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Lower respiratory tract infection Flashcards

1
Q

What is pneumonia?

A

inflammatory condition affecting the alveoli of the lungs, but in vast majority of patients this is secondary to a bacterial infection

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2
Q

What are 3 types of causes of pneumonia and what is the commonest?

A
  1. Bacteria (commonest)
  2. Viral
  3. Fungal (e.g. Pneumocystis jiroveci)
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3
Q

What are the top 3 bacterial causes of typical pneumonias? Which is the commonest?

A
  1. Streptococcus pneumoniae (commonest - 80%)
  2. Haemophilus influenzae
  3. Staphylococcus aureus
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4
Q

What prevention against pneumonia caused by Streptococcus pneumoniae is available?

A

vaccine to pneumococcus

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5
Q

What are 4 features particularly associated with streptococcus pneumoniae pneumonia?

A
  1. High fever
  2. Rapid onset
  3. Pleuritic chest pain
  4. herpes labialis
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6
Q

In which group of patients is Haemophilus influenzae particularly common?

A

patients with COPD

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7
Q

What are 2 causes of atypical pneumonias?

A
  1. Mycoplasma pneumoniae
  2. Legionella pneumonophilia
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8
Q

What is the type of pneumonia classically seen in alcoholics?

A

Klebsiella pneumoniae

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9
Q

What is the presentation of mycoplasma pneumoniae?

A

dry cough and atypical chest signs / x-ray findings

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10
Q

When does Staphylococcus aureus pneumonia commonly occur?

A

following influenza infection

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11
Q

What are 2 conditions which may be seen with Mycoplasma pneumoinae pneumonia?

A
  1. Autoimmune haemolytic anaemia
  2. Erythema multiforme
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12
Q

What are 2 common features of legionella pneumophilia?

A
  1. Hyponatraemia
  2. Lypmhopenia
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13
Q

What is the classical cause of legionella pneumophilia?

A

secondary to infected air conditioning units

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14
Q

What type of pneumonia typically seen in patients with HIV?

A

Pneumocystic jiroveci

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15
Q

What are 3 features of pneumocystic jiroveci?

A
  1. Dry cough
  2. Exercise-induced desaturations
  3. Absence of chest signs
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16
Q

What is idiopathic interstitial pneumonia?

A

group of non-infective causes of pneumonia

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17
Q

What are is an example of an idiopathic interstitial pnuemnoa and what is it?

A

Cryptogenic organising pneumonia: form of bronchiolitis which may develop as a complication of rheumatoid arthritis or amiodarone therapy

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18
Q

What are 2 things that can cause cryptogenic organising pneumonia?

A
  1. Rheumatoid arthritis
  2. Amiodarone therapy
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19
Q

What is the source of the majority of causes of pneumonia?

A

Community-acquired pneumonia

20
Q

Why is it important to distinguish between hospital and community acquired pneumonia?

A

different causative organisms and different first line antibiotic therapy

21
Q

What are 5 symptoms of pneumonia?

A
  1. Cough
  2. Sputum
  3. Dyspnoea
  4. Chest pain: may be pleuritic
  5. Fever
22
Q

What are 3 signs of pneumonia?

A
  1. Systemic inflammation response: fever, tachycardia
  2. Reduced oxygen saturations
  3. Auscultation: Reduced breath sounds, bronchial breathing
23
Q

What are 3 important investigations in pneumonia?

A
  1. CXR
  2. Bloods: FBC, U+Es, CRP
  3. ABG
24
Q

What will FBC show in pneumonia?

A

neutrophilia in bacterial infections

25
Why is it important to measure U+Es in pneumonia?
U (urea) for CURB65, and other changes seen with some atypical pneumonias
26
What are 2 situations when ABG is indicated for pneumonia?
low oxygen saturations or patient has pre-existing respiratory disease e.g. COPD
27
What is the broad management of pnuemonia?
antibiotics and supportive care e.g. oxygen, IV fluids
28
What does each part of CURB-65 represent?
* C: confusion (abbreviated mental test score 8 or less /10) * U: urea \>7mmol/L * R: respiratory rate 30 or more * B: blood pressure systolic \<90 or diastolic \<60 * 65: age 65 or over
29
What is the risk stratification process for pneumonia and what is it used to decide?
CURB65: where patient can be managed i.e. community or hospital
30
What does a CURB65 score of 0 indicate?
can manage in community
31
What does a CURB65 score of 1 indicate?
* need oxygen sats assessed, should be over 92 to be safely managed in community and CXR performed * if CXR shows **bilateral**/ **multilobar** shadowing, hospital admission advised
32
What 2 investigations must be performed with a CURB65 score of 1?
1. sats; if 92 or above can manage in community 2. CXR: if bilteral or multilobar shadowing, manage in hospital
33
What does a CURB65 score of 2 or more indicate?
manage in hospital - represents severe CAP
34
What does the CURB65 score tell you about mortality?
patient with score of 4 approaching 30% mortality rate at 30 days
35
What are the 5 commonest causes of community-acquired pneumonia?
1. Streptococcus pneumoniae (accounts for around 80% of cases) 2. Haemophilus influenzae 3. Staphlycoccus aureus 4. Atypical pneumonias e.g. due to Mycoplasma pneumoniae 5. Viruses
36
What criteria can be used in the primary care setting to determine whether someone with pneumonia can be managed in the community or not?
CRB65 * C: confusion; 8 or more on AMTS * R: resp rate 30 or more * B: blood pressure systolic \<90 diastolic \<60 * 65: age 65 or more
37
How can CRB-65 be used to classify patients for risk of death?
* 0: low risk (\<1% mortality risk) * 1-2: intermediate risk (1-10% mortality) * 3-4: high risk (\>10% mortality risk)
38
How can the result of the CRB65 be interpreted?
home-based care if score 0 **hospital assessment for all other patients** (especially 2 or more)
39
What test is recommended by NICE as a 'point of care' test in the primary care setting for pneumonia?
CRP - not widely available but recommended by NICE
40
How is CRP as a point of care test in primary care meant to be interpreted?
\<20: don't routeinly offer abx 20-100: consider delayed abx prescription \>100: offer abx therapy
41
Based on the CURB65 score when sould intensive care assessment be considered for patients?
score of 3 or more
42
In secondary care what are 5 investigations which may be performed?
1. CXR 2. intermediate or high risk: blood cultures 3. intermediate or high risk: sputum cultulres 4. intermediate or high risk: pneumococcal and legionella urinary antigen tests 5. CRP monitoring to determine response to treatment
43
What is the management of low-severity community-acquired pneumonia?
* amoxicillin first line * if penicllin allergic use macrolide or tetracycline * 5 day course
44
What is the recommended management of moderate and high-severity community acquired pneumonia?
* dual antibiotic therapy with amoxicillin and macrolide (erythromycin or clindamycin) * 7-10 day course * consider beta-lactamase stable penicillin such as **co-amoxiclav**, ceftriaxone or piperacillin with **tazobactam** and **macrolide** in high severity community acquired pneumnoia
45
What are 7 reasons not to routinely discharge patients following pneumonia managed in hospital?
if **2 or more** of the following in the **past 24 hours:** 1. temperature higher than 37.5 2. respiratory rate 24 or more 3. heart rate over 100 4. systolic BP \<90 5. sats \<90% on room air 6. abnormal mental status 7. inability to eat without assistance
46
What do NICE recommend about temperature following pneumonia and discharge?
if temperture \>37.5 they recommend delaying discharge
47
What are 5 points to advise patients on about the timescale of their recovery following pneumonia?
* 1 week: fever should resolve * 4 weeks: chest pain and sputum production should have substantially reduced * 6 weeks: cough and breathlessness should have substantially reduced * 3 months: most symptoms should have resolved but fatigue may still be present * 6 months: most poeple will feel back to normal

GP (43 decks)

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