SGS 8 - Pneumonia Quiz

Older people are more likely to get pneumonia when which of the following situations is present?

Note more than one answer can be correct.

• Dehydration

• Group Living

• Malnutrition

• Severe periodontal disease

Answer explanation

Residing in group living situations increases the chance of disease transmission. Malnutrition impairs host defences, which could predispose to pneumonia.

Which of the following organisms most commonly causes community-acquired pneumonia in adults?

• Haemophilus influenzae

• Klebsiella pneumoniae

• Streptococcus pneumoniae

• Staphylococcus aureus

Answer explanation

Pneumococcal or streptococcal pneumonia, caused by streptococcus pneumoniae, is the most common cause of community-acquired pneumonia. H. influenzae is the most common cause of infection in children. Klebsiella species is the most common gram-negative organism found in the hospital setting. Staphylococcus aureus is the most common cause of hospital-acquired pneumonia.

An elderly patient with pneumonia may appear with which of the following symptoms first?

• Fever and chills 

• Altered mental status and dehydration

• Pleuritic chest pain and cough

• Haemoptysis and dyspnoea

Answer explanation

Fever, chills, haemoptysis, dyspnoea, cough, and pleuritic chest pain are common symptoms of pneumonia, but elderly clients may first appear with only an altered mental status and dehydration due to a blunted immune response. Confusion features as a criterion in many clinical scoring systems for the severity of pneumonia including the CORB, CURB65, PSI and SMARTCOP.

When auscultating the chest of a client with pneumonia, you would expect to hear which of the following sounds over areas of consolidation?

• Bronchial

• Bronchovesicular

• Tubular

• Vesicular

Answer explanation

Chest auscultation reveals bronchial breath sounds over areas of consolidation. Bronchovesicular are normal over mid lobe lung regions, tubular sounds are commonly heard over large airways, and vesicular breath sounds are commonly heard in the bases of the lung fields.

A diagnosis of pneumonia is typically achieved by which of the following diagnostic tests?

• Arterial blood gas analysis

• Blood cultures

• Chest x-ray

• Sputum culture and sensitivity

Answer explanation

The diagnosis of pneumonia requires a chest X-ray. Although important for detecting the causative organism, a positive sputum culture does not differentiate between bronchitis, bronchiolitis and pneumonia. Only consolidation on chest X-ray can confirm the diagnosis. In some cases, treatment is offered on clinical evidence if a chest XRAY is negative very early in infection but this is the exception rather than the rule.

Arterial blood gas analysis will determine the extent of hypoxia present due to the pneumonia, and blood cultures will help determine if the infection is systemic.

A patient with pneumonia develops dyspnoea with a respiratory rate of 32 breaths/minute and difficulty expelling his secretions. You auscultate his lung fields and hear bronchial sounds in the left lower lobe. You determine that the patient requires which of the following treatments first?

• A.Antibiotics

• Bed rest

• Nutritional intake

• Oxygen

Answer explanation

The patient is having difficulty breathing and is probably becoming hypoxic. As an emergency measure, oxygen should be provided. Antibiotics may be warranted, but this isn’t a matter of urgency. The patient should be maintained on bedrest if he is dyspnoeic to minimize his oxygen demands, but providing additional oxygen will deal more immediately with his problem. The patient will need nutritional support, but while dyspnoeic, he may be unable to spare the energy needed to eat and at the same time maintain adequate oxygenation.

A patient has been treated with antibiotic therapy for right lower-lobe pneumonia for 10 days
and will be discharged today.
Which of the following physical findings would lead you to believe
it is appropriate to discharge this patient?

• Continued dyspnoea

• Fever of 39C 

• Respiratory rate of 32 breaths/minute

• Vesicular breath sounds in right base

Answer explanation

If the patient still has pneumonia the breath sounds in the right base will be bronchial, not the normal vesicular breath sounds. If the patient still has dyspnoea, fever, and increased respiratory rate, he/she should be examined again before discharge because he may have another source of infection or still have pneumonia.