Pneumonia

Question 1

What is pneumonia?

Answer 1

Pneumonia refers to lung inflammation associated with consolidation or infiltrates secondary to infection.

Question 2

What are some of the classes of pneumonia?

Answer 2

• Community aquired pneumonia - Presents from the community
• Hospital aquired pneumonia - Presents after at least 48 hours in a hospital setting
• Aspiration pneumonia - cause by inhalation of contents (eg vomitus)

Question 3

Presentation of pneumonia

Answer 3

• Fever
• Cough with purulent sputum which may be blood stained
• Shortness of breath
• Malaise, loss of appetite and myalgia
• Pleuritic chest pain

Question 4

General signs of pneumonia

Answer 4

• Tachypnoea
• Tachycardia
• Hypoxia
• Hypotension
• Fever
• Confusion

Question 5

Characteristic chest signs of pneumonia

Answer 5

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

Question 6

How would you assess the severity of community acquired pneumonia?

Answer 6

CURB-65

• C – Confusion (new disorientation in person, place or time)
• U – Urea > 7
• R – Respiratory rate ≥ 30
• B – Blood pressure < 90 systolic or ≤ 60 diastolic.
• 65 – Age ≥ 65

Score 0/1: Consider treatment at home

Score ≥ 2: Consider hospital admission

Score ≥ 3: Consider intensive care assessment

Question 7

Which bacteria is the most common cause of community aquired pneumonia?

Answer 7

Streptococcus pneumoniae (50%)

Question 8

Which bacteria is the most likely casue of pneumonia following an influenza infection?

Answer 8

Staph. aureus

Question 9

Which bacterial cause of pneumonia is typically associated with alcoholics and diabetics?

Answer 9

Klebsiella pneumoniae

Question 10

Which bacterial cause of pneumonia is associated with air conditioning or a recent history of travel to a foreign country?

Which features are associated with this. bacteria?

Answer 10

Legionella

Hyponatraemia and deranged LFTs

Question 11

Investigations for pneumonia

Answer 11

• Chest xray
• Bloods: FBC, U&Es, LFTs, CRP and blood cultures
• Sputum for microscopy and culture
• Legionella and pneumococcal urinary antigens

Question 12

Complications of pneumonia

Answer 12

• Sepsis
• Pleural effusion
• Empyema
• Lung abscess
• Death

Question 13

Managment of community aquired pneumonia if CURB-65 score 0-1

Answer 13

Outpatient treatment

Amoxicillin 500mg TDS OR clarithromycin 500mg BD for 5 days

Question 14

Managment of community aquired pneumonia if CURB-65 score 2

Answer 14

Inpatient treatment

Amoxicillin 500mg TDS AND clarithromycin 500mg bd for 7 days (oral or IV)

Question 15

Managment of community aquired pneumonia if CURB-65 score ≥3

Answer 15

Consider ITU admission

Co-amoxiclav 1.2g TDS IV AND clarithromycin 500mg BD IV for 7 days

Question 16

Define a lung abscess

Answer 16

A lung abscess refers to the development of necrotic lung tissue and cavity formation secondary to infection.

Question 17

Causes of lung abscess

Answer 17

Primary disease:

• Existing pneumonia or lung disease
• Untreated pneumonia can cause abscess formation

Secondary lung disease:

• Aspiration
• Alcoholics
• Septic emboli from right sided infective endocarditis

Question 18

Clinical features of lung abscess

Answer 18

• Swinging fevers
• Night sweats
• Productive cough with purulent sputum

Question 19

Investigations for lung abscess

Answer 19

CXR, CT and sputum culture

Question 20

Treatment of lung abscess

Answer 20

Treat with IV broad spectrum antibiotics.

If refractory to medical therapy, surgical resection may be considered.