia?

Answer 8

1. hot, flushed with peripheral dilatation
2. dull to percussion but increased breath sounds on auscultation
3. crackles due to the presence of fluid
4. pleural rub

Question 9

What is pleural rub?

Answer 9

The sound of the pleural linings rubbing together

Occurs when pleura are inflamed and have lost their lubrication

Question 10

What are the 7 treatments for pneumonia?

Answer 10

1. antibiotics
2. oxygen
3. analgesia
4. fluids to treat hypotension and maintain perfusion
5. physiotherapy
6. nutrition
7. stop smoking

Question 11

How is pneumonia classified?

Answer 11

Based on a CURBA score:

Confusion (8 or less)
Urea (>7)
Respiratory rate (>/= 30)
Blood pressure (S<90 D= 60)
Age >/= 65

A score of 1 point is added for each abnormal reading

Question 12

What do the CURBA scores mean for treatment?

Answer 12

0 or 1 - likely suitable for home treatment

2 - consider hospital Rx

3 or more - manage in hospital as severe pneumonia

Question 13

What other lung conditions can pneumonia lead to?

Answer 13

1. lung abscess due to collection of pus or fluid
2. pleural effusion
3. empyema

Question 14

What is empyema?

Answer 14

Similar to pleural effusion, but the fluid becomes infected and contains pus

Question 15

What are the 5 treatments for pneumonia?

Answer 15

1. antibiotics
2. pleural aspiration
3. drain
4. VATS/Surgery
5. rhDNase/TPA (breaks down areas of scarring in tissue)