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3: MED1 Y3 - Respiratory [18] > [11] Pneumonia > Flashcards

[11] Pneumonia Flashcards

1
Q

What is pneumonia?

A

Pneumonia is a general term denoting inflammation of the gas-exchanging region of the lung, usually due to infection (bacterial or viral). It is therefore an infection of the lung parenchyma

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2
Q

What is pneumonitis?

A

Inflammation of the lung parenchyma due to other causes, such as physical or chemical damage

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3
Q

What are the different types of pneumonia?

A
  • Lobar pneumonia
  • Bronchopneumonia
  • Aspiration pneumonia
  • Interstital pneumonia
  • Chronic pneumonia
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4
Q

What is lobar pneumonia?

A

Pneumonia that is localised to a particular lobe of the lung

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5
Q

What is lobar pneumonia most commonly due to?

A

Streptococcus pneumoniae

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6
Q

What is bronchopneumonia?

A

Pneumonia that is diffuse and patchy

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7
Q

How does bronchopneumonia develop?

A

It starts in the airways, and spreads to adjacent alveoli and lung tissue

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8
Q

What organisms cause bronchopneumonia?

A
  • Streptococcus pneumoniae
  • Haemophilus influenza
  • Staphylococcus aureus
  • Anaerobes
  • Coliforms
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9
Q

What is aspiration pneumonia?

A

When aspiration of food, drink, saliva, or vomit causes pneumonia

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10
Q

What organisms cause aspiration pneumonia?

A
  • Oral flora
  • Anaerobes
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11
Q

What is interstitial pneumonia?

A

Inflammation of the intersticium of the lung

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12
Q

What does the intersticium of the lung consist of?

A
  • Alveolar epithelium
  • Pulmonary capillary endothelium
  • Basement membrane
  • Perivascular and perilymphatic tissue
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13
Q

What is chronic pneumonia?

A

Inflammation of the lungs that persist for an extended period of time

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14
Q

What are the common bacteria causing pneumonia?

A
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Klebsiella pneumoniae
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15
Q

What are the atypical bacteria causing pneumonia?

A
  • Chlamydia pneumophilia
  • Mycoplasma pneumoniae
  • Legionella pneumophilia
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16
Q

What hospital acquired bacteria cause pneumonia?

A
  • Gram -ve enteric bacteria
  • Pseudomonas
  • Staphylococcus aureus/MRSA
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17
Q

What features are associated with S. Pneumoniae pneumonia?

A
  • Elderly
  • Co-morbidities
  • Acute onset
  • High fever
  • Pleuritic chest pain
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18
Q

What features are associated with H. Influenzae pneumonia?

A

COPD

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19
Q

What features are associated with legionella pneumonia?

A
  • Recent travel
  • Younger patient
  • Smoker
  • Illness
  • Multi-system involvement
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20
Q

What features are associated with mycoplasma pneumonia?

A
  • Young
  • Prior antibiotics
  • Extra-pulmonary involvement, e.g. haemolysis, skin and joint problems
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21
Q

What features are associated with S. Aureus pneumonia?

A
  • Post-viral
  • IV drug users
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22
Q

What features are associated with chlamydia pneumonia?

A

Contact with birds

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23
Q

What features are associated with klebsiella pneumonia?

A
  • Thrombocytopenia
  • Leucopenia
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24
Q

What viruses can cause pneumonia?

A
  • Most commonly RSV
  • Influenza type A or B
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25
Q

What % of pneumonia cases are caused by viruses?

A

About 15%

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26
Q

What groups are at higher risk of pneumonia?

A
  • Babies and very young children
  • Elderly
  • Smokers
  • Co-morbidities
  • Immunocompromised
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27
Q

What co-morbidities can increase the risk of pneumonia?

A
  • Asthma
  • CF
  • Heart, kidney, or liver conditions
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28
Q

What can cause immunocompromisation?

A
  • Recent illness such as flu
  • Infection with HIV/AIDS
  • Chemotherapy
  • Anti-organ transplant rejection medication use
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29
Q

What are the risk factors for aspiration pneumonia?

A
  • Altered level of conciousness
  • Problems swallowing
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30
Q

What can cause altered level of consciousness increasing the risk of aspiration pneumonia?

A
  • Anaesthesia
  • Alcohol
  • Drug abuse
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31
Q

What can cause problems swallowing increasing the risk of aspiration pneumonia?

A

Nerve or oesophageal damage, e.g after stroke

32
Q

Is the presentation of pneumonia consistent?

A

It can be variable, however there is almost always malaise, fever, and a productive cough

33
Q

How quickly is the onset of pneumonia?

A

Can be of very rapid onset, particularly if pneumococcal or staphylococcal

34
Q

What are the symptoms of pneumonia?

A
  • Malaise
  • Fever
  • Productive cough
  • Dyspnoea
  • Pleuritic chest pain
  • Malaise
  • Anorexia and vomiting
  • Headache
  • Myalgia
  • Diarrhoea
  • Sweats or chills
35
Q

What is pleuritic chest pain?

A

A sharp pain when you breathe, cough, or sneeze

36
Q

What is involved in the diagnosis of pneumonia?

A
  • History and examination, including percussion and auscultation
  • Chest x-ray
  • Oxygen testing
  • Microbiological testing
  • Blood tests
37
Q

What is the CURB 65 score used for?

A

To assess the severity of pneumonia

38
Q

How is the CURB score interpreted?

A

A score of 2 or more is an indication for hospital treatment, and higher scores may require ICU treatment

39
Q

What is C in the CURB 65 score?

A

New mental confusion

40
Q

What is U in CURB 65?

A

Urea >7mmol/L

41
Q

What is R in CURB 65?

A

Respiratory rate >30/min

42
Q

What is B in CURB 65?

A

Blood pressure < 90/60mmHg

43
Q

What is 65 in CURB 65?

A

Over 65 years old

44
Q

What are the chest signs of pneumonia?

A
  • Bronchial breath sounds
  • Crackles
  • Wheeze
  • Dullness to percussion
  • Reduced vocal resonance
45
Q

What are the CXR findings in pneumonia?

A
  • Lobar or multilobar infiltrates
  • Cavitation
  • Pleural effusion
46
Q

What samples can be collected in pneumonia?

A
  • Sputum
  • Nose and throat swabs
  • Endotracheal aspirates
  • Broncho-alveolar-lavage fluid (BAL)
  • Open lung biopsy
  • Blood culture, preferably before antibiotics
  • Urine
  • Serum
47
Q

What is the purpose of microbiological testing in pneumonia?

A
  • To confirm a diagnosis
  • Isolate the causative organism to guide treatment
48
Q

What microbiological testing can be done in pneumonia?

A
  • Macroscopic examination
  • Microscopy
  • Culture
  • PCR
  • Antigen detection
  • Antibody detection
49
Q

What is done in macroscopic examination of sputum in pneumonia?

A

Look to see if sputum is purulent or blood stained

50
Q

What is included in microscopy in pneumonia?

A

Gram staining and acid fast

51
Q

What is the purpose of culture in pnuemonia?

A

To isolate bacteria and viruses

52
Q

What is the purpose of PCR in pneumonia?

A

To identify respiratory viruses

53
Q

What is the purpose of antigen detection in pneumonia?

A

To look for Legionella

54
Q

What blood tests are done in pneumonia?

A
  • FBC
  • U&E
  • LFT
  • CRP
55
Q

What is included in the management of pneumonia?

A
  • Antibiotics
  • Oxygen therapy
  • Fluids
  • Analgesia if pleurisy
56
Q

When should ITU be considered in the management of pneumonia?

A

If shock, hypercapnia, or persistent hypoxia

57
Q

What antibiotic regime is used in the treatment of pneumonia when the CURB score is 0-1 and the causative organism is S. Pneumoniae or H. influenza?

A

Oral amoxicillin, clarithromycin, or doxycycline for 5 days

58
Q

What antibiotic regime is used in the treatment of pneumonia when the CURB score is 2 and the causative organism is S. pneumoniae, H. influenza, or mycoplasma pneumoniae?

A
  • Oral amoxicillin and clarithromycin or doxycycline
  • If IV required, amoxicillin and clarithromycin for 7 days
59
Q

What antibiotic regime is used in the treatment of pneumonia when the CURB score is 3+ and the causative organism is S. pneumoniae, H. influenzae, or mycoplasma pneumoniae?

A

IV Co-amoxiclav or cephalosporin, and

IV clarithromycin for 7 days

60
Q

What antibiotic regime is used in the treatment of pneumonia when the CURB score is 3+ and the causative organism is suspected to be S. Aureus?

A
  • IV co-amoxiclav or cephalosporin, and
  • IV clarithromycin for 7 days, and
  • Flucoxacillin and/or rifampicin for 10 days
61
Q

What antibiotic regime is used in the treatment of pneumonia when the CURB score is 3+ and the causative organism is suspected to be MRSA?

A
  • IV Co-amoxiclav or cephalosporin for 7 days, and
  • IV clarithromycin for 7 days, and
  • Vancomycin for 10 days
62
Q

What antibiotic regime is used in the treatment of pneumonia when the causative organism is legionella pneumophilia?

A

Fluroquinolone combined with clarithromycin, or rifampicin if severe

63
Q

What antibiotic regime is used in the treatment of pneumonia when the causative organism is chlamydial species?

A

Tetracycline

64
Q

What antibiotic regime is used in the treatment of pneumonia when the causative organism is pneumocystis jiroveci?

A

High dose co-trimoxazole

65
Q

What antibiotic regime is used in the treatment of pneumonia when the causative organism is gram -ve bacilli, Pseudomonas, or anaerobes?

A

IV aminoglycosides, and antipseudomodal penicillin, or 3rd generation cephalosporin

66
Q

What antibiotic regime is used in the treatment of pneumonia when the causative organism is S. pneumoniae or anaerobes?

A

IV cephalosporin and metronidazole

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67
Q

What is the aim of oxygen therapy in pneumonia?

A

Aim to keep PaO2 >8.0, and/or saturations >94%

68
Q

What should you explain to patients recovering from community-acquired pneumonia>

A

That after starting treatment, their symptoms should steadily improve

69
Q

What should people be told to expect regarding their symptoms after 1 week of treatment?

A

Fever should have resolved

70
Q

What should people be told to expect regarding their symptoms after 4 weeks?

A

Chest pain and sputum production should have substantially reduced

71
Q

What should people be told to expect regarding their symptoms after 6 weeks/

A

Their cough and breathlessness should have substantially reduced

72
Q

What should people be told to expect regarding their symptoms after 3 months?

A

Most symptoms should have resolved, but fatigue may still be present

73
Q

What should people be told to expect regarding their symptoms after 6 months?

A

Most people should feel back to normal

74
Q

What should patients be advised to do if they feel that their symptoms are deteriorating, or not improving as expected after treatment?

A

Consult their HCP

75
Q

What are the potential complications of pneumonia?

A
  • Pleural effusion
  • Empyema
  • Lung abscess
  • Respiratory failure
  • Septicaemia
  • Brain abscess
  • Pericarditis
  • Myocarditis
  • Cholestatic jaundice
76
Q

What can cause pneumonia in immunocompromised patients?

A

Immunocompromised patients might have a virulent infection with a common organism, or might be infected by an opportunistic pathogen, for example;

  • Cytomegalovirus
  • Mycobacterium avium intracellulare
  • Aspergillus
  • Candida
  • Pneumocystis jiroveci
  • Cryptosporidia
  • Toxoplasma

3: MED1 Y3 - Respiratory [18] (15 decks)

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