🎓
Pneumonia
Respiratory
Cough
Fever
Pleuritic chest pain
Pneumonia is an acute infection of the lung parenchyma. It is classified into Community-Acquired (CAP) or Hospital-Acquired (HAP) and managed based on severity scoring like CURB-65.
🎯 Key Learning Objectives
- Calculate the CURB-65 score to guide management and admission.
- Identify the most common causative organism (Streptococcus pneumoniae).
- Select appropriate empirical antibiotics based on severity.
- Recognize atypical pneumonia features (e.g., Legionella, Mycoplasma).
- Interpret chest X-ray findings (lobar vs bronchopneumonia).
- Differentiate between CAP and HAP (onset >48h after admission).
🔬 Pathophysiology
Pathogens reach the alveoli, where they multiply and trigger an inflammatory response. Alveoli fill with exudate, neutrophils, and RBCs, causing consolidation and impaired gas exchange.
🩺 Clinical Features
Symptoms
- Productive cough (rusty/green sputum)
- Fever/rigors
- Dyspnoea
- Pleuritic chest pain
- Confusion (especially in elderly)
Signs
- Tachypnoea
- Dullness on percussion
- Increased vocal resonance
- Bronchial breath sounds
- Crepitations
🔬 Investigations
🛏️ Bedside
- Oxygen saturations
- Sputum microscopy/culture
🩸 Bloods
- CRP/WBC (markers of infection)
- U&Es (for Urea in CURB-65)
- Blood cultures (in moderate/severe)
📷 Imaging
- Chest X-ray (essential for diagnosis)
⚗️ Special
- Urinary antigens (Legionella/Pneumococcus)
- Bronchoscopy (in immunocompromised)
💊 Management
🚨 Acute Management
- Empirical Antibiotics (Amoxicillin for low risk; Co-amoxiclav + Clarithromycin for high risk)
- Oxygen
- IV fluids
📋 Long-Term
- Repeat CXR at 6 weeks (to exclude underlying malignancy)
- Smoking cessation advice
🏃 Lifestyle
- Rest
- Adequate hydration
- Pneumococcal vaccination for at-risk groups
⚠️ Complications
Parapneumonic effusion
Pleural empyema
Lung abscess
Sepsis
Type 1 respiratory failure
⭐ High-Yield Pearls
- CURB-65: Confusion, Urea > 7, RR >= 30, BP < 90/60, Age >= 65.
- Klebsiella pneumonia is associated with alcoholics and 'red currant jelly' sputum.
- Mycoplasma pneumoniae often presents with extra-pulmonary symptoms like erythema multiforme.
- Legionella is linked to air conditioning and can cause hyponatraemia.
- Antibiotic course duration for uncomplicated CAP is usually 5 days.
📖 GUIDELINES:
NICE NG138
BTS Guidelines for CAP
❓ Practice Questions
Q1. A 64-year-old woman presents with sudden onset shortness of breath and pleuritic chest pain. She underwent a total hip replacement two weeks ago. Her observatio…
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Q2. A 22-year-old man presents to the Emergency Department with an acute asthma exacerbation. He is unable to complete sentences in one breath, his respiratory rate…
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Q3. A 68-year-old male with known COPD presents with increasing breathlessness and productive cough with green sputum. On examination, he is stable but has widespre…
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