Condition- pneumonia Flashcards
What is Pneumonia?
An acute Lower Respiratory Tract Infection
What are the different categories to classify pneumonia aetiologically?
- Community acquired
- Hospital acquired (developed >48hrs after admission)
- Aspiration Pneumonia
- Immunocompromised
List the three main causative agents of Community acquired Pneumonia
- Streptococcus Pneumoniae
- Haemophilius Influenza
- Moraxella Catarrhalis
List the three main causative agents if Hospital- acquired pneumonia…
- Gram -ve enterobacter:
- Klebsiella
- Pseudomonas aeroginosa
- Staphylococcus Areus
List the main causative agent of aspiration pneumonia
Streptococcus Pneumoniae
List the 3 (+2) main causative agents of immunocompromised pneumonia…
- Streptococcus pneumoniae
- Haemophilius Influenza
- Staphylococcus Aureus
- Moraxxella catarrhalis (COPD)
- Mycoplasma pneumoniae
List some of the presenting symptoms of pneumonia…
- Fever
- SOB
- Cough- green sputum
- Pleuritic Chest pain
- Malaise
- Weight loss
- Sweats
- Rigors
- haemoptysis
- Confusion
List some of the signs of pneumonia on physical examination…
- Low oxygen saturation, pyrexia, tachycardia, tachyopnoea, hyoptension
- Confusion (AMT), hypothermia
- Percuss: dullness
- Palpate: reduced expansion
- Auscultate:
- Increased tactile fremitus/ vocal resonance
- Bronchial breathing
- Coarse crackles
What are the different types of pneumonia you can see on an x-ray?
- Bronchopneumonia: Patchy shadowing
- Lobar/ multilobar
- Consolidation: Pleural effusion/ cavitation
List the different investigations you would perform on someone with suspected Pneumonia
- Bedside: pulse ox, BP, sputum sample, urine dip
- Bloods: FBC (elevated WCC), LFTs (in case its HPS), U+Es (urea), CRP, ABG (to check for resp failure)
- Imaging: CXR, bronchoscopy
- Special: Bronchoalveolar lavage, sputum and pleural fluid (MC+S)
Which scoring system can be used to assess the severity of pneumonia? What are the criteria?
CURB-65
- Confusion (AMTS<8)
- Urea >7mmol/L
- Resp rate >30
- BP <90 SBP or 60 DBP
- >65yrs
What do you interpret the CURB-65 score?
- 0-1: can treat at home
- 2: Short hospital admission reqiured
- 3: Severe, ITU may be required
What are the steps to be taken in the management of pneumonia?
- CURB-65
- ABC:
- Supplemental Oxygen
- Treat hypotension/ shock: IV fluids
- Analgesia if pleurisy
- CPAP if necessary
- Surgical drainiage (if abscess/ empyema)
- Antibiotics
- Vaccination
Which antibiotics are given to a patient with community acquired pneumonia with a CURB-65 score of:
- 0-1
- 2
- >3
- 0-1: oral amoxicillin or clarithromycin
- 2: oral amoxicillin AND clarithromycin
- >3: IV co-amoxiclav/ cephalosporin AND IV clarithromycin
Which antibiotics are given to a patient with hospital acquired pneumonia?
- IV aminoglycoside
- AND IV pseudomonal penicillin/cephalosporin
Which antibiotics are given to patient with aspiration pneumonia?
- IV cephalosporin + IV metronidazole
Which antibiotics are given to patients with pneumonia caused by atypical bacteria?
- Clarithromycin
Which antibiotic is given to patients pneumonia caused by Staph A (2)
- If staph: Flucloxacillin + gentamycin
- If MRSA: Vancomycin
Which pathogen often causes pneumonia in alcoholics?
Klebsiella
Which pathogen commonly causes pneumonia in COPD patients?
Haemophilus Influenza B
List some potential complications of Pneumonia…
- Spread of infection:
- Sepsis
- Lung abscess
- Empyema
- Pleural effusion
- myopericarditis
- Damage to structure:
- ARDS
- Bronchiectasis
- Pneumothorax
Which vaccinations protect against strains of pneumonia causing agents and which subset of the population are allowed the vaccines?
- HIB and pneumococcus vaccine
- GROUPS:
- >65
- Chronic heart, liver or renal disease
- Immunocompromised
- DM
Which pathogen is likely to infect a pt who has recently had a new AC fit in? and describe its presentation
Legionella (hypoNa + lymphopenia)
Which pathogen is likely to infect a pt with pneumonia who has dogs and cats?
Chlamydia psittaci
Which two pathogens can cause cavitating lesions in pts with Pneumonia?
Staph aureus
Klebsiella (cause lung abscess and empyema in alcoholics)
Which pathogen commonly causes pneumonia in elderly patients who have recently been infected by the influenza virus?
Staph aureus
List some symptoms of an atypical presentation of pneumonia
- Dry cough
- headache
- Diarrhoea
- Myalgia
- Hepatitis
List 4 pathogens which cause an atypical presentation of pneumonia
- Mycoplasma pneumonia (causes dry cough + AIHA + erythema multiforme)
- Legionella pneumophila (from A/C causes hypoNa + lymphopenia)
- Clamydhia psittaci (from pet birds)
- Clamydia pneumoinae
Which groups of the population is pneumocytis jiroveci common in? and how does it present?
In HIV and TB patients
Dry cough and SOBOE
