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DTMH Block 3 > Community acquired pneumonia > Flashcards

Community acquired pneumonia Flashcards

1
Q

Define typical pneumonia

A

CAP
Acquired outside of hospital/healthcare facilities

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2
Q

Define atypical pneumonia

A

Milder symptoms with gradual onset
Resistance to beta-lactams
Extrapulmonary symptoms

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3
Q

Name causative bacterial organisms of typical pneumonia

A

S. pneumo (most common)
H. influenza
S. aureus
GNB (klebs)
Anaerobes
Pseudo

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4
Q

Name causative viral organisms of typical pneumonia

A

Influenza
RSV
Rhinovirus
Adenovirus
Parainfluenza virus
Metapneumovirus
Coronavirus

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5
Q

Name common causative organism of typical pneumonia in HIV patients

A

PJP

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6
Q

Name strong risk factors for typical pneumonia

A

Age>65y
Residence in healthcare setting
COPD
Smoker
Alcohol
Poor oral hygiene
PPIs
Contact with children

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7
Q

Name weak risk factors for typical pneumonia

A

DM
CKD
Opioid use

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8
Q

What are risk factors for hospitalisation in pneumonia?

A

HIV
Increasing age
Underlying lung disease

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9
Q

What are risk factors for mortality in pneumonia?

A

HIV
Increasing age
Mechanical ventilation
Supplemental oxygen

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10
Q

What is the clinical presentation of pneumonia?

A

SOB, chest pain, cough, tachypnea, mucopurulent sputum with at least 1 systemic feature

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11
Q

Which manifestation of pneumonia is most common in the elderly?

A

Confusion

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12
Q

What is the differential diagnosis for pneumonia

A

PE
Pneumothorax
Cardiac failure

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13
Q

What is the workup of typical pneumonia?

A

CXR
Laboratory (CRP, PCT, FBC, urea)
Micro (sputum MCS, urine legionella and pneumococcal, PCR)

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14
Q

Which micro test is being phased out of typical pneumonia work up?

A

Blood culture

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15
Q

Which scores are used to determine outpatient vs hospitalised pneumonia care?

A

CURB65
Pneumonia Severity Index (PSI)

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16
Q

What are the parameters of CURB65

A

Confusion
Urea>7
RR>30
BP <90
Age>65y

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17
Q

What is the gold standard for PJP diagnosis?

A

Immunofluroscent staining

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18
Q

Which biomarkers can be done to assist with PJP diagnosis?

A

BDG
LDH

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19
Q

What is the empiric choice of antibiotics in CAP in low risk patients?

A

Outpatient - amoxil
Inpatient (non-severe) - ampi
Inpatient (severe) - augmentin or 3rd gen plus macrolide

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20
Q

What is the empiric choice of antibiotics in CAP in high risk patients?

A

Outpatient - augmentin or 2nd gen
Inpatient (non-severe) - augmentin or 3rd gen
Inpatient (severe) - augmentin or 3rd gen plus macrolide

21
Q

What is empiric TB therapy?

A

Rarely required - only in severely ill patient with biliary pattern on CXR with suspected TB

22
Q

What is empiric PJP therapy?

A

Bactrim
Systemic corticosteroids

23
Q

What is the empiric therapy for influenza?

A

Oseltamivir 75mg bd

24
Q

What are features of clinical stability to switch from IV to oral in CAP?

A

Haemodynamic stability
Respiratory stability
No fever
No delirium
Able to take oral

25
Q

What are causative bacteria of atypical pneumonia?

A

Mycoplasma pneumo
C. psittaci/pneumonia
Legionella
F. tularensis
Y. pestis
B. anthracis
C. burnetii

26
Q

What are causative fungi of atypical pneumonia?

A

Histoplasma
Blastomyces
Coccidioides
Pneumocystis

27
Q

What are causative viral of atypical pneumonia?

A

Influenza
Parainfluenza
RSV
Adenovirus
Metapneumovirus
VZV
Measles
EBV
CMV
Hantavirus

28
Q

Name strong risk factors for atypical pneumonia

A

Closed communities
Immunosuppression
Hx of exposure
<50y

29
Q

Name weak risk factors for atypical pneumonia

A

Smoking
Male
Travel
Immunomodulators
Chronic lung disease

30
Q

Discuss the clinical features of atypical pneumonia

A

Constitutional
Persistent, dry cough
Throat involvement
Fever
Non-respiratory

31
Q

Name common features of legionella pneumonia

A

Diarrhea
Encephelopathy
Severe infx with multi system involvement
Contaminated artificial water sytems

32
Q

Name common features of mycoplasma pneumonia

A

Diarrhea
Abdo pain
Nausea
Headache
Sore throat

33
Q

Name common features of chlamydia pneumonia

A

No specific

34
Q

Name common features of Q fever

A

Exposure to infected animal sourcesName common features of

35
Q

Name common features of klebs pneumonia

A

Alcohol dependency

36
Q

Discuss investigations for atypical pneumonia

A

CXR
Lab (FBC, LFT, urea, O2)
Micro (covid PCR, urine and sputum legionella, mycoplasma/chlamydia PCR, coxiella serology, nasopharyngeal viral cultures)

37
Q

Which pneumonia can have low Hb?

A

Mycoplasma

38
Q

Elevated LFTs suggest which pneumonia?

A

Mycoplasma
Legionella

39
Q

What is first line treatment for atypical pneumonia?

A

Macrolide
Doxycycline
If severe, add beta lactam

40
Q

Name causes of pleural effusions as a complication

A

Legionella
Mycoplasma

41
Q

Name causes of rash as a complication

A

Mycoplasma

42
Q

Name causes of neurology as a complication

A

Mycoplasma

43
Q

Name causes of pericarditis as a complication

A

Legionella
Mycoplasma

44
Q

Name causes of atherosclerosis as a complication

A

Chlamydia pneumonia

45
Q

What is the treatment if aspiration pneumonia?

A

Augmentin, clindamycin and flagyl

46
Q

How much gastric contents must be aspirated to develop aspiration pneumonitis?

A

> 150ml

47
Q

When should you give empiric therapy for aspiration pneumonitis

A

If symptoms >48h post aspiration

48
Q

What are the current PCV vaccines and the new ones?

A

Current - PPSV23, PCV13
New - PCV15, PCV10

49
Q

If you have only taken the PPSV23 vaccine, when can you take the PCV13 vaccine

A

Wait at least one year after last PPSV23 dose

DTMH Block 3 (18 decks)

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