Pneumonia

Question 2

What is pneumonia?

Answer 2

Infection of the lung tissue, causing inflammation in the alveoli

Question 3

What is the difference between CAP & HAP?

Answer 3

Community acquired pneumonia develops in the community whereas hospital acquired pneumonia develops after more than 48 hours in hospital

Question 4

What is acute bronchitis?

Answer 4

Refers to infection and inflammation in the bronchial tubes

Both pneumonia and acute bronchitis are lower respiratory tract infections

Question 5

What is bronchiolitis?

Answer 5

Infection & inflammation in the bronchioles and occurs in children under 2 years, usually under 6 months - most often caused by RSV

Question 6

What normally causes upper respiratory tract infections?

Answer 6

Viral

Question 7

Top causes of bacterial pneumonia?

Answer 7

Streptococcus pneumoniaea
Haemophilus influenzae

Question 8

What are other causes of bacterial pneumonia?

Answer 8

Group A strep (Streptococcus pyogenes)
Staphylococcus aureus
Mycoplasma pneumoniae

Question 9

Viral causes of pneumonia?

Answer 9

Respiratory syncytial virus
Parainfluenza virus
Influenza virus

Question 10

Where may the causative organism come from via the birth canal?

Answer 10

Group B streptococcus
Escherichia coli
Listeria
Klebsiella

Question 11

What are the causes in cystic fibrosis?

Answer 11

Staphylococcus aureus
Pseudomonas aeruginosa

Question 12

What are the causes in immunocompromised people?

Answer 12

Pneumocystis jirovecii
Cytomegalovirus

Question 13

Symptoms of pneumonia?

Answer 13

Productive cough
High fever
SOB
Lethargy
Drowsiness or confusion

Question 14

Signs of pneumonia?

Answer 14

Fever (above 38.5 degrees)
Tachypnoea (raised resp rate)
Tachycardia (raised heart rate)
Signs of resp distress
Low oxygen saturation
Hypotension
Cyanosis

Question 15

What investigations would you find on chest auscultation?

Answer 15

1. Bronchial breath sounds - are harsh & equally loud on inspiration and expiration which are caused by consolidation of the lung tissue around the airway
2. Focal coarse crackles - caused by air passing through the fluid, similar to using a straw to blow into a drink
3. Dullness to percussion over the affected area occurs due to lung tissue collapse or consolidation

Question 16

Investigations for pneumonia?

Answer 16

1. In uncomplicated pneumonia investigations are not routinely performed or helpful
2. CXR may be helpful if there is a diagnostic doubt or in severe or complicated cases. Pneumonia can be seen as a consolidation.
3. WBC and CRP are raised roughly
4. Sputum culture for bacterial culture and viral PCR can establish the causative organism and guide treatment
5. Blood cultures are required in pts with suspected sepsis
6. Capillary blood gas analysis measures the lactate and pH and is used to identify acidosis in acutely unwell patients

Question 17

Management of pneumonia?

Answer 17

Amoxicillin
Co-amoxiclav - particularly with concurrent influenza or cystic fibrosis to cover Staph aureus
Clarithromycin - to cover atypical bacteria

Question 18

What would you consider in recurrent chest infections?

Answer 18

Cystic fibrosis
Primary ciliary dyskinesia
Bronchiectasis
Immunodeficiency (HIV or selective IgA deficiency)
Neurological disease (cerebral palsy)
Congenital heart disease

Question 19

What tests may be considered?

Answer 19

FBC to check levels of WBCs
CXR for any structural abnormalities or long term scarring
Serum immunoglobulins for selective IgA deficiency & other immunoglobulin disorders
Immunoglobulin G to previous vaccines
Sweat test for cystic fibrosis
HIV test