Pneumonia 1
What is the definition of pneumonia?
Inflammation of tissue in one or both lungs typically due to bacterial infection.
What are the lungs' protective mechanisms?
Cough reflex, mucociliary clearance , alveolar macrophages
Draw and label the basic anatomy of a bacteria cell.
Must include:
Cell wall, cytoplasm, ribosomes, flagellum, nucleoid, plasmid.
What is CURB-65?
C - Confusion, disorientation, impaired consciousness
U - Urea levels > 7mmol (20 mg/dL)
R - Respiratory rate > 30/min
B - Blood pressure: systolic < 90 mmHg, diastolic < 60 mmHg
65 - Patient is over 65 years old
What is the difference between bactericidal and bacteriostatic drugs?
Bactericidal will kill the bacteria, bacteriostatic will impede further growth.
Draw and label the lungs.
Must include:
Right side - superior, middle, and inferior lobes, and horizontal and oblique fissure
Left side - superior and inferior lobes, oblique fissure, lingulla, and cardiac notch
What are the risk groups for pneumonia?
Babies and very young children
Elderly people
Smokers
People with other health conditions (e.g. asthma)
People with a weakened immune system (e.g. due to immunosuppressants)
What is the difference between Gram-positive and Gram-negative bacteria?
Gram-negative bacteria have a thin but stronger membrane and are often more resistant to antibiotics.
Gram-positive bacteria have a greater volume of peptidoglycan, which is what makes the thick outer covering. These are more easily treated.
What are three general measures for pneumonia?
Possible answers:
Rest, high liquid intake, antipyretics and analgesics, pulse oximetry monitoring, expectorants
How do you determine if a patient needs hospitalisation?
CURB-65 used as a guideline. Each category is worth a point (5 max).
≥2 points is indication for hospitalisation
≥3 points means ICU should be considered
List four symptoms of pneumonia.
Possible answers:
Productive cough, pyrexia, tachycardia, sweating and shivering, loss of appetite, chest pain, haemoptysis, poor chest expansion, tachypnea and dyspnea, dullness on percussion
What are three tests you could order to diagnose a case of pneumonia?
Possible answers:
Blood, blood culture, chest X-ray, thorax CT, testing sputum, bronchoscopy, pleurocentesis, urine
What are virulence factors? Give an example relating to S. pneumoniae.
Factors that facilitate colonisation, growth and spread in the host, and evasion of the host immune system. Examples:
Capsule - prevents phagocytosis; surface adhesins - attach to respiratory lining; secretory IgA protease - cleaves IgA; neuraminidase - cleaves neuramic acids from sugar residues on the host cell surface; pneumolysins - pore forming (tissue damage)
What are three causes of bacterial antibiotic resistance?
Possible answers:
Natural - selective pressure, mutation, gene transfer
Societal - inappropriate drug use, inadequate diagnostics, agricultural use, hospital use
What are preventative measures against pneumonia?
Vaccination - pneumococcal and influenza
Quitting smoking
Hygiene - washing hands, covering coughs and sneezes
What are two routes of infection for pneumonia?
Possible answers:
Inhaling of airborne pathogens
Aspiration of gastric acid (Mendelson's syndrome), food or liquids
Haematogenous dissemination (e.g. from endocarditis)
What are the possible complications of pneumonia?
Pleuritis, pleural effusion, empyema, sepsis, respiratory failure, ARDS
What are three bacteria that cause pneumonia?
Possible answers:
Streptococcus pneumoniae (most common)
Staphylococcus aureus
Haemophilius influenzae
Mycoplasma pneumoniae
Chlamidophilia pneumoniae
Explain why both penicillin and macrolide were given to the patient.
Different antibiotics will work better against different bacteria, and act against a broader spectrum.
What are some ways to help reduce antibiotic resistance in bacteria?
Possible answers:
Improving infection prevention and control practices; optimising prescribing practice; improving professional education, training, and public engagement; developing new drugs, treatments and diagnostics; better access to and use of surveillance data; better identification and prioritisation of AMR research needs; strengthened international collaboration
Describe the pathophysiology of pneumonia.
Pulmonary protective methods fail → Pathogen infiltrates pulmonary parenchyma → interstitial and alveolar inflammation → impaired alveolar ventilation → V/Q mismatch with intrapulmonary shunting (right to left) → hypoxia due to increased alveolar-arterial oxygen gradient
What is nosocomial pneumonia?
Also called hospital-acquired pneumonia (HAP), it occurs over 48h after admission and did not appear to be developing at the time. It has a mortality rate of over 20%.
Which bacteria causing pneumonia are more common among teenagers and children?
Mycoplasma pneumoniae and chlamidophilia pneumoniae
Describe the mechanism of action of penicillins.
Penicillins prevent the cross-linkage between the linear peptidoglycan polymer chains that make up the cell wall. Part of their structure resembles the d-alanyl-d-alanine of the peptide chains of the bacterial cell wall.
Describe the mechanism of action of macrolides.
Macrolides bind to the 50S subunit of bacterial ribosomes and inhibit translocation.