Pneumonia: Overview and Practice Questions (2023)

Pneumonia is a serious respiratory illness that affects millions of people worldwide. It is caused by an infection of the lungs, which leads to inflammation and fluid buildup in the alveoli.

While anyone can develop pneumonia, certain groups of people are at a higher risk, including older adults, young children, and people with weakened immune systems.

Despite advances in medical technology, pneumonia remains a leading cause of death and hospitalization, making it important for medical professionals to understand the causes and treatment options for this condition.

In this article, we will provide a comprehensive overview of pneumonia, including helpful practice questions about this topic.

What is Pneumonia?

Pneumonia is an infection that causes inflammation in the lungs and results in fluid build-up, fever, cough, and difficulty breathing. It’s caused by a various organisms, such as viruses, bacteria, and fungi.

Pneumonia can range in severity from mild to life-threatening, and it can affect people of all ages. It is a leading cause of illness and death worldwide, particularly in older adults, young children, and patients with weakened immune systems.

Causes

There are several causes of pneumonia, including viruses, bacteria, fungi, and parasites. Common viruses that can cause pneumonia include influenza (flu), respiratory syncytial virus (RSV), and rhinoviruses (common cold).

The most common types of bacteria that can cause pneumonia include Streptococcus, Mycoplasma, Haemophilus influenzae, and Legionella pneumophila.

Some common fungi that can cause pneumonia are Pneumocystis jirovecii, Cryptococcus, and Histoplasmosis.

Signs and Symptoms

The signs and symptoms of pneumonia can vary in severity from person to person. Here are some of the most common examples:

• Productive cough
• Fever and chills
• Tachypnea
• Shortness of breath
• Chest pain
• Diaphoresis
• Fatigue
• Cyanosis

Keep in mind that other signs and symptoms for pneumonia may be present. These are just a few of the most common examples.

Types of Pneumonia

Pneumonia is often classified according to how the patient acquired the disease. Here are the different types:

• Community-Acquired Pneumonia (CAP)
• Hospital-Acquired Pneumonia (HAP)
• Ventilator-Associated Pneumonia (VAP)
• Aspiration Pneumonia

CAP is when a patient acquires pneumonia outside of the hospital. HAP is when it’s acquired during a hospital stay. VAP is acquired while the patient is on a mechanical ventilator.

Lastly, aspiration pneumonia is acquired when a patient aspirates bacteria into the lungs.

Pneumonia Diagnosis

Pneumonia is most commonly diagnosed by looking at the patient’s chest x-ray, which will show signs of consolidation. Other useful tests and findings include:

• Vital signs
• Arterial Blood Gas (ABG)
• Pulmonary Function Tests (PFT)
• Sputum culture
• Complete Blood Count (CBC)

Pulse oximetry would likely reveal hypoxemia, and a faster breathing rate is also common. The patient’s breath sounds will likely reveal crackles (rales) or rhonchi, and a dull note may be heard during chest percussion.

The patient’s PFT results would likely reveal decreased lung volumes and capacities. A sputum culture would reveal which type of bacteria is causing the infection.

And a complete blood count (CBC) would show the number of white blood cells to help determine if the infection is viral or bacterial.

Treatment

Pneumonia should be treated on a case-by-case basis depending on the patient’s signs and symptoms. However, here are some of the most common treatment methods:

• Antibiotic medications
• Oxygen therapy
• Bedrest
• Airway clearance therapy
• Hyperinflation therapy
• Fluid management

Again, each patient will be treated differently depending on the cause of infection and severity of symptoms. In severe cases, intubation and mechanical ventilation would be indicated.

Pneumonia Practice Questions:

1. What is pneumonia?
An inflammatory condition of the lungs that primarily affects the alveoli, which may fill with fluid and pus

2. What are the symptoms of pneumonia?
High fever and chills, headache, loss of appetite, mood swings, cough with sputum, shortness of breath, joint pain, fatigue, and aches

3. What are some ways to diagnose pneumonia?
Chest x-ray, sputum culture, CBC, and ABG

4. What is the assessment of viral pneumonia?
Low-grade fever, non-productive cough, WBC normal (or slightly increased); it is typically less severe than bacterial pneumonia

5. What is the assessment of bacterial pneumonia?
High fever, productive cough, WBC elevated, and severe infiltrates on the chest x-ray

6. What methods can be used for the therapeutic management of pneumonia?
Antibiotic medications, oxygen therapy, bed rest, airway clearance therapy, hyperinflation therapy, and fluid management

7. What medications can be used for the treatment of pneumonia?
Antibiotics, bronchodilators, and corticosteroids

8. What type of pneumonia is frequently undiagnosed?
Nonbacterial pneumonia

9. What are the three key signs of bacterial pneumonia?
Expectoration of yellow sputum, increased white blood cell count, and the presence of fever.

10. What type of anatomic alteration leads to aspiration pneumonia?
Alveolar consolidation, atelectasis, and inflammation of the alveoli

12. The term “walking pneumonia” is generally used to describe what type of pneumonia?
Mycoplasma pneumonia

13. What is the most common bacterial cause of pneumonia?
Streptococcus pneumonia

14. What are the clinical manifestations of patients with severe pneumonia?
Chest pain, tachycardia, hemoptysis, cyanosis, hypoxia, tachypnea, and dyspnea

15. What is breathing like for a patient with pneumonia?
Pulse oximetry would likely reveal hypoxemia, and they will likely show signs of tachypnea.

16. What causes “walking pneumonia,” and who typically gets it?
It is caused by atypical organisms like mycoplasma pneumonia and chlamydophila. It affects young, healthy adults and presents with a dry, hacking cough.

17. What viruses can cause pneumonia?
Influenza A or B, respiratory syncytial virus, rhinovirus, and coronavirus (SARS, MERS-CoA)

18. What fungi can cause pneumonia?
Cryptococcus, histoplasma, coccidioides, aspergillus, and mucor

19. What are the non-infectious etiologies of pneumonia?
Carcinomas, lymphomas, vasculitis, sarcoidosis, heart failure, and pulmonary embolism

20. What are the causes of pneumonia?
Bacteria, viruses, mycoplasma, fungi, parasites, and fluid stasis of the lungs caused by the accumulation from secondary conditions, such as asthma and COPD

21. What is the problem with pneumonia?
Even with antibiotics, patients with pneumonia still have high morbidity and mortality rates.

22. What are the types of pneumonia?
Community-acquired pneumonia, hospital-acquired pneumonia, and aspiration pneumonia

23. What is community-acquired pneumonia?
A type of pneumonia that is acquired prior to hospitalization

24. What kind of therapy is required to treat pneumonia?
Antibiotic medications

25. What is hospital-acquired pneumonia?
A type of pneumonia that is acquired at least 48 hours after admission to the hospital

26. What is the pathophysiology of pneumonia?
Microorganisms enter the alveoli of the lungs, which leads to an infection and inflammatory response.

27. What is the inflammatory response that occurs with pneumonia?
Neutrophils are activated, which results in edema of the airways and fluid leaks from the capillaries into the alveoli. This affects normal oxygen transport.

28. What are the mechanical barriers of a bacterial infection?
Air filtration, epiglottis, cough reflex, mucociliary response, reflex bronchoconstriction, and the secretion of immunoglobulins and alveolar macrophages

29. What are the risk factors of pneumonia?
Pneumonia is caused by a weakening of processes such as loss of consciousness (intubation), air pollution, and tobacco use. Also, people older than 65 are at a higher risk. Other risk factors include abdominal/thoracic surgery, bedrest/immobility, chronic disease/illness, immunosuppressed, and alcohol use.

30. What is aspiration pneumonia?
A type of pneumonia that occurs when bacteria is aspirated into the lungs

32. What are the sudden symptoms of pneumonia?
Sudden symptoms include fever, shaking, chills, shortness of breath, tachypnea, cough, purulent sputum, and pleural cerebral palsy

33. What is consolidation?
It is a common sign of bacterial pneumonia. When the normally air-filled alveoli become filled with fluid and debris, mucus production increases, which can potentially obstruct airflow and impair gas exchange even further.

34. Why is antibiotic therapy beneficial for pneumonia?
Macrophages break down bacteria and process debris. Lung tissue is then allowed to recover and gas exchange returns to normal.

35. What are the diagnostic tests for pneumonia?
Chest x-ray, sputum culture, sputum gram stain, blood cultures, WBCs, and ABGs

36. What are the standard treatment options for pneumonia?
Antibiotics, IVF and PO hydration, supplemental O2, analgesics, antipyretics, nutrition-frequent small meals, and a balance between rest and physical activity

37. What are the standard practices that patients with pneumonia should learn?
They need to learn hand hygiene, cough etiquette, a balanced diet, adequate rest, and to stop smoking.

38. What are the various complications of pneumonia?
Atelectasis, pleurisy, bacteremia, meningitis, acute respiratory failure, sepsis, septic shock, and empyema

39. What event can trigger the clinical syndrome of pneumonia?
The host’s immune response leads to the inflammatory mediators that create an alveolar-capillary leak. This leak results in rales on auscultation, hypoxemia, and chest x-ray infiltrates.

40. What are the physical examination findings of pneumonia?
Crackles, rhonchi, or wheezes on auscultation; tachypnea; and dullness to percussion

41. What is the one-year mortality rate of someone with pneumonia older than 65?
40%

42. What chest x-ray finding indicates that pneumonia may be life-threatening and difficult to treat?
Lung abscess

43. What is the most common chest x-ray finding with pneumonia?
Consolidation

44. What chest x-ray finding is usually associated with empyema?
Parapneumonic effusion

45. What is a bronchogram on a chest x-ray?
Air-filled bronchi made visible by opacification of surrounding alveoli and peribronchial thickening

46. What will you usually see on a CBC with pneumonia?
Leukocytosis and an L shift

47. What will the ABG typically show for a patient with pneumonia?
Respiratory alkalosis (hyperventilation) with hypoxemia

48. What biomarkers are used to help diagnose pneumonia?
CRP and Procalcitonin (PCT)

49. What is a typical workup for a patient with suspected pneumonia?
Medical history, physical examination, laboratory tests, PA and lateral chest x-ray, microbial studies, culture and gram stain, and blood cultures in a hospitalized patient with sepsis

50. What should true sputum show when trying to find the cause of pneumonia?
An abundance of inflammatory cells, no squamous epithelial cells, and large numbers of a single organism

51. What pattern of pneumonia will have entire lobe consolidation?
Lobar pneumonia

52. What pattern of pneumonia is typically multifocal and patchy?
Bronchopneumonia

53. What pattern of pneumonia is caused by viruses?
Interstitial

54. What are the four most common symptoms of pneumonia?
Productive cough, shortness of breath, chest pain, and fever/chills

55. What are the different categories of pneumonia?
Acute vs. chronic (time), typical vs. atypical (clinical characteristics), alveolar vs. interstitial (x-ray pattern), and community-acquired vs. nosocomial (location of illness onset)

56. What are the types of hospital-acquired pneumonia?
Ventilator-associated (VAP) and healthcare-associated (HCAP)

57. What type of pneumonia is considered community-acquired (CAP)?
Pneumonia that develops outside of the hospital setting

58. What causes CAP?
It is most commonly caused by bacteria that traditionally has been divided into two groups (typical and atypical).

59. Can COVID-19 cause pneumonia?
Yes, some infected with coronavirus can develop pneumonia in one or both lungs.

60. What factors impair the pulmonary clearance of pneumonia?
Viral upper respiratory tract infection, smoking, alcohol, uremia, and bronchial obstruction

61. What is an early symptom of pneumonia?
Breathlessness

62. Can pneumonia lead to acute respiratory distress syndrome (ARDS)?
Yes, pneumonia can lead to ARDS in severe cases.

63. What would the PFT results of a patient with pneumonia show?
Decreased lung volumes and capacities

64. What bacteria can cause pneumonia?
Streptococcus, Mycoplasma, Haemophilus influenzae, and Legionella pneumophila

65. What can cause hypoxemia in a patient with pneumonia?
Alveolar consolidation