Pneumonia

Question 1

Define pneumonia

Answer 1

Defined as any inflammatory condition affecting the alveoli of the lungs

Question 2

Pneumonia refers to any inflammatory condition affecting which parts of the lungs

Answer 2

Alveoli

Question 3

What is the most common causative organism for community acquired pneumonia

Answer 3

Streptococcus pneumonia

Question 4

Most common causative organism for community acquired pneumonia is Streptococcus pneumonia, followed by?

Answer 4

Haemophilus influenzae and Mycoplasma pneumoniae

Question 5

Define Community acquired pneumonia

Answer 5

Refers to a pneumonia that is contracted in the community

Question 6

Define Hospital acquired pneumonia

Answer 6

Pneumonia that develops more than 48 hours after hospital admission

Question 7

What are the 3 most common causative organisms of hospital acquired pneumonia

Answer 7

Pseudomonas aeruginosa

Staphylococcus aureus

Legionella pneumophila

Question 8

Which organism that causes community acquired pneumonia is particularly common in patients with COPD

Answer 8

Haemophilus influenzae

Question 9

Pneumonia can be divided into 3 categories.

Name them

Answer 9

Community acquired pneumonia

Hospital acquired pneumonia

Aspiration pneumonia

Question 10

Define aspiration pneumonia

Answer 10

Develops as a result of aspiration i.e. inhalation of foreign material e.g. food

Question 11

What is the most common causative organisms in aspiration pneumonia

Answer 11

Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, and Pseudomonas aeruginosa

Question 12

Community acquired pneumonia is a type of pneumonia.

It can be subdivided into two groups. Name them

Answer 12

Atypical organisms

Typical organisms

Question 13

Which organisms is classically the cause of community acquired pneumonia in alcoholics

Answer 13

Klebsiella pneumoniae

Question 14

Typicals are a group of community acquired pneumonia organisms.

Define the term typicals

Answer 14

Called because of the classical rapid onset of symptoms, including high fever and productive cough;

Question 15

Typicals are a group of community acquired pneumonia organisms.

Define the term atypicals

Answer 15

Called because of the more gradual onset of symptoms, which may be non-specific initially (fever, myalgia, dry cough). The organisms are also intracellular;

Question 16

Give an example of a typical community acquired pneumonia organism

Answer 16

Streptococcus pneumoniae (gram +ve cocci found in pairs)

Staphylococcus aureus

Haemophilus influenzae (gram -ve rod, potent beta-lactamase producer)

Moraxella catarrhalis (gram -coccus, potent beta-lactamase producer)

Question 17

Give an example of an atypical community acquired pneumonia organism

Answer 17

Mycoplasma pneumoniae

Chlamydia pneumoniae

Legionella pneumophila

(Coxiella burnettii

Chlamydia psittaci)

Question 18

In the vast majority of patients pneumonia is secondary to which kind of an infection.

Answer 18

Bacterial

Question 19

What are the 3 classic symptoms of pneumonia

Answer 19

Cough

SOB

Signs of consolidation

Question 20

What are the 4 signs indiactive of sepsis secondary to pneumonia

Answer 20

Tachypnoea (raised respiratory rate)

Tachycardia (raised heart rate)

Hypoxia (low oxygen)

Hypotension (shock)

Question 21

How is pneumonia diagnosed in the hospital setting

Answer 21

CXR - showing consolidation

Question 22

How is pneumonia diagnosed in the community setting

Answer 22

Clinical diagnosis

Chest x-ray is not routinely used for patients managed in the community

Question 23

What is the scoring system used to aid clinical judgement in assessing whether the patient with pneumonia should be managed in hospital or at home

Answer 23

CURB-65

Question 24

CURB-65 is a scoring system used for what?

Answer 24

Pneumonia - to assess whether a patient should be managed in the hospital or at home

Question 25

What are the components of the CURB-65 score

Answer 25

(1 point for each if present) **C -** new onset Confusion **U -** Urea (\> 7) **R -** Respiratory Rate (\>30) **B -** Blood Pressure (\< 90 / \< 60) **65 -** Age \> 65

Question 26

At what CURB-65 score is it recommended that the patient be admitted for pneumonia

Answer 26

Score 2 or more

Question 27

At what CURB-65 score is it recommended that a patient with pneumonia should be managed in the ICU setting

Answer 27

Score 3 or more

Question 28

What is the mainstay of treatment for pneumonia

Answer 28

Antibiotics as per local guidelines

Question 29

What are potential complications of pneumonia

Answer 29

**Pulmonary complications:** * Parapneumonic effusion * Pneumothorax * Abscess * Empyema **Extrapulmonary complications:** * Sepsis * Atrial fibrillation

Question 30

What is the scoring system for pneumonia in the community

Answer 30

CRB-65 due to the inability to get a serum urea result (urea is the 'U' in CURB-65).

Question 31

What generally is the first line antibiotics for pneumonia

Answer 31

Amoxicillin

Question 32

Define sepsis

Answer 32

Infection with evidence of organ hypoperfusion (confusion, low GCS, high RR or low systolic pressure)

Question 33

What are the 3 routes in which a bacteria can reach the lungs

Answer 33

Inhalation Aspiration Haematogenous

Question 34

Define Bronchitis

Answer 34

Lower respiratory tract infection of the large airways.

Question 35

What are the two types of bronchitis

Answer 35

Acute and chronic

Question 36

Define Acute bronchitis

Answer 36

An acute infection of the lower airways without evidence of pneumonia (infection of the lung tissue)

Question 37

Define Chronic bronchitis

Answer 37

Subtype of chronic obstructive pulmonary disease Characterised by a chronic productive cough for ≥3 months over two consecutive years

Question 38

What usually causes Acute bronchitis

Answer 38

Viral infection

Question 39

Investigations should not delay antibiotic treatment for hospital acquired pneumonia. How long after diagnosis should a patient be started on treatment?

Answer 39

Within 4 hours

Question 40

What supportive management options are there for hospital acquired pneumonia

Answer 40

Oxygen titrated to saturations IV fluids Appropriate analgesia