Pneumonia and chest infections MCQ

Pneumonia and respiratory infection  illness

Dr Chaitanya Joshi

DEFINITION: 

chest anatomy

Pneumonia is an infection of the pulmonary parenchyma

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 Factors that predispose to pneumonia 

• Cigarette smoking 
• Upper respiratory tract infections 
• Alcohol 
• Corticosteroid therapy 
• Old age 
• Recent influenza infection 
• Pre-existing lung disease 
• HIV 
• Indoor air pollution 

Classification: setting in which the person has contracted their infection

Community-acquired pneumonia (CAP) definition :

   It   occurs  outside hospital setting or less than 48 hours after admission

 Hospital-acquired pneumonia (HAP):

       Hospital-acquired or nosocomial pneumonia refers to a new episode of pneumonia occurring at least 2 days after admission to hospital. 

Contd…

 Health care-associated pneumonia (HCAP) :

      refers to the development of pneumonia in a person who has spent at least 2 days in hospital within the last 90 days, attended a haemodialysis unit, received intravenous antibiotics, or been resident in a nursing home or other long-term care facility. 

 Immunocompromised host :

Neutropenic, HIV +, Cancer,Mycobacterium tuberculosis, Pneumocystis jiroveci ,Immunosuppressives  

Classification by site of pneumonia

 Lobar pnemonia :

 Infection can be localized with the whole of one or more lobes affected. >90% of the cases is due to Strep.pneumoniae

 Interstitial Pneumonia

 Inflammation confined to interalveolar septa

 Mycoplasma pneumoniae, Pneumocystis jiroveci

 Bronchopnemonia:

 often due to infection centred on the bronchi and bronchioles

Staphylococcal pneumonia

CLASSIFICATION BY ETIOLOGY

• PRIMARY PNEUMONIA (due to specific pathogenic organism)

Common: 

• Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus

Less common:

• Klebsiella pneumoniae, Strep pyogenes, Pseudomonas aeruginosa, Virus: H1N1 Influenza Virus, Corona Virus

 ATYPICAL PNEUMONIA)**

**Mycoplasma pneumoniae, Legionella, Chlamydophila, and Coxiella burnetii 

2. SECONDARY PNEUMONIA

(absence of any specific pathogenic organism in sputum and presence of some pre-existing abnormality of respiratory system)

• 
  
• Aspiration of pus from nasal sinuses
• Vomitus
• Aspiration of gastric contents in GERD
• Inhalation of septic matter during procedures like dental extraction
• Community-acquired pneumonia (CAP) 
• World-wide, CAP continues to kill more children than any other illness. 
• Most cases are spread by droplet infection
•  Strep. pneumoniae  remains the most common infecting agent
• Viral infections are an important cause of CAP in children 

Clinical features of CAP

The clinical presentation varies according to the immune state of the patient and the infecting agent.

Cough: In pneumococcal pneumonia, sputum is characteristically rust-coloured. 

• 
  

 Breathlessness: Coarse crackles are often heard on auscultation,  Bronchial breath sounds may be heard over areas of consolidated lung.

• 
  

 Fever: this can be as high as 39.5–40°C. If swinging fevers are present this often indicates empyema 

Clinical features

Chest pain: this is commonly pleuritic in nature. A pleural rub may be heard early on in the illness.

• 
  

Extrapulmonary features : 

Haemolysis due to cold agglutinins occurs (in approximately 50% cases of Mycoplasma pneumonia). Thrombocytopenia is relatively common.

• 
  

Other features: in the elderly, CAP can present with confusion or nonspecific symptoms such as recurrent fall.

Initial Assessment

INVESTIGATIONS

1. CBC and DLC: Leucocytosis suggests bacterial pneumonia. In viral and atypical pneumonias, total leucocyte count is often less 5000/m3.
2. CRP levels are raised.
3. Blood culture: Recommended only in hospitalized patients, particularly in case of pneumococcal pneumonia
4. Respiratory secretions: Do Gram Stain and Ziehl Neelsen Stain. Culture and Sensitivity.
5. Pulse oximetry and arterial blood gas analysis is necessary if oxygen saturation is below 94%.
6. HIV testing: since pneumonia is a common initial presenting illness 

Investigations for pnneumonia

Chest x-ray

Strep. Pneumoniae : Consolidation with air bronchograms, effusions and collapse can  be seen. Radiological abnormalities can lag behind clinical signs. 

     Repeat a normal chest X-ray where CAP is suspected

Mycoplasma. Usually one lobe is involved but infection

    can be bilateral and extensive.

Legionella: There is lobar and then multi-lobar  shadowing

 Radiological examination is helpful if a complication such as parapneumonic effusion, intrapulmonary abscess formation or empyema is suspected. 

General management of pneumonia

Oxygen :Supplemental oxygen should be administered to maintain saturations between 94% and 98%

Intravenous fluids : Required in hypotensive patients

     showing any evidence of volume depletion.

Thromboprophylaxis. If admitted for >12 hours

 Physiotherapy: Chest physiotherapy is not needed unless sputum retension

Nutritional supplementation:

Analgesics : paracetamol ,  Non steroidal anti-inflammatory medication helps treat pleuritic pain, thereby reducing the risk of further complication

Management continued

Antibiotics. The first dose of antibiotic should be

     administered within 4 hours of presentation 

– Parenteral antibiotics should be switched to oral once

      the temperature has settled for a period of 24 hours

MANANGEMENT: ANTIBIOTICS

COMPLICATIONS OF PNEUMONIA

• Para-pneumonic effusion-common 
• Empyema
• Retention of sputum causing lobar collapse 
• Development of thromboembolic disease 
• Pneumothorax-particularly with Staph. aureus 
• Suppurative pneumonia/lung abscess
• ARDS, renal failure, multi-organ failure 
• Hepatitis, pericarditis, myocarditis, meningoencephalitis 

Prevention of further episodes

Smoking cessation advice and support

Influenza vaccination is recommended to those at high risk of mortality from influenza or pneumonia

All patients over the age of 65 who have not previously been vaccinated and are admitted with CAP should have the pneumococcal vaccine before discharge 

Pneumonia MCQs

Dr Chaitanya

1

Most common symptom of the respiratory disease is?

1. a) Wheeze
2. b) Cough
3. c) Fever
4. d) Hemoptysis

Ans:

B cough

2

Common sound heard on auscultation in pneumonia is

1. • Rales
2. • Ronchi
3. • Wheeze
4. • Crackles

crackles

3

An old man comes to u with complaint of fever for 4 days and cough associated with chills. On examination the patient is in respiratory distress and AND HAS HIGH GRADE FEVER OF 104 DEGREE FAHRENHEIT.  The most possible diagnosis is

1. • COPD
2. • PTB
3. • Bronchial asthma
4. • Pneumonia

Pneumonia

4

A pus sample is called purulent if

Pneumonia depiction

1. • Pus cells > 25 and epithelial cells < 10
2. • Pus cells > 15 and epithelial cells < 5
3. • Pus cells > 30 and epithelial cells < 10
4. • Pus cells > 20 and epithelial cells < 5

A. Pus cells > 25 and epithelial cells < 10

5

A patient who is known case of COPD under medication has complained of increased shortness of breath. He said that he could walk on plane level with his friends easily but now he needs to take break every 100 m or so due to shortness of breath. What is the mMRC grade of SOB for this patient?

1. 1
2. 2
3. 3
4. 4
5. 0

3

6 Difficulty in breathing is called

1. Dyspnoea
2. Orthopnoea
3. Tachypnoea
4. Apnoea

Dyspnoea

7

Which organism causes the so called walking pneumonia (Hint: atypical pneumonia)

1. Streptococcus
2. Klebsiella
3. H1n1
4. SARS-CoV2
5. Mycoplasma

Mycoplasma

8

HAP is called if symptoms/diagnosis

1. Within 2 days of admission
2. After 48 hours of admission
3. 2 days of admission to 2 days of discharge
4. If patient admitted to ICU

2 days of admission to 2 days of discharge

9

Common causative agent for congenital or neonatal oneumonia is

1. H. influenziae
2. Chlamydia pneumoniae
3. Streptococcus pneumoniae
4. Broup B streptococcus

Gr. B strep

10

In CURB 65 scoring B stands for

1. Blood urea nitrogen
2. Blood count
3. Blood pressure 
4. Breathing

Blood pressure ( sys<90 or dias <60)

11

Lung abscess following pneumonia is caused by

1. Staphylococcus
2. Streptococcus
3. Pneumocystis
4. Coronavirus

Staphylococcus

12

Antibiotic of choice for CAP in OPD setting is

1. Amoxycillin
2. Ciprofloxacin
3. Metronidazole
4. Doxycycline

Amoxycillin

13

Pneumothorax is

1. Hyperexpansion of lungs
2. Air in thoracic cavity
3. No breathing by lungs
4. Lung mixed with ait

Air in thoracic cavity

14

Your patient has BP of 130/90 mm of Hg. What is his MAP

1. 103
2. 101
3. 109
4. 122

What is his pulse pressure in above case

1. 103
2. 40
3. 20
4. 90

103 and 40

Thank you 

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