Pneumonia

Question 1

Pneumonia is fluid e____ into alveoli due to ______ from infection

Answer 1

exudation
inflammation

Question 2

Is pneumonia typically caused by a bacterial or viral infecton?

Answer 2

Bacterial

Question 3

What does CAP stand for?

Answer 3

Community acquired pneumonia (in community or less than 48 hours in hospital)

Question 4

What bacteria are most commonly responsible for CAP?

Answer 4

S. pneumoniae
H. influenzae
Mycoplasma pneumoniae

Also (can’t use beta lactam antibiotics):
S aureus
Legionella
Chlamydia pneumoniae

Question 5

What is commonly the cause of Legionella?

Answer 5

Air conditioning, holidays to spain

Question 6

For the infections that can’t be given beta lactam antibiotics, what should be given?

Answer 6

Macrolides instead like clarithromycin

Question 7

How do beta lactam antibiotics work?

Answer 7

They inhibit bacterial cell wall biosynthesis.

However some bacteria are resistant to beta lactam antibiotics because they can make enzymes that hydrolyse the beta lactam ring, inactivating the antibiotic.

Question 8

What does HAP stand for?

Answer 8

Hospital acquired pneumonia

Question 9

What bacteria commonly cause HAP?

Answer 9

Gram negative aerobic bacilli:

P. aeruginosa
E. coli
Klebsiella

Question 10

Why is HAP usually more severe?

Answer 10

Many of the bacteria causing HAP are multi drug resistant

Question 11

What are 2 viral causes of pneumonia?

Answer 11

CMV
Haemophilus influenzae

Question 12

What fungi can cause pneumocystis pneumonia (PCP) in immunocompromised patients?

Answer 12

Pneumocystis jirovecii

Question 13

PCP is an ____ defining illness

Answer 13

AIDS

Question 14

How is pneumonia caught?

Answer 14

Typically via inhaling or aspirating the pathogen

Question 15

What are risk factors for pneumonia?

Answer 15

Immunocompromised (HIV/long term steroids)
IVDU (staph aureus)
Pre-existing respiratory disease
Extremes of age

Question 16

In typical pneumonia, where does exudate form in response to the bacteria?

Answer 16

Inside alveoli lumen

Sputum present

Question 17

In atypical pneumonia where does the exudate form in response to the bacteria?

Answer 17

interstitium of alveoli

Question 18

Is sputum present in typical or atypical pneumonia?

Answer 18

Typical

In atypical there is a dry cough

Question 19

What are symptoms of pneumonia?

Answer 19

Productive cough with rusty coloured sputum (purulent)
Pyrexia (fever) due to infection
Pleuritic chest pain, worse with breathing/coughing
Tachypnoea
Dyspnoea
Tachycardia
Hypotension
Confusion in elderly

Question 20

How is pneumonia diagnosed?

Answer 20

1st line = Chest XR showing consolidation and an air bronchogram (can see the structure of the air-filled bronchioles as surrounded by opacified lung parenchyma)

Sputum sample and culture to 10 organism

Question 21

What does consolidation mean on a Chest XR?

Answer 21

The air in small airways of the lungs is filled with a fluid/solid/other material which shows up as dense and white

Question 22

Which bacteria may cause multilobar pneumonic lesions?

Answer 22

S. pneumoniae
S. aureus
Legionella

Question 23

Which bacteria may cause multiple abscesses seen in the lungs on a chest XR?

Answer 23

S. aureus

Question 24

On a Chest XR what may cause upper lobe pneumonic lesions?

Answer 24

TB
Klebsiella

Question 25

What tool is used to assess severity of CAP?

Answer 25

CURB65

Question 26

What does CURB65 stand for?

Answer 26

Confusion Urea nitrogen greater than 7mmol/l Respiratory rate greater than 30 Bp is lower than 90/60 mmHg (if either drops) 65+ y/o

Question 27

What is used to assess confusion in CURB65?

Answer 27

abbreviated mental test score (AMTS) confusion = 8/10 or lower

Question 28

If only 1 of the CURB65 criteria applies to a patient what happens?

Answer 28

Given oral antibiotics and discharged. 3% mortality

Question 29

If 2 of the CURB65 criteria apply, what happens?

Answer 29

Consider short hospital stay and give antibiotics

Question 30

If 3 or more of the CURB65 criteria apply, what happens?

Answer 30

15% mortality rate hospitalised in ICU Given IV antibiotics

Question 31

How is pneumonia treated?

Answer 31

O2 (stats 94-98%) Broad spec antibiotics NSAIDs for pleuritic chest pain

Question 32

What antibiotic is given for CAP with a CURB65 score of 0-2?

Answer 32

Amoxicillin

Question 33

What antibiotics is given for CAP with CURB65 score of 3-5?

Answer 33

Co-amoxiclav and Clarithromycin

Question 34

Which organism causing pneumonia should be treated with clarithromycin as 1st line, irrespective of the CURB65 score?

Answer 34

Legionella (also notifiable to PHE)

Question 35

What conditions can cause aspiration pneumonia?

Answer 35

Stroke Bulbar palsy Myasthenia Gravis