LTRI: Pneumonia

Question 1

What is Pneumonia? (3 things)

Answer 1

1. Infection of lung tissue
2. Inflamm of lung tissue + Sputum filling airways + alveoli
3. Seen as consolidation on CXR

Question 2

What are the classifications of Pneumonia? (3 things)

Answer 2

1. Community Acquired Pneumonia
2. Hospital Acquired Pneumonia (Nosocomial)
3. Aspiration Pneumonia (after inhaling foreign material e.g food)

Question 3

Why is it important to distinguish between Community vs Hospital acquired pneumonias?

Answer 3

Causative organisms different –> abx treatments will be different

Question 4

What are the Risk Factors for Pneumonia? (6 things)

Answer 4

1. Age (under 5 / over 65)
2. Low immunity (obv)
3. Smoking
4. Alcohol abuse
5. Malnutrition
6. Chronic lung disease (COPD / CF)

Question 5

What are the causes of Community vs Hospital Acquired Pneumonias? (2 + 3 things)

Answer 5

CAP: Strep pneumoniae / H influenzae

HAP: Gram -ve enterobacteria / Staph aureus / Pseudomonas

Question 6

What are the pathophysiological steps of Pneumonia? (5 things)

Answer 6

1. Bac aspirated
2. Bac proliferate in Alveolar space
3. Immune response thru Alveolar MACs
4. Capillary leak + Alveolar infiltration
5. Pneumonia signs + symptoms

Question 7

What are the CF of Pneumonia? (9 things)

Answer 7

1. Fever
2. Delirium (might be only sign in elderly)
3. SOB / Tachypnoea
4. Productive Cough (purulent / bloody sputum)
5. Pleuritic chest pain

@ exam

1. Tactile fremitus (louder 99) (consolidation) (solid vocals)
2. Dullness to percussion (consolidation)
3. Bronchial breath sounds (consolidation)
4. Crackles

(Bold ones distinguish Pneumonia from Bronchitis)

Question 8

What severity score should you do to assess if a sus Pneumonia pt needs further investigation / hospitalisation?

Answer 8

CURB-65

Question 9

What is the CURB-65 score?

Answer 9

• Confusion (disorientated in person / place / time)
• Urea (over 7)
• Resp Rate (over 30)
• BP under 90/60
• 65+ yrs old

1 point for each

• 0 - 1 = Home treatment / Abx (don’t need investigations)
• 2 = Hospital
• 3+ = ITU

Question 10

What investigations should you do for CURB-65 score 2 (aka hospitalized) Pneumonia patients? (4 things)

Answer 10

1. CXR
2. FBC (high WCC)
3. UnE (high urea)
4. CRP (raised in inflamm / infection)

Question 11

What further investigations should you do for CURB-65 score 3+ (aka ITU) Pneumonia patients? (3 things)

Answer 11

1. Sputum Culture
2. Blood Culture
3. Urine sample (to check for Legionella + Pneumococcal Urinary Antigens)

Question 12

What will a CXR show in Pneumonia? (2 things)

Answer 12

1. Interstitial infiltrates (idk)
2. Consolidation

Question 13

What are the management options for Pneumonia? (5 things)

Answer 13

1. Abx
2. Oxygen (keep sats over 94%)
3. Fluids
4. Analgesia (if pleuritic chest pain)
5. ITU (if shock / hypercapnia / remaining hypoxic)

Question 14

What is the NICE Abx recommendations for LOW grade COMMUNITY Acquired Pneumonia?

Answer 14

FIRST LINE: Amoxicillin (5 day course)

If allergic: Macrolide / Tetracycline

Question 15

What is the NICE Abx recommendations for MODERATE - HIGH grade COMMUNITY Acquired Pneumonia?

Answer 15

DUAL Abx Therapy: Amoxicillin + Macrolide (7-10 day course)

Question 16

Why is it important to check local guidelines for Abx for Pneumonia, esp for HAP? (2 things)

Answer 16

1. Guidelines developed according to popular causative bacteria in the specific area
2. They also take into account specific Abx resistance in area

Question 17

How do you monitor Pneumonia to see if Abx treatment working? (2 things)

Answer 17

1. WCC
2. CRP

Question 18

What are the complications of Pneumonia? (4 things)

Answer 18

1. Pleural effusion (Empyema (pus build up))
2. Lung abscess
3. Sepsis
4. Death