12 - Pneumonia Flashcards
What is CAP
Community Aquired Pneumonia - signs of lower respiratory tract infection (fever/cough/phlegm/crepitations or bronchial breathing) + CXR changes.
What is CURB-65 used for?
Assessing severity of CAP
What criteria does CURB-65 include?
Confusion
Ureas > 7mmol/L
RR > 30
BP < 90/60
> 65 years
=> 0-1 - low, 2- moderate >3 servere risk of death.
What conditions are included in URTI?
Common cold
Sinusited
Pharyngitis
Laryngitis
What conditions are included in LRTI?
Acute bronchiectasis
Pneumonia
COPD exacerbation
Bronchiectasis exacerbation
Lung absess
Empyema
Are UTRI mostly bacterial or viral?
Viral
Are LRTI mostly bacterial or viral?
Bacterial
Which LRTI condition is mainly viral?
Acute bronchiectasis
What types of COPD exacerbations are there?
Simpe - no changes on CXR
Pnumonia - Changes on CXR
Which bacteria cause COPD exacerbations?
H. influenza
S. pneumonia
What is the pathology of bronchiectasis exacerbations?
Bronchioles have wall damaged leading dilatations causing bronchipneumonia.
What quilifies someone as having Hospital aquired pneumonia (HAP)?
Developed within 48 hours of hosptial
What complications can occur from pneumonia?
Effusion
Empyema
PE
AF
Antibiotic rash and phlebitis
What does neutrophilia indicate?
Indicates bacterial infection
What does neutropenia indicate?
Viral infection
What does an increase white cell count indicate?
Acute infection
What does lymphopenia indicate?
Severe infection
What does Raised CRP indicate?
Indicates infection (more prominnat with bacteria), a lower increase indicates a inflammatory condition or malignancy.
What is Rigor?
Symptom which describes a sudden feeling of cold with shivering but an increase in body temperature
What is the Window peroid od HIV?
Time where blood test shows the person to be HIV negative however is infected and infectious. Antibodies are developed during this time.
Around 4 weeks
How many days after hospital admission is late onset HAP?
5 days
Bacteria causing CAP?
80% are Streptococcus pneumoniae
Bacteria involved in late onset HAP?
Enterobacteria
MRSA
Pseudomonas
Which lobe is aspiration pneumonia most likely tobe in?
Lower right as the bonchus is more in line with the right main bronchiole
Which organisms cause TB?
Myobacterium tuberculosis
Myobacterium bovis
Descirbe the phases of TB?
Primary phase - no or minor symtpoms localised to lungs and may leaves domant myobacterium in macrophages
Secondary phase - reactivation of persisting myobacterium leading to immunorepsonce and therefore symptoms
What are the symptoms of TB?
Cough
Weight loss
Night sweats
Fever
Malaise
Specific symptoms to the organ that TB has spread to…
Investigations for TB
CXR
ESR and CRP
HIV test
LFT
Sputum and blood cultures
What does CPE stand for?
Carbapenemase
Carbapenemase-producing Enterobacteriaceae
What are the features of myobacteria?
AAFB -alcohol and acid fast bacilli
Spread through droplets in the air
What is Miliary TB?
TB spread to the lungs from othr areas of the body leading to comolidations the size of miliary seeds. These are scene on CXR.
What is the standard Inital treatment for TB?
Isoniazide
Rifampicin
Pyrazinamide
Ethambutol
For 2 months
What happens after the intial phase for TB treatment?
Isoniazide
Rifampicin
Ethambutol and Pyrazinamide are dropped.
Which antibiotic in TB therapy has the side effect of turining body fliuds orange?
Rifampicin
Is TB a notifiable disease?
Yes, Local health authority has to be notified.
?What are the complications of TB?
Death
Antibiotic SE (neuropathy from Isoniazide)
Amyloidosis
Site specific:
Lungs - avities, pleural thickening, bronchiectasis
Spine - paraplegia
Brian - cranial nerve pulse, hemiparesis
What and when should be done in follow up for TB?
CXR at 6 weeks
What the features of consolidations which allow it to be differentiated from effusions on CXR.
Margines are not well defined
Costo-phrenic angles are preserved
There are air bronchiograms
What are the features of effusion which alow it to be differentiated from consolidation on CXR?
No lung markings
No air bronchiograms
Costodiaphragmatic angles are lost
What does the tuberculosis skin test and Interferon gamma release essay show?
Assesing previous exposer to TB
Same in latent and active disease
Who gets the pneumoccal vaccine?
>65 years
Chronic liver/heart and lung disease
DM not controlled by diet
Immunosupresseed (chemo, hyposplenic etc.)
What harbours legionella pneumophilia?
Water tanks kept below 60°C
What type of organism most comonly causes pneumonia in the immunosupressed?
Pneumocystis Jirovecci
What type of organism most comonly causes pneumonia in bronchiectasis and cystic fibrosis?
Psuedomonas
What type of organism most comonly causes pneumonia in IVDU?
Staphylococcus
What the pathology behind bronchiectasis?
Inflammation leading to permanent dilatiotion of bronchioles
What type of organism most comonly causes pneumonia for alcoholics?
Klebsiella pneumoniea
