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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
Q

Why is it important to measure U+Es in pneumonia?

A

U (urea) for CURB65, and other changes seen with some atypical pneumonias

26
Q

What are 2 situations when ABG is indicated for pneumonia?

A

low oxygen saturations or patient has pre-existing respiratory disease e.g. COPD

27
Q

What is the broad management of pnuemonia?

A

antibiotics and supportive care e.g. oxygen, IV fluids

28
Q

What does each part of CURB-65 represent?

A
  • 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
Q

What is the risk stratification process for pneumonia and what is it used to decide?

A

CURB65: where patient can be managed i.e. community or hospital

30
Q

What does a CURB65 score of 0 indicate?

A

can manage in community

31
Q

What does a CURB65 score of 1 indicate?

A
  • 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
Q

What 2 investigations must be performed with a CURB65 score of 1?

A
  1. sats; if 92 or above can manage in community
  2. CXR: if bilteral or multilobar shadowing, manage in hospital
33
Q

What does a CURB65 score of 2 or more indicate?

A

manage in hospital - represents severe CAP

34
Q

What does the CURB65 score tell you about mortality?

A

patient with score of 4 approaching 30% mortality rate at 30 days

35
Q

What are the 5 commonest causes of community-acquired pneumonia?

A
  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
Q

What criteria can be used in the primary care setting to determine whether someone with pneumonia can be managed in the community or not?

A

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
Q

How can CRB-65 be used to classify patients for risk of death?

A
  • 0: low risk (<1% mortality risk)
  • 1-2: intermediate risk (1-10% mortality)
  • 3-4: high risk (>10% mortality risk)
38
Q

How can the result of the CRB65 be interpreted?

A

home-based care if score 0

hospital assessment for all other patients (especially 2 or more)

39
Q

What test is recommended by NICE as a ‘point of care’ test in the primary care setting for pneumonia?

A

CRP - not widely available but recommended by NICE

40
Q

How is CRP as a point of care test in primary care meant to be interpreted?

A

<20: don’t routeinly offer abx

20-100: consider delayed abx prescription

>100: offer abx therapy

41
Q

Based on the CURB65 score when sould intensive care assessment be considered for patients?

A

score of 3 or more

42
Q

In secondary care what are 5 investigations which may be performed?

A
  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
Q

What is the management of low-severity community-acquired pneumonia?

A
  • amoxicillin first line
  • if penicllin allergic use macrolide or tetracycline
  • 5 day course
44
Q

What is the recommended management of moderate and high-severity community acquired pneumonia?

A
  • 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
Q

What are 7 reasons not to routinely discharge patients following pneumonia managed in hospital?

A

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
Q

What do NICE recommend about temperature following pneumonia and discharge?

A

if temperture >37.5 they recommend delaying discharge

47
Q

What are 5 points to advise patients on about the timescale of their recovery following pneumonia?

A
  • 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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