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ICC1 > community acquired pneumonia > Flashcards

community acquired pneumonia Flashcards

1
Q

what is pneumonia ?

A

an acute infection characterized by clinical signs of consolidation along with radiological signs of consolidation

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2
Q

what are the different types of pneumonia ?

A

CAP - acquired in community
HAP - in hospital ( more than 48 hours of admission)
VAP - on mechanical ventilation for more than 48 hours on ventilator

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3
Q

what are the different routes of transmission associated with pneumonia ?

A

inhalation
aspiration
colonization
blood spread
associated with viruses and atypical bacteria

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4
Q

what are the causes of having an unprotected airway and what are thee associated organisms ?

A

cerebrovascular stroke
alcohol
hypnotics
which can all cause aspiration, associated with oral flora which is anaerobic bacteria

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5
Q

what are the reasons behind colonization in pneumonia and what are the associated organisms ?

A

pre-existing lung disease :
bronchieactsis
chronic bronchitis
cystic fibrosis
variable organisms

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6
Q

what are the causes of bacteremia what are the associated organisms ?

A

IV drug addiction
intravenous cannula
heamodialysis
staph aureus, gram negative bacteria

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7
Q

what are the stages of pneumonia ?

A

congestion
red hepatization
grey hepatization
resolution

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8
Q

what does incomplete resolution in pneumonia result in ?

A

permanent scaring

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9
Q

how long do the stages pf pneumonia take ?

A

7-10 days

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10
Q

what is the clinical picture of atypical pneumonia ?

A

extra-thoracic affection
otitis, pharyngitis
haemolytic anemia
GI symptoms
confusion
hyponatraemia

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11
Q

in terms of pathology what is different about atypical pneumonia ?

A

formation of hyaline tissue

superimposed infection

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12
Q

what are the microorganisms causing atypical pneumonia ?

A

legionella pneumonia
mycoplasma pneumonia
chalmydia pneumoniae

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13
Q

what routine investigations would be performed on a patient suspecting pneumonia ?

A 
chest x-ray 
CT Chest 
CBC
ABG 
BUN ( renal function) divide urea by 2
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14
Q

what would the findings be on auscultation ?

A

reduced breathing sounds
bronchial breathing
crackles

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15
Q

what are the radiological findings with atypical pneumonia vs bacterial pneumonia ?

A

ground glass opacities in atypical pneumonia
consolidations in bacterial pneumonia

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16
Q

what is required to make a diagnosis of severe pneumonia ?

A

IDS/ATS criteria

1 major or 3 minor

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17
Q

what are the major criteria for pneumonia ?

A
  • septic shock with need for vasopressors
  • respiratory failure in need of mechanical ventilation

- respiratory failure requiring mechanical ventilation

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18
Q

what are the minor criteria ?

A 
respiratory rate less than 30
hypotension corrected by IV fluids 
hypothermia 
confusion 
leukopenia 
thrombocytopenia 
uremia 
PaO2/FiO2 ratio is less than 250 
multi lobar infiltrates
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19
Q

what are the specific tests for a case of pneumonia ?

A

1- sputum gram stain
2- sputum culture and sensitivity
3- blood culture and sensitivity
4- urinary antigen for legionella and pneumococcal bacteria
molecular test (PCR)
5- procalcitonin levels

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20
Q

what are the specific situations where it is required to make those special tests ?

A

patients managed inn the hospital AND have severe pneumonia according to the IDSA/ATS criteria
or
have risk factors for specific/resistant bacteria

- patients who have risk factors for specific/resistant bacteria

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21
Q

what is the target sample to test with intubated patients ?

A

endotracheal aspirate

22
Q

what are the risk factors for acquiring specific/resistant bacteria ?

A
  • recent hospitalisation and receipt of recent IV antibiotics inn the last 90 days
  • previous isolation of pseudomans aeruginosa or MRSA
  • presence of comorbidities
23
Q

when would it be necessary to carry out a urinary antigen test ?

A

legionella outbreak/recent travel
or
severe pneumonia

24
Q

when would a PCR resting of influenza be required ?

A

in influenza outbreaks or in pandemics like COVID-19

25
Q

what may help in the differentiation between bacterial or viral pneumonia ?

A

procalcitonin

a high level of procalcitonin may be an indication of bacterial infection

26
Q

how do we decide the site of care for a pneumonia patient ?

A

CURB-65 score

27
Q

what does the CURb-65 score measure ?

A 
confusion 
BUN level ( below 20 )
Respiratory rate ( below 30 )
low blood pressure (90/60)
and an age of 65 years old
28
Q

what scores indicate what location with the CURB-65 ?

A

0-1 at home outpatient
2 - ward
3-5 then the ICU

29
Q

what is the treatment for a patient who scored 0-1 on the CURB-65 ?

A

depends on comorbidities and no risk of MRSA
no comorbidities :amoxycillin OR doxycilline OR macrolide
with comorbidities : we give a combination therapy of
amoxicillin/clauvanate + macrolide
OR
fluoroquinolone ( mono therapy)

30
Q

if the patient is an inpatient ( score of 2 in the CURB-65), what treatments are required ?

A 
IF NON SEVERE:
give a combination of b lactam and macrolide 
OR 
fluoroquinolone 
 IF SEVERE :
give a combination of b lactam and macrolide 
OR 
B lactam and fluoroquinolone
31
Q

what must the patient take if there is a risk of acquiring resistant/MRSA/p.aeruginosa ?

A

Anti-MRSA or

Anti-P.aeruginosa

32
Q

what are examples of macrolides ?

A

azithromycin

clarithomycin

33
Q

what are examples of fluroquinolones ?

A

levofloxacin

moxifloxacin

34
Q

what are the antibiotics effective against MRSA?

A

vancomycin

linezolid

35
Q

what is aspiration pneumonia caused by ?

A

anaerobic bacteria

36
Q

when do you add anti-anerobic antibiotics in aspiration pneumonia ?

A

only when the patient develops complications including lung abscess or empyema ( clindamycin)

37
Q

when should corticosteroids be used ?

A

only in CAP patients who are in septic shock that are not responsive to resuscitation and vasopressor support

38
Q

when do you follow up on the patient when managing pneumonia ?

A

after 3 days - 72 hours

39
Q

when do we diagnose non-responding pneumonia ?

A

if there is deterioration or no clinical improvement in antibiotic therapy that has lasted 5-7 days

40
Q

what are the causes of non responsive pneumonia ?

A

doctor related
organism related
patient related

41
Q

what can be done to prevent pneumonia ?

A

vaccination against influenza

vaccination against pneumococcal polysacchride vaccine

42
Q

what are the types of influenza vaccine ?

A

inactivated influenza vaccine
recombinant influenza vaccine
live attenuated influenza vaccine

43
Q

when is the live attenuated vaccine contraindicated ?

A

pregnant women
immunosuppression
adults older than 65
history of allergic reaction

44
Q

in order to make a diagnosis of severe pneumonia using the IDSA/ATS criteria how many of each do wee need ?

A

1 major
or
3 minor

45
Q

what is the treatment for P.areguinosa ?

A

levofloxacin or meropenem

46
Q

what is the presentation of legionella pneumonia ?

A

associated with legionnaires disease
look for hyponatraemia and deranged LFTs

47
Q

how is legionella pneumonia spread ?

A

through aerosolized water particles - bad air conditioning

48
Q

what is the synonym for klebsiella pneumonia ?

A

friedlanderrs pneumonia

49
Q

which type of patients are at a higher risk of developing klebsiella ?

A

diabetics and alcoholics

50
Q

what is seen on chest x ray of a patient with klebsiella ?

A

fissure bulging sign ( due to massive enlargement of the right upper lobe )

51
Q

what is distinctive about the appearance off the sputum of klebeisella ?

A

red currant sputum

ICC1 (50 decks)

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