Pneumonia

Question 1

Presentation of pneumonia

Answer 1

• Cough (typically wet and productive)
• High fever (> 38.5ºC)
• Tachypnoea
• Tachycardia
• Increased work of breathing
• Lethargy
• Delirium (acute confusion associated with infection)

Question 2

Signs of penumonua

Answer 2

• Tachypnoea (raised respiratory rate)
• Tachycardia (raised heart rate)
• Hypoxia (low oxygen)
• Hypotension (shock)
• Fever
• Confusion

Question 3

Characteristic chest signs of pneumonia

Answer 3

Bronchial breath sounds
Focal course crackles
Dullness to percussion

Question 4

What are the characteristic breath sounds in pneumonia caused by?

Answer 4

• Bronchial breath sounds. These are harsh breath sounds that are equally loud on inspiration and expiration. These are caused by consolidation of the lung tissue around the airway.
• Focal coarse crackles caused by air passing through sputum similar to using a straw to blow into a drink.
• Dullness to percussion due to lung tissue collapse and/or consolidation.

Question 5

Causes bacterial oneumonia

Answer 5

• Streptococcus pneumonia is most common
• Group A strep (e.g. Streptococcus pyogenes)
• Group B strep
• Staphylococcus aureus.
• Haemophilus influenza
• Mycoplasma pneumonia

Question 6

S aureus pneumonia on X ray

Answer 6

This causes typical chest xray findings of pneumatocoeles (round air filled cavities) and consolidations in multiple lobes.

Question 7

Which bacteria look out for in unvaccinated children?

Answer 7

H.influenzae

Question 8

What bacteria is atypical and causes extrapulmonary symptoms in pneumonina?

Answer 8

legionella and mycoplasma pneumoniae

Question 9

Viral causes of pneumonia

Answer 9

RSV
parainfluenza
Influenza

Question 10

What is pneumonia

Answer 10

Pneumonia is simply an infection of the lung tissue. It causes inflammation of the lung tissue and sputum filling the airways and alveoli. Pneumonia can be seen as consolidation on a chest xray. It can be caused by a bacteria, virus or atypical bacteria such as mycoplasma.

Question 11

Child vs adults investigations pneumonian

Answer 11

Children rarely do X ray due to exposure, more clinical judgement, throat swabs, virla PCR and sputum cultures, cap blood gas analysis, blood lactactee

Question 12

First line antibiotics for pneumonia

Answer 12

Amoxicillin

Question 13

What antibiotics cover atypical pneumonias

Answer 13

Macrolide - erythromycin, clarithro/azithromyscin (monotherapy if penicillin allergy)

Question 14

What assess for if recurrent pneumonias

Answer 14

reflux, aspiration, neurological disease, heart disease, asthma, cystic fibrosis, primary ciliary dyskinesia and immune deficiency.

Question 15

Investigations for recurrent pneumonias

Answer 15

FBC
CXR - structural, scarring
Serous immunoglobulins
IgG to prev vaccines - pneumoccoscu, haemophilus
Sweat test - CF
HIV test

Question 16

Why test for IgG in recurretn pnuemonia

Answer 16

Test for immunoglobulin class switch recombination deficinecy - people cant convert IgM to IgG - cant form long term immunity