1: Pneumonia Flashcards
Define pneumonia
LRTI - causing inflammation of alveoli and lung parenchyma
How is pneumonia divided
Depending on where it is acquired into:
- Hospital acquired
- Community acquired
What is primary community acquired pneumonia
Acquired in the community in individuals with no underlying respiratory illness
What is the most common cause of CAP
S. Pneumonia
Explain features of S.Pneumonia involvement
- Rapid onset
- High fever
- Associated with herpes labialis (HSV1)
Aside from S. Pneumonia, what are two other common organisms to cause CAP
- H.Influenza
- Morexalla Catarrhalis
What are the 5 atypical organisms causing CAP
- Klebsiella
- Legionalla
- Mycoplasma
- Chalmydia
- S. Aureus
What are the features of mycoplasma pneumonia
- Dry cough and abnormal CXR
- Erythema multiform
- Autoimmune haemolytic anaemias
When does S. aureus usually present as a cause of pneumonia
Following influenza infection
What are the two distinctive features of legionella pneumonia
Hyponatraemia
Lymphopenia
Where is legionalla pneumonia contracted from
Air-conditioning units
What is chalmydia psiattci associated with
Birds (Parrots)
What is secondary community acquired pneumonia
Pneumonia that occurs in individual with underlying lung disease - such as asthma, COPD, CF
What is most common organism to cause pneumonia in COPD patients
H.Influenza
Define hospital acquired pneumonia
Onset symptoms pneumonia 48h following admission
What usually causes hospital acquired pneumonia
Gram negative bacteria or S.aureus
What organism is associated with alcoholics
Klebseilla
What causes aspiration pneumonia
Oropharyngeal anaerobes
What causes pneumonia in HIV patients
Pneumocystitis Jirovecci
What are the features of PCP in HIV patients
- Dry Cough
- Exercise-Induced desaturations
- Absent chest signs
What are 4 risk factors for pneumonia
- Old age
- Smoker
- Immobile
- Immunocompromised
What are risk factors for aspiration pneumonia
- CN palsy
- MND
- Intoxication
- Myasthenia Gravis
- Stroke
What are symptoms of pneumonia
- Productive cough
- Pleuritic chest pain
- Fever
- Dyspnoea
- Malaise
What is heard on auscultation in pneumonia
- Decreased air entry
- Bronchial breathing
What is present on percussion in pneumonia
Dull to percussion
What are symptoms of an atypical pneumonia
- Dyspnoea
- Dry cough
- Low-grade fever
- Malaise, Headache
- Auscultation is unremarkable
What is lobar pneumonia
Pneumonia of an entire lobe
In primary care how is pneumonia assessed
CRB65 and CRP
When is CRP performed in primary care in suspected pneumonia
CRP is performed if individual has a LRTI, but is not diagnosed with pneumonia based on clinical assessment
What CRP are antibiotics offered
> 100
If an individual has CRP 20-100 what is done
Consider delayed antibiotics (eg. I’ll give you antibiotics now but don’t use them for a few days)
If an individual has CRP less than 20 what is done
Do not give Abx
What does CRB65 stand for
Confusion
RR
BP
65
What defines confusion on CRB65
AMTS less than 8.
New onset disorientation in time, place or person
What defines RR in CRB65
> 30
What defines BP in CRB65
Systolic BP <90
Diastolic BP <60
What defines age in CRB65
> 65 years-old
If CRB65 is 0 what is done
Manage at home
If CRB65 is 1 what is done
Consider hospital assessment
If CRB65 is 2 what is done
Hospital assessment
What criteria is used in hospital to assess pneumonia
CURB65
What does the U of CURB65 mean
Urea >7
In hospital if someone scores 0-1, how are they managed
Home based care
In hospital if someone scores 2 how are they managed
Ward-based care
In hospital if someone scores 3 how are they managed
ITU
What imaging is ordered in pneumonia
CXR
How will lobar pneumonia present
Consolidation of a single lobe
How will bronchopneumonia present
Patchy infiltrates scattered throughout the lung
What is ordered 6 weeks later in pneumonia and why
CXR - exclude lung cancer
If patients have a moderate-high severity CAP, what investigations should be ordered
- Sputum MC+S
- Blood Culture
- Legionella and pneumococcal urinary antigen test
Explain CRP in hospital
CRP should be measured in all inpatients to assess response to treatment
How is low severity pneumonia managed
Amoxicillin (5d)
What is offered to patients allergic to penicillin
Clarithromycin (5d)
What is offered to medium severity pneumonia (CRB 1/2)
Amoxicillin and clarithromycin 7-10d
What is offered for severe pneumonia (CRB 3/4)
Co-amoxiclav and clarithromycin 7-10d
What is given to prevent pneumonia
Pneumococcal vaccine
Influenza vaccine
What time frame would you expect fever to resolve in pneumonia
1 Week
What time frame would you expect chest pain and fever to resolve in pneumonia
4 Weeks
What time frame would you expect cough and breathlessness to resolve on pneumonia
6 Weeks
What time frame would you expect symptoms to have resolved in pneumonia
3-months
What may be present at 3-months in pneumonia
Fatigue
When should individuals feel back to themselves
6 months
What are 5 complications of pneumonia
- Pleural effusion
- Empyema
- Lung abscess
- Resp Failure
- Septicaemia
