Pneumonia (pathology)

Question 1

What is pneumonia?

Answer 1

Inflammation of lung parenchyma (filling of alveolar air spaces with exudate, inflammatory cells, and fibrin)

Question 2

What is bronchopneumonia?

Answer 2

Patchy throughout 1 lung

ventilation:perfusion mismatch —> responds to O2

Question 3

What is lobar pneumonia?

Answer 3

Consolidation of entire lobe

Question 4

What is interstitial pneumonia?

Answer 4

Inflammatory-viral

Question 5

What are the differential diagnosis of pneumonia (5)?

Answer 5

• TB
• Lung cancer
• PE
• Pulmonary oedema (crackles)
• Pulmonary vasculitis

Question 6

What happens in severe bronchopneumonia/lobar pneumonia?

Answer 6

Large consolidation—>shunt (ventilation = 0) —> does NOT respond to O2

Question 7

Risk factors of pneumonia (9)?

Answer 7

• Smoking
• XS alcohol
• Extremes of age
• Preceding viral illness- disruption of mucociliary escalator
• Pre-existing lung disease (COPD, CF)
• Chronic illness
• Immunocompromised (HIV, cancer therapy)
• Hospitalisation (onset 40hrs after admission)
• Intravenous drug users

Question 8

Symptoms of pneumonia (5)?

Answer 8

• fever, rigors, myalgia
• cough + sputum
  
  • rusty brown sputum= Strep pneumoniae
• pleuritic chest pain- worse on inspiration
• dyspnoea
• haemoptysis

Question 9

Signs of pneumonia?

Answer 9

Signs

• tachypnoea (RR> 25)
• Tachycardia (HR> 100bpm)
• Reduced expansion due to consolidation
• Dull percussion-> exudate
• Bronchial breathing (rather than vesicular)
• Crepitations
• ↑↑ vocal resonance-> consolidation= solid better at sound transmission

Question 10

Investigations of pneumonia in primary care

Answer 10

• clinical diagnosis

- CXR if in doubt (cancer)

Question 11

Hospital investigations of pneumonia (8)?

Answer 11

• FBC
• CRP
• U&Es
• Serum biochemistry
• Blood cultures if pyretic
• CXR
• Sputum culture + viral throat swab
• Legionella urinary antigen for atypicals
  Repeat CXR after 6 weeks if > 50 and smoker- cancer!

Question 12

What are the criteria of the CURB-65 severity scoring?

Answer 12

Decides the severity of risk of pneumonia case (1 point for every category)

Confusion: abbreviated mental test <=8
Urea: > 7mmol/L
RR: >=30/min
BP: <90 systolic and/or 60 diastolic 
65: age >=65

Question 13

Complications of pneumonia (7)

Answer 13

• Sepsis
• AKI
• Adult RDS
• Parapneumonic effusion
• Empyema
• Lung abscess
• Bacteraemia

Question 14

Signs there may be complications with pneumonia (5)

Answer 14

• Swinging fevers
• Sweats
• ↑ WCC/CRP
• Weight loss
• Failure to improve

Question 15

Pneumonia management: CURB 0-1
Community/hospital
Antibiotic
Penicillin allergy
Duration

Answer 15

Home treatment
Amoxicillin
Clarithromycin or doxycycline
5 days

Question 16

Pneumonia management: CURB 2
Community/hospital
Antibiotic
Penicillin allergy
Duration

Answer 16

Hospital admission
Amoxicillin + clarithromycin (atypicals)
Levofloxacin
5-7 days

Question 17

Pneumonia management: CURB >=3
Community/hospital
Antibiotic
Penicillin allergy
Duration

Answer 17

ITU
Co-amoxiclav + clarithromycin (atypicals)
Levofloxacin or co-trimoxazole
7-10 days

Question 18

Common causes of aspiration pneumonia

Answer 18

Stroke, Myasthenia gravis, MS, sedation, oesophageal disease

Question 19

Antibiotic for aspiration pneumonia? (+if allergic to penicillin?

Answer 19

Anaerobes

Allergic to penicillin: amoxicillin + metrodinazole

Question 20

Which antibiotic to use for MRSA?

Answer 20

Vancomycin

Question 21

Which organisms cause community acquired-typical pneumonia?

Answer 21

S. Pneumoniae
H. influenzae
Mycoplasma pneumoniae