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1. Pneumonia Flashcards

1
Q

Define pneumonia

A

Inflammatory consolidation of the lung parenchyma caused by the formation of intra-alveolar exudate from infection

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2
Q

What are the risk factors for pneumonia?

A 
>65
Smoke
Malnourished
Immunocompromised
Recurrent RTIs
Medications
Winter
Virulence of organisms
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3
Q

What pathogens can cause pneumonia in the immunocompromised?

A

PCP
CMV
Mycobacteria
Toxoplasma

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4
Q

Which bacteria can cause pneumonia?

A 
Strep pneumoniae
Haemophilus influenzae
Staph aureus
Mycoplasma pneumonia
Legionella pneumophilia
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5
Q

What viruses cause pneumonia?

A

Influenza pneumoniae
Respiratory synctial virus
COVID-19

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6
Q

What fungus can cause pneumonia?

A

PCP

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7
Q

Give the aetiology of pneumonia

A

Organisms get into alveoli
immune cells infiltrate and release CKs
Cause vasodilation and vascular permeability
Alveoli are filled with fluid: congestion

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8
Q

What causes SOB in pneumonia?

A

Reduced oxygen flow due to congestion

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9
Q

What causes a cough in pneumonia?

A

Bronchoconstriction and increased mucous secretion

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10
Q

What causes pleuritic chest pain in pneumonia?

A

Pain receptors on alveoli

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11
Q

What causes pyrexia in pneumonia?

A

CK release

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12
Q

What is lobar pneumonia?

A

Affects a section or lobe

Starts at bottom of lung and spreads up

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13
Q

What are the symptoms of lobar pneumonia?

A

SOB
Cough
Chest pain
Pyrexia

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14
Q

What are the signs of lobar pneumonia?

A

Decreased chest expansion
Dull on percussion
Bronchial breathing
Crackles

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15
Q

Give the stages of lobar pneumonia

A

Congestion
Red hepatisation
Grey hepatisation
Resolution/scarring

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16
Q

How does the lung appear during congestion?

A

Heavy and red due to vascular engorgement

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17
Q

What causes red hepatisation?

A

exudate with RBCs, neutrophils and fibrin in intra-alveolar spaces

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18
Q

How does red hepatisation appear?

A

Lobes are red, firm, airless like a liver

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19
Q

What causes grey hepatisation?

A

RBCs disintegrate and exudate remains

20
Q

What is the difference between resolution and scarring?

A

Resolution: infection is cleared and enzymes digest exudate
Scarring: infiltration of fibroblasts and collagen deposition

21
Q

What kind of population is lobar pneumonia associated with?

A

Neglect, alcoholics

22
Q

Which pathogen most commonly causes lobar pneumonia?

A

Strep pneumoniae

23
Q

How does bronchopneumonia appear on radiography?

A

Patchy

24
Q

What are the symptoms of bronchopneumonia?

A 
productive cough
Pyrexia
chest pain
dyspnoea
crackles
25
Q

What population is associated with bronchopneumonia?

A

Extremes of age

26
Q

What is a possible complication of bronchopneumonia?

A

Microabscess formation

27
Q

What is atypical pneumonia also known as?

A

Interstitial pneumonia- no consolidation of alveoli

28
Q

How does atypical pneumonia appear on a CXR?

A

Reticulonodular pattern ie. fluffy

29
Q

How does the immune response to atypical pneumonia differ?

A

Causes lymphocyte infiltration rather than neutrophils

symptoms are milder and more insidious

30
Q

What are the symptoms of atypical pneumonia?

A

Dry cough
Low grade pyrexia
Sore throat, myalgia, fatigue, diarrhoea

31
Q

What are the signs of atypical pneumonia?

A

Rales
WCC is normal or only slightly elevated
Responsible pathogen has no gram stain or is a virus

32
Q

What pathogens cause atypical pneumonia?

A 
Mycoplasma
Chlamydia
Legionella
Mycobacteria
COVID-19
33
Q

What are the risk factors for aspiration pneumonia?

A 
Impaired cough
Unconscious
Pyloric stenosis
Oesophageal obstruction
Hiatus hernia
34
Q

What kind of pneumonia is associated with aspiration?

A

Widespread bronchopneumonia

Can cause chemical pneumonitis with widespread inflammation and damage

35
Q

What investigations should be done into pneumonia?

A

CXR
Blood tests
Blood, sputum, BAL for culture

36
Q

What blood tests should be done if pneumonia is suspected?

A 
FBC (high WCC)
U&E (atypical pneumonia)
LFTs
Glucose
CRP (used to monitor progressin)
37
Q

What prognostic tools are used in pneumonia?

A

CURB-65

Pneumonia severity index

38
Q

What complications can arise from pneumonia?

A 
Parapneumonic effusion/empyema
Abscess
Delirium and sepsis
ARDS
Respiratory failure
Organisms spread to other sites
39
Q

What is an empyema?

A

Collection of pus within the pleural cavity resulting from a parapneumonic effusion

40
Q

How should an empyema be investigated?

A

CXR

Aspirate pleural fluid (cytology and micro)

41
Q

What is the treatment for an empyema?

A

Antibiotics
Chest drain
Surgical decortication if complex

42
Q

What is a lung abscess also known as?

A

Necrotising pneumonia

43
Q

What is a lung abscess?

A

Localised area of suppurative necrosis within parenchyma
Cavity formation
Caused by anaerobic bacteria

44
Q

What are the causes of a lung abscess?

A

Aspiration
Complication of bacterial pneumonia
Bronchial obstruction
Septic embolus

45
Q

What are the symptoms of a lung abscess?

A

Cough with lots of smelly sputum
Spiking fevers and malaise
Clubbing, weight loss, anaemia
Secondary amyloidosis

resp (17 decks)

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