LRTI: Pneumonia

Question 1

Common organisms that cause community-acquired pneumonia (CAP)?

Answer 1

(1. ) Streptococcus pneumoniae
(2. ) Haemophilus influenzae
(3. ) Pneumocystis jirovecii in IMC

Question 2

What is Pneumonia?

Answer 2

(1. ) Pneumonia is an infection of the lung tissue.
(2. ) It causes inflammation of lung tissue and sputum filling the airways and alveoli.
(3. ) Pneumonia can be seen as consolidation on a chest x-ray.
(4. ) Typical Sx = productive cough, fever, pleuritic chest pain

Question 3

Aetiology of Pneumonia

Answer 3

These may reach the lungs by inhalation, aspiration, haematogenous

(1. ) Bacteria is the most common
- Strept.pneumoniae, H.influenzae = in typical
- gram-negative bacilli, s.aureus, legionella

(2.) Viruses

(3. ) Fungi
- pneumocystis jiroveci PCP to be considered in IMC

(4.) Parasites

Question 4

Classifications of Pneumonia

Answer 4

(1. ) Community Acquired pneumonia
(2. ) Hospital acquired pneumonia

(3. ) Aspiration pneumonia
- inhalation of oropharyngeal or gastric contents

(4. ) Typical pneumonia
- Strept.pneumonia, H.influenza

(5. ) Atypical pneumonia
- Legionella, Mycoplasma pneumonia, Chlamydopilla pneumonia, Chemaydia psittaci

Question 5

Clinical features of Pneumonia

Answer 5

(1. ) SoB
(2. ) Productive cough +/- haemoptysis
(3. ) Systemic Sx = fever, malaise, sepsis
(4. ) Pleuritic chest pain (sharp + worse on inspiration)

Signs

• Dull percussion note
• Reduced breath sounds = harsh + loud
• Coarse crepitations
• Tachycardia
• Hypotension
• Confusion
• Cyanosis

Extra-pulmonary Sx

• neuroloigcal or GI with legionella
• rash with mycoplasma

Question 6

What’s CURB 65?

Answer 6

(1.) Scoring systems that predicts mortality + help guide whether to admit the patient to hospital

• Score 0/1: Consider Tx at home (PO Abx)
• Score ≥ 2: Consider hospital admission (IVAbx)
• Score ≥ 3: Consider ITU

(2.)  C = Confusion (AMTS <=8/10)
U = Urea > 7
R = RR ≥ 30
B =  ≤ 90/60mmHg
65 = Age ≥ 65

Question 7

Ix of Pneumonia

Answer 7

(1.) CXR = consolidation. May show pneumothorax, abscess, empyema, lobular infiltrate.

(2. ) Bloods:
- FBC = raised white cells
- U&Es = for urea
- raised CRP = inflammation + infection

(3. ) Sputum and blood cultures
- if moderate-severe

(4. ) Legionella + pneumococcal urinary antigens
(5. ) Offer HIV test

Question 8

Mx of Pneumonia

Answer 8

Typical

(1. ) Abx
- If septic = IV Abx -> PO
- Mild CAP = 5d PO amoxicillin or macrolide, or clarithomycin (allergy)
- Moderate-severe CAP = 7-10d amoxicillin AND macrolide

(2. ) Oxygen
- 94-98% in pt without underlying lung disease
- 88-92% of type 2 failure risk

(3. ) IV fluid
(4. ) Analgesia

Atypical
(1.) Don’t respond to penicillins and can be treated with: macrolides (e.g. clarithomycin), fluoroquinolones (e.g. levofloxacin), tetracyclines (e.g. doxycycline).

Question 9

Salient Sx and signs of CAP

Answer 9

(1. ) Fever
(2. ) Cough
(3. ) SoB
(4. ) Tachycardia
(5. ) Tachypneoa
(6. ) Hypoxemia

Question 10

RF for Pneumonia

Answer 10

(1. ) Age
(2. ) Post URTI
(3. ) Structural lung disease
(4. ) IMC