Lobar Pneumonia Flashcards
What is the difference between lobar- and broncho- pneumonia?
Bronchopneumonia:
- Patchy consolidation of different lobes
Lobar Pneumonia:
- Fibrosuppurative consolidation of a single lobe
What are the common causes of community acquired pneumonia?
- Pneumococcus, mycoplasma, haemophilus
- S. aureus, Moraxella, Chlamydia, Legionella
- Viruses: 15%
What is a hospital acquired pneumonia?
Hospital Acquired Pneumonia:
- onset of symptoms >48hrs after hospital admission
- Gm-ve enterobacteria, S. aureus
What classification of pneumonia is a patient at greater risk of if they exhibit one or more of the following:
- Stroke
- Bulbar palsy
- Reduced GCS
- GORD
- Achalasia
Aspiration pneumonia
What patient group are at risk of pneumocystis carinii pneumonia?
Immunocompromised
What symptoms might you expect to find a patient with pneumonia suffering from?
- Fever, rigors
- Malaise, anorexia
- Dyspnoea
- Cough, purulent sputum, haemoptysis
- Pleuritic pain
What signs might you expect to find in a patient with pneumonia?
- ↑RR, ↑ HR
- Cyanosis
- Confusion
- Consolidation
- ↓ expansion
- Dull percussion
- Bronchial breathing
- ↓ air entry
- Crackles
- Pleural rub
- ↑VR
How would you investigate pneumonia?
Bloods: FBC, U+E, LFT, CRP, culture, ABG (if ↓SpO2)
Urine: Ag tests (Pneumococcal, Legionella)
Sputum: Microscopy, culture and sensitivity (MC&S)
Imaging: CXR
- infiltrates, cavities, effusion
Special
- Paired serum antibody tests for atypicals (Mycoplasma, Chlamydia, Legionella)
- Immunofluorescence (PCP)
- Broncheoalveolar lavage
- Pleural tap
What score is used to determine the severity of a pneumonia? How is this score interpretted?
CURB-65
Confusion (AMT < 7) Urea (>7) Respiratory rate (>30) BP (<90/60) 65 or older
Score
0-1: Home Rx
2: Hospital Rx
3+: consider ITU
How is pneumonia managed?
Abx
O2: PaO2≥8, SpO2 94-98%
Fluids
Analgesia
Chest physio
Consider ITU if shock, hypercapnoea, hypoxia
F/up @ 6wks with CXR
- Check for underlying Ca
What are the main risk factors associated with pneumococcus pneumonia?
Elderly EtOH Immunosuppressed CHF Pulmonary disease
What are the main risk factors associated with S. aureus pneumonia?
Influenza infection
IVDU
Co-morbidities
What are the main risk factors associated with klebsiella pneumonia?
[Rare]
Elderly
EtOH
DM
What are the main risk factors associated with Pseudomonas pneumonia?
Bronchiectasis
CF
What are the main risk factors associated with Pseudomonas pneumonia?
Local epidemic
