Pneumonia

Question 0

Outline the natural defences of the respiratory tract against infection

Answer 0

Nasal hairs
Ciliated, columnar epithelium
Mucociliary escalator 
Cough/sneezing reflex 
Lymphoid follicles
Alveolar macrophages 
IgA, IgG

Question 1

Outline the distribution and composition of the normal flora of the respiratory tract

Answer 1

Upper respiratory tract - strep. viridans, neisseria, anaerobes, candida, strep. pneumoniae, strep. pyogenes, haemophilus influenzae
Lower respiratory tract - strep. pneumoniae, haemophilus influenzae, pseudomonas, staph. aureus, mycoplasma

Question 2

List the main infectious diseases of the upper respiratory tract and state the organisms commonly causing these infections

Answer 2

Rhinitis
Pharyngitis
Epiglottitis
Sinusitis

Question 3

Define the term ‘pneumonia’; distinguish between acute ‘lobar pneumonia’, ‘bronchopneumonia’, ‘interstitial pneumonia’, ‘aspiration pneumonia’, and chronic pneumonia

Answer 3

Pneumonia - infection of pulmonary parenchyma with consolidation, inflammatory exudation, heavy, stiff lung, gas exchange impaired
Lobar pneumonia - confluent consolidation involving a complete lung lobe, strep. pneumoniae, community acquired
Bronchopneumonia - infection starting in airways and spreading to adjacent alveoli and lung tissue, complication of viral infection, aspiration of gastric contents, patchy consolidation, not confined by lobar architecture
Aspiration pneumonia - aspiration of exogenous material or endogenous secretions, stroke, epilepsy, drowning, mixed infection

Question 4

Understand the spectrum of clinical features of acute community acquired and acute hospital acquired pneumonias

Answer 4

Symptoms - fever/chills/sweats, cough (+ sputum), breathlessness, pleuritic chest pain, malaise, myalgia
Signs - bronchial breath sounds, crackles, wheeze, dullness to percuss, reduced vocal resonance

Question 5

Understand how to assess severity of pneumonia

Answer 5

CURB-65
Confusion
Urea
Respiratory rate 
BP
Age (>65)

Question 6

Understand the principles of collecting specimens for laboratory diagnosis of pneumonias

Answer 6

Sputum collecting

Bronchoalveolar lavage

Question 7

List the common opportunistic pathogens causing pneumonias in immunosuppressed hosts

Answer 7

Candida
Aspergillus
Pneumocystis
Cytomegalovirus (CMV)

Question 8

Describe the principles of antimicrobial therapy in pneumonia and understand the rationale for selecting different antibiotics for different pneumonias

Answer 8

Amoxicillin
Co-amoxiclav
Erythromycin (for atypical)
Antivirals for severe/during pregnancy

Question 9

Describe the classification of pneumonia

Answer 9

Clinical setting - community/hospital
Presentation - acute/sub acute/chronic
Organism - bacterial/fungi/viral
Lung pathology - lobar/broncho/interstitial

Question 10

Describe some methods to prevent pneumonia

Answer 10

Flu vaccine
Pneumococcal vaccine
Chemoprophylaxis