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What is the most common cause of typical pneumonia in adults?
What is the most common cause of typical pneumonia in adults?
Which pathogen is identified as the most common cause of atypical pneumonia?
Which pathogen is identified as the most common cause of atypical pneumonia?
Which of the following conditions is NOT considered a chronic disease risk factor for pneumonia?
Which of the following conditions is NOT considered a chronic disease risk factor for pneumonia?
Pneumocystis jirovecii pneumonia is primarily associated with which patient population?
Pneumocystis jirovecii pneumonia is primarily associated with which patient population?
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What has been a significant factor in reducing mortality from Pneumocystis jirovecii pneumonia in hospitalized patients?
What has been a significant factor in reducing mortality from Pneumocystis jirovecii pneumonia in hospitalized patients?
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What are typical symptoms of pneumonia?
What are typical symptoms of pneumonia?
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Which of the following is a key feature of atypical pneumonia?
Which of the following is a key feature of atypical pneumonia?
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In the context of pneumonia, which population is most susceptible to hospitalisation?
In the context of pneumonia, which population is most susceptible to hospitalisation?
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Which imaging finding is associated with pneumonia?
Which imaging finding is associated with pneumonia?
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What does tactile fremitus suggest in a respiratory examination?
What does tactile fremitus suggest in a respiratory examination?
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Which laboratory test is indicative of infection in pneumonia cases?
Which laboratory test is indicative of infection in pneumonia cases?
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What is a common extrapulmonary symptom associated with atypical pneumonia?
What is a common extrapulmonary symptom associated with atypical pneumonia?
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What clinical sign indicates loss of lung parenchyma borders on chest X-ray?
What clinical sign indicates loss of lung parenchyma borders on chest X-ray?
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Which vital sign abnormality is commonly seen in pneumonia patients?
Which vital sign abnormality is commonly seen in pneumonia patients?
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What is the primary goal of pneumonia treatment?
What is the primary goal of pneumonia treatment?
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What is the primary characteristic of pneumonia regarding lung tissue?
What is the primary characteristic of pneumonia regarding lung tissue?
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Which factor contributes to the impaired ventilation observed in pneumonia?
Which factor contributes to the impaired ventilation observed in pneumonia?
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Which of the following is NOT a failure of pulmonary protective mechanisms in pneumonia?
Which of the following is NOT a failure of pulmonary protective mechanisms in pneumonia?
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Which of these options best describes the pathogenesis of pneumonia?
Which of these options best describes the pathogenesis of pneumonia?
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What happens during the early inflammatory phase of lobar pneumonia?
What happens during the early inflammatory phase of lobar pneumonia?
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Which symptom is commonly associated with pneumonia?
Which symptom is commonly associated with pneumonia?
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What role do environmental pathogens play in pneumonia?
What role do environmental pathogens play in pneumonia?
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What does the presence of numerous bacteria in the early stage of pneumonia indicate?
What does the presence of numerous bacteria in the early stage of pneumonia indicate?
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What are common signs of pulmonary oedema?
What are common signs of pulmonary oedema?
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In moderate severity pneumonia, which two antibiotics are recommended?
In moderate severity pneumonia, which two antibiotics are recommended?
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What is a key consideration for patients suspected of having malignancies related to pneumonia?
What is a key consideration for patients suspected of having malignancies related to pneumonia?
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What should be done if there is no clinical improvement after 5 days of antibiotic therapy in immunocompromised patients?
What should be done if there is no clinical improvement after 5 days of antibiotic therapy in immunocompromised patients?
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Which antibiotic should replace oral amoxycillin in patients with a penicillin hypersensitivity?
Which antibiotic should replace oral amoxycillin in patients with a penicillin hypersensitivity?
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When should therapy be ceased according to clinical evaluation?
When should therapy be ceased according to clinical evaluation?
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Which of the following conditions increases the risk factors for aspiration pneumonia?
Which of the following conditions increases the risk factors for aspiration pneumonia?
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What is a potential sign of empyema in pneumonia patients?
What is a potential sign of empyema in pneumonia patients?
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What does a CURB-65 score of 1 indicate regarding treatment disposition?
What does a CURB-65 score of 1 indicate regarding treatment disposition?
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Which of the following is stated as an advantage of the CORB criteria?
Which of the following is stated as an advantage of the CORB criteria?
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Which symptom is NOT included in the CURB-65 criteria?
Which symptom is NOT included in the CURB-65 criteria?
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What does an elevated urea level indicate in the CURB-65 scoring system?
What does an elevated urea level indicate in the CURB-65 scoring system?
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Which of the following is a CORB criterion for assessing severity of pneumonia?
Which of the following is a CORB criterion for assessing severity of pneumonia?
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What happens to the risk of death as a CURB-65 score increases?
What happens to the risk of death as a CURB-65 score increases?
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Which of the following criteria indicates a severe pneumonia case requiring hospitalization?
Which of the following criteria indicates a severe pneumonia case requiring hospitalization?
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Which parameter does NOT contribute to the CURB-65 score?
Which parameter does NOT contribute to the CURB-65 score?
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Study Notes
Pneumonia
- A lower respiratory tract infection caused by various pathogens.
- Characterized by inflammation of the lung parenchyma, leading to consolidation or interstitial lung infiltrates.
Etiology and Pathogenesis
- Pathogens like Streptococcus pneumoniae, Mycoplasma pneumoniae, and Pneumocystis jirovecii can cause pneumonia.
- These pathogens can be present in the environment and spread through micro-aspiration.
- Failure of pulmonary protective mechanisms such as cough reflex, mucociliary clearance, and macrophage clearance can lead to pathogen infiltration.
Subtypes of Pneumonia
-
Community-Acquired Pneumonia (CAP)
- Most common cause of typical pneumonia is Streptococcus pneumoniae.
- Most common cause of atypical pneumonia is Mycoplasma pneumoniae.
- Atypical pathogens cause approximately 22% of CAP cases.
-
Hospital-Acquired Pneumonia (HAP)
- Most common nosocomial infection, often associated with advancements in UTI prevention.
- Streptococcus pneumoniae is a common causative agent.
-
Pneumocystis jirovecii Pneumonia (PJP)
- The most common HIV/AIDS-related cause of mortality in hospitalized patients.
- Prevalence is low in other populations, primarily affecting immunocompromised individuals.
- Antiretroviral therapy and PJP prophylaxis have reduced mortality rates.
Risk Factors
- Older age (typically >65 years)
- Chronic diseases including COPD, asthma, bronchiectasis, cystic fibrosis, and heart failure.
- Smoking
- Environmental exposures (e.g., water cooling towers, soil, agriculture)
- Hospitalization (poor infection control, prolonged rest, low inspiratory volumes due to pain)
- Immunosuppression (congenital immunodeficiency disorders, HIV)
Presentation
-
Typical pneumonia:
- Sudden onset of symptoms.
- Fever, cough, dyspnea, and chest pain.
- Severe malaise.
- High fever and chills.
- Productive cough.
-
Atypical pneumonia:
- Slow onset with extrapulmonary symptoms.
- Low-grade fever.
- Non-productive, dry cough.
- Dyspnoea.
- Common extrapulmonary features include fatigue, headaches, sore throat, myalgia, and malaise.
- **General inspection: **
- Looking unwell.
- Diaphoresis.
- Chills/rigors.
- Cough.
- ± Sputum production.
- Respiratory distress.
- Dyspnoeic/Breathless at rest.
Diagnosis
-
Bedside tests:
- Urinary Streptococcus pneumoniae/Legionella/Chlamydia antigens.
-
Laboratory tests:
- FBE: Elevated WBC count suggesting infection.
- CRP.
- UEC/LFT.
- Serum Glucose.
- Serum LDH.
- Arterial blood gases.
- Induced sputum.
- Blood cultures (if temperature above 38°C or suspected sepsis).
-
Imaging:
-
Chest X-ray:
- Opacification of lung parenchyma.
- Air bronchogram (air containing bronchioles passing through consolidated lung).
- Silhouette Sign: Loss of sharp borders of lung parenchyma.
- Loss of left heart border = left lingula lobe pneumonia.
- Loss of right heart border = right middle lobe pneumonia.
-
Other findings:
- Pulmonary oedema, empyema, malignancies (lung cancer, mesothelioma), and aspiration pneumonia.
-
Chest X-ray:
Treatment
- Main aim: Determine the severity of the pneumonia and treat appropriately.
-
Duration:
- 5-7 days: For non-ICU or high dependency patients with rapid response to initial antibiotic therapy or alternate diagnoses.
- 7-14 days: Intensive care cases, up to 14 days of therapy may be required for proven pseudomonal infection.
-
Typical Pneumonia:
- Low severity: Oral Amoxycillin or Doxycycline.
- Moderate severity: Intravenous Benzylpenicillin AND Doxycycline.
- Severe severity: Intravenous Ceftriaxone AND Azithromycin.
- Atypical Pneumonia: Doxycycline or Macrolide (oral Clarithromycin or intravenous Azithromycin).
- Hypersensitivity to penicillin: Azithromycin instead of oral amoxycillin, Vancomycin IV instead of benzylpenicillin or cefotaxime/ceftriaxone.
-
Immunocompromised patients:
- Consultation with an infectious diseases specialist and broad-spectrum antimicrobial therapy indicated.
- Antibiotic depends on the immune system defect and risk factors for specific pathogens.
-
Clinical and microbiology status review:
- Review at 48 hours.
- Cease therapy if an alternate diagnosis is made.
- Narrow the spectrum of antibiotics to target identified pathogens.
- Switch to oral therapy once clinical improvement is observed.
Complications
- Sepsis.
- Respiratory failure.
- Pleural effusion.
- Cavitations on chest x-ray (may affect upper lobes).
- Abscess.
- Cardiac failure.
Additional Resources
-
CORB Criteria: (Advantage: Less investigations needed)
- Confusion (acute).
- Oxygen saturation 90% or less.
- Respiratory rate > 30 breaths per minute.
- Blood pressure.
-
CURB-65 Criteria: (Risk of death increases as score increases)
- Confusion of new onset
- Urea > 7 mmol/L.
- Respiratory rate >30/min or greater.
- Blood pressure.
- 65 years or older.
Disposition Recommendations
- 0-1: Treat as an outpatient.
- 2-3: Consider a short stay in hospital or watch very closely as an outpatient.
- 4-5: Requires hospitalization, consider ICU admission.
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Description
This quiz explores the characteristics, etiology, and subtypes of pneumonia. It covers the pathogens involved, the mechanisms leading to infection, and distinctions between community-acquired and hospital-acquired pneumonia. Test your knowledge of this important respiratory condition!
