Pneumonia

Question 0

What are the 2 broad categories of pneumonia? Explain the differences

Answer 0

Typical: abrupt onset, fever, pure lent sputum and focal consolidation
Atypical: gradual onset, dry cough, myalgias and headache
(No reliable way of telling them apart)

Question 1

Explain what CURB65 is and what measurements are of concern

Answer 1

Confusion - new onset
Urea - >7mmol
RR - >30
BP - <60
65 - years or older
Helps to decide upon treatment (1 oral ABs, 2 IV ABs, 3 let senior know, 4 keep them comfortable...)

Question 2

What groups are most at risk of pneumonia?

Answer 2

Children - esp chronically ill
Elderly 
Immunosuppressed
Alcoholics
Splenectomy patients (likely to cause common cold in many others)

Question 3

How does pneumonia spread?

Answer 3

Inhalation of droplets

Question 4

What are the clinical signs of pneumonia?

Answer 4

High or low temp; confusion (sepsis); tachypnoea; dull percussion note; crackles; bronchial breathing; increased tactile vocal fremitus

Question 5

What are the symptoms of pneumonia?

Answer 5

Fever, cough (sputum), pain, dyspnoea, coryza, pharyngitis, vomiting, headaches, myalgias, general malaise

Question 6

What investigations do you perform if pneumonia is suspected?

Answer 6

“SUBEX”
Sputum - AFB, general cultures, gram stain
Urine - output decrease one if 1st things to occur (legionella antigen)
Blood - cultures, FBC (WBC), urea, serology
ECG
X-ray- CXR (look for consolidations)

Question 7

If CXR reveals a consolidation but you haven’t yet got your cultures back what should you do?

Answer 7

Give two antibiotics to cover both gram negative and positive bacteria and both typical and atypical pneumonia

Question 8

How would you treat uncomplicated pneumonia?

Answer 8

p.o. Clarithromycin and p.o. Amoxicillin
OR
p.o. Cephalosporin

Question 9

How would you treat complicated pneumonia?

Answer 9

I.v. Cefuroxime and p.o. Clarithromycin
OR
I.v. Augmentin and p.o. Clarithromycin

Question 10

Name a likely cause of pneumonia in an alcoholic who was brought in unconscious with signs of having vomited?

Answer 10

E. coli (common with aspiration)

Question 11

In an instance where aspiration is likely to have caused the pneumonia what antibiotics would you use to treat?

Answer 11

i.v. Cefuroxime and i.v. Metronidazole

Question 12

What antibiotics would you use to treat a cavitation pneumonia ? (Klebsiella, E. coli, Staphylococcus)

Answer 12

i.v. Cefuroxime and i.v. Metronidazole
Or
i.v. Flucloxacillin

Question 13

How would you treat atypical pneumonia?

Answer 13

p.o. Clarithromycin and i.v. Rifampicin (and or tetracycline)

Question 14

Define pneumonia in pathological terms

Answer 14

Inflammation and consolidation of the lung tissue due to an infectious agent

Question 15

Define pneumonia in clinical terms

Answer 15

Acute LRTI, usually associated with fever, symptoms and signs with abnormal CXR

Question 16

Besides antibiotics what other treatments are you likely to need to prescribe?

Answer 16

Fluids if BP low
Analgesia if significant pain
Ventilate if RR increasing

Question 17

What is the most likely pathogen involved in pneumonia?

Answer 17

Streptococcus

Question 18

How do you assess the severity of a pneumonia?

Answer 18

CURB 65

Question 19

What is the initial treatment for pneumonia?

Answer 19

2x antibiotics

Question 20

What are the potential complications with pneumonia?

Answer 20

Empyema
Bronchiectasis 
Abscess
ARDS
PE

Question 21

What sort of (where located) pneumonia do Streptococcus and Klebsiella typically cause?

Answer 21

Lobar pneumonia

They make patients very ill and are a medical emergency!

Question 22

Give some examples of bronchopneumonias?

Answer 22

Streptococcus (can cause), staphylococcus, H. Influenzae, P. aeruginosa, some fungi

Question 23

What is a common cause for Staphylococcal pneumonia?

Answer 23

Prior infection, such as a viral infection

it is commonly a secondary infection

Question 24

Where is Klebsiella likely to infect and how might you recognise it before a culture is taken?

Answer 24

``` As Klebiella is often associated with aspiration (e.g. Those with swallowing difficulties) is commonly occurs in the right lower lobe. A rusty (bloody) mucus is common due to the cavitation capacity of the bacteria ```

Question 25

If someone is coughing up copious amounts of dark green sputum what is the likely bacteria causing the pneumonia?

Answer 25

Pseudomonas aeriginosa

Question 26

In which groups is P. aeriginosa common?

Answer 26

Those with chronic illness (immunosuppressed) | Should not occur in normal healthy individuals

Question 27

What type of pneumonia is considered primary and what is considered secondary?

Answer 27

Lobar pneumonia = primary | Bronchopneumonia = secondary

Question 28

Other than Klebsiella which other bacterial pneumonia commonly causes lung cavitation?

Answer 28

Staphylococcus

Question 29

Besides Klebsiella which other bacterial pneumonia commonly causes right lower lobar pneumonia?

Answer 29

E. coli

Question 30

In which groups does lobar pneumonia more commonly occur?

Answer 30

Young healthy adults

Question 31

In which groups does bronchopneumonia more commonly occur?

Answer 31

Those in their extremities of life (very young, very old) or suffering with comorbidities

Question 32

Why when you suspect pneumonia from a given history should you ask a patient about their contact with birds?

Answer 32

Chlamydia psittacci infects birds and can be passed on to humans (Can be lethal or persist for upto 6 weeks)

Question 33

If you discover Mycobacterium tuberculosis in a patient what must you do?

Answer 33

Isolate the patient and undertake contact tracing to irradicate Family, those they work closely with, those travelling regularly with them

Question 34

What is Pneumocystis carinii and where does is usually infect?

Answer 34

The most common opportunistic infection in HIV sufferers; usually the bronchi so often CXRs reveal no silhouette signs

Question 35

What bacterial pneumonia has been associated with these symptoms: Arthralgia, myalgia, myocarditis, meningitis, hepatitis, idiopathic hyperaldosteronism, skin eruptions and vomiting

Answer 35

Mycoplasma pneumoniae | Commonly a secondary infection