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Year 3 Respiratory Core Conditions > Lobar Pneumonia > Flashcards

Lobar Pneumonia Flashcards

1
Q

What is pneumonia?

A

A lower respiratory tract infection associated with fever, and abnormal Chest Xray

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2
Q

What is the commonest bacterial cause of community acquired pneumonia?

A

1) Streptococcus pneumoniae (—–> rust coloured sputum)

Then:

  • haemophilus influenzae
  • mycoplasma pneumoniae

remainder:

  • staph aureus
  • Legionella
  • Morexella
  • chlamydia
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3
Q

What is hospital acquired pneumonia and what is the most common bacterial cause?

A

HAP is development of symptoms 48hrs after admission to hospital.

Gram neg -ve enterobacteria
staph aureus
Pseudomonas
Klebsiella
Clostridia
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4
Q

what are the symptoms of pneumonia?

A
  • acute cough
  • purulent sputum (haemoptysis - rusty brown)
  • SOB
  • pleuritic chest pain
  • fever + rigors
  • malaise
  • loss of appetite
  • abdo pain, diarrhoea, vomiting
  • headache
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5
Q

What is the differance between lobar and bronchopneumonia/

A 
Lobar = localised (one or more lobe)
Bronchopneumonia = patchy, associated with bronchi / bronchioles
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6
Q

Aspiration is a caused of pneumonia. What are the risk factors / causes of aspiration?

A
  • stroke —> dysphagia
  • Myasthenia gravis (muscle weakness)
  • decreased consciousness
  • oesophageal disease (achalasia, reflux)
  • poor dental hygiene increases risk of aspirating dental anaerobes.
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7
Q

What is the cause of pneumonia in compromised patients?

A
  • Step pneumoniae
  • Haemophilus influenza
  • staph Aureus
  • Morexella catarrhalis

Viruses:
CMV
HSV

fungi e.g. cryptococcys, candida, aspergillus

mycobacteria

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8
Q

Who does lobar pneumonia caused by Klebsiella typically affect?

A

elderly , diabetics , alcoholics

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9
Q

Who does pneumococcal pneumonia typically affect?

A

healthy adults between 20 and 50 years

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10
Q

What are the signs of pneumonia?

A

Signs of consolidation :

  • dull percussion
  • bronchial breathing.
  • reduced chest expansion
  • increased tactile fremitus / vocal resonance.
  • pleural rub
  • crackles
  • Pyrexia (over 40 degrees)
  • cyanosis
  • confusion
  • tachypnoea
  • tachycardia
  • hypotension
  • rusty sputum
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11
Q

What are the 4 stages in the pathology of lobar pneumonia?

A

1) Congestion (24hrs of exudate secretion into alveolar space, venous congestion, heavy-oedematous-red lung)

2) Red hepatisation 
(last for few days, 
infilatration of inflammatory cells into alveolar space and red cells from blood.
fibrinous exudate in pleura
red-solid-airless lung)

3) Grey hepatisation
(fibrin, destruction of inflamm cells, grey-brown-solid lung)

4) Resolution 
at about 8-10 days in untreated cases.
reabsorption of exudate
digestion of inflammatory debris
(preservation of alveolar wall)
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12
Q

What are the risk factors for community acquired pneumonia?

A

Age (young and old)
Co-morbidities (HIV, DM, CKD,)
Other Resp conditions( CF, bronchiectasis, COPD)
lifestyle (smoking, alcohol, IVDU)
Iatrogenic (immunosuppressants, long term steroids)

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13
Q

What is the pathology behind SOB in pneumonia:?

A

pus fills alveoli so gas exchange impaired

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14
Q

stevens-johnson syndrome is a rare and potentially life threatening complication of pneumonia - what is it?

A
  • Stevens-Johnson syndrome is a rare but serious disorder that affects the skin, mucous membrane, genitals and eyes.
  • begins with flu-like symptoms, followed by a red or purple rash that spreads and forms blisters. The affected skin eventually dies and peels off.
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15
Q

What are the extrapulmonary features of CAP caused by legionella and mycoplasma?

A
  • myalgia
  • arthralgia
  • malaise
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16
Q

Mycocarditis and pericarditis are complications of CAP most commonly in …

A

Mycoplasma pneumonia

17
Q

Hepatis can a be a feature of ????..pneumonia

A

Hepatitis can be a feature of legionella pneumonia

18
Q

How can CAP present in the elderly?

A
  • confusion

- recurrent falls

19
Q

What condition should be excluded if symptoms of pneumonia are present for several weeks or have failed to respond to Abx?

A

tuberculosis

20
Q

What are the Invx for pneumonia?

A

1) Chest Xray
(consolidation, pleural effusion)

2) Obs : O2 sats, BP, resp rate0
3) ABG if SaO2 < 92%

4) Bloods
- FBC (raised WCC)
- U&E (kidney function)
- LFT
- CRP
- BLOOD CULTURES (sepsis)

5) Sputum culture
6) Pleural effusion aspiration for analysis
7) bronchoscopy if immunocompromised

21
Q

How is the severity of pneumonia assessed?

A

CURB- 65

C- Confusion
U - urea >7mmol/L
R - resp rate > 30/min
B - blood pressure < 90systolic or 60 diastolic
65yrs age

**if score 0-1 then home treatment, if 2+ hospital

score of more than 3 indicates a mortality of 15-40%

22
Q

Describe the use of a chest xray for invx of pneumonia?

A

CXR shows:

  • consolidation
  • pleural effusion (blunt costophrenic angle)
  • if normal CXR then should be repeated 2-3 days after if CAP suspected.
  • repeat CXR after 6 weeks of treatment to rule out bronchial malignancy
23
Q

What is the blood results of pneumonia caused by strep pneumoniae ?

A
  • raised WCC >15x10^9/L

- raised inflammatory markers (CRP and ESR >100)

24
Q

What is the blood results of pneumonia caused by mycoplasma?

A

WCC normal

25
Q

what type of bacteria is strep pneumoniae?

A

Gram positive diplococci

26
Q

How is pneumonia managed?

A

1) Abx
2) Oxygen ( maintain SpO2>94% and PaO2 >8)
3) IV fluids
4) VTE prophylaxis (tinzaparin)
5) Analgesia for pleurisy
6) pneumococcal vaccine for at risk groups (elderly, co-morbidities)

27
Q

What are the complications of pneumonia?

A
  • Respiratory failure ( type 1 , PaO2 less than 8kPa, treat with high flow oxygen)
  • Hypotension (caused by sepsis)
  • Atrial fibrillation
  • Pleural effusion (chest drain)
  • Empyema (chest drain)
  • lung abscess
  • sepsis
  • pericarditis, myocarditis,
  • cholestatic jaundice (due to sepsis or abx therapy - flucolxacillin or co-amoxiclav)
28
Q

How can cholestatic jaundice be a complication of pneumonia?

A

pneumonia —> sepsis —-> cholestatic jaundice.

pneumonia —–> Abx (flucloxacillin or co-amoxiclav) ——> cholestatic jaundice

Year 3 Respiratory Core Conditions (9 decks)

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