pneumonia

Question 1

what is pneumonia

Answer 1

common LRTI characterised by inflammation of the lungs

Question 2

what are the 3 most common causes of pneumonia

Answer 2

strep pneumoniae - 70%. most common, CAP

Haemophilus influenzae - 5%. usually elderly and COPD patients

staphylococcus aureus - 4%. PWIDs, often following influenza

Question 3

describe the microbiological appearence of strep pneumoniae

Answer 3

gram +ve cocci

chains

Question 4

describe the microbiological appearence of H. influenzae

Answer 4

gram -ve coccobacilli (rods)

Question 5

describe the microbiological apprearence of staph aureus

Answer 5

gram +ve cocci

clusters

Question 6

name atypical causes of pnenumonia and what causes them

Answer 6

legionella - inhalation of contaminated water droplets - spanish travel

mycoplasma pneumoniae - children and young adults. peaks every 4 years

coxiella burnetti (can cause Q fever)- farming

chlamydia psittaci - birds as pets

klebsiella - aspiration pneumonia (e.g. from alcoholism)

pneumocystis jivroveci - immunocompromised e.g. AIDS pts

Question 7

what are the 2 areas of pneumonic infection

Answer 7

lobar pneumonia -lung lobes

bronchopnuemonia - airways

Question 8

BRIEF description of the disease process in pneumonia

Answer 8

infection

inflammatory exudation

consolidation

Question 9

describe the pathophysiology of lobar pneumonia

Answer 9

confluent consolidation involving a complete lung lobe

most commonly strep pneumoniae

classically in otherwise healthy young adults

Question 10

describe the pathophysiology of bronchopneumonia

Answer 10

infection starting in the airways and spreading to the adjacent alveolar lung

most often seen in the context of pre-existing disease

Question 11

describe the symptoms of a pneumonia

Answer 11

dyspnoea
pleuritic chest pain
younger pt - typically productive cough and high fever
older pt -variety of atypical symptoms - confusion, diarrhoea, reduced mobility, not much cough

Question 12

describe the clinical signs of a pneumonia

Answer 12

rigors
crepitation over the affected area
tachypnoea

Question 13

describe the investigations used in pneumonia

Answer 13

investigations not necessary when managed in the community

when in hospital:
FBCs, U+Es, CRP
CXR
if moderate -> severe - sputum expansion and culture, legionella and urinary antigens

Question 14

what is the CURB65 score used for?

Answer 14

determine the severity of a CAP

Question 15

describe the CURB65 score

Answer 15

C Confusion
U urea >7
R resp rate >30
B BP <90/60 mmHg
aged 65+

Question 16

describe the different sputum apprearence in different bugs in pneumonia

Answer 16

strep pneumoniae - rust coloured
pseudomonas, haemophilus - green
klebsiella - sticky, brown/ dark red
anaerobes - foul smelling, bad tasting

Question 17

outline the management of CAP

Answer 17

CURB 0-2 - amoxicillin IV/ PO, if penicillin allergic, doxycycline day 1 then a course of either doxycycline or IV clarythromycin. 5 days of treatment

CURB 3-4 - co-amoxiclav IV then doxycycline IV, if penicillin allergic then levofloxin

CURB 4-5 - co-amoxiclav and clarythromycin IV (levofloxin if penicillin allergic)

Question 18

outline management for hospital acquired pneumonia

Answer 18

extended gram -ve cover

non-severe: PO amoxicillin (PO doxycycline if penicillin allergy)

severe: IV amoxicillin and clarythromycin IV (penicillin allergy: PO doxycycline and gentamycin)

Question 19

outline management for aspiration pneumonia

Answer 19

non severe- PO amoxicillin and metronidazole (penicillin allergy: doxycycline)

severe - IV amoxicillin, gentamycin and metronidazole (PO doxycycline if penicillin allergic)