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Respiratory > Lower Respiratory tract infections: Pathology etc - pneumonia and all those ones > Flashcards

Lower Respiratory tract infections: Pathology etc - pneumonia and all those ones Flashcards

1
Q

What are the main LRTIs seen clinically?

A

ACUTE bronchitis

Exacerbation of COPD

Pneumonia

Empyema

Lung abscess

Bronchiectasis

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2
Q

What is the incidence rate of pneumonia in the UK?

A

5-11 people per 1000 adult population

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3
Q

What is the mortality rate of hospitalised patients with pneumonia?

A

5.7 - 12%

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4
Q

What are the symptoms of pneumonia?

A 
Malaise 
Myalgia 
Fever 
Pleuritic (chest) pain
Cough 
Purulent sputum 
Dyspnoea
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5
Q

What is myalgia?

A

Pain in a (group of) muscle(s)

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6
Q

What is malaise?

A

General feeling of illness or discomfort

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7
Q

What is Dyspnoea?

A

Difficulty breathing

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8
Q

What is the appearance of ‘purulent’ sputum with someone with pneumonia?

A

Off-white to rusty to green colour

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9
Q

What are the main signs of pneumonia on examination?

A

Pyrexia

Tachpnoea

Central cyanosis

Dullness on percussion of affected lobes

Bronchial breath sounds

Inspiratory crepitations

Increased vocal resonance

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10
Q

What are the main investigations for pneumonia?

A

Serum biochemistry, CRP and full blood count

CXR

Blood cultures

Throat swab (for atypical pathogens)

Urinary legionella antigen test

Sputum microscopy and culture

HIV test

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11
Q

Where is pneumonia typically located in the lung(s) and why?

A

Lower lobes

Gravity innit

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12
Q

Pneumonia caused by inhalation of something normally affects which lung?

Why?

A

Right lung

Primary bronchus of RL is more vertical than LL’s so stuff goes down there easier

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13
Q

Which microorganism most commonly causes pneumonia?

How prevalent?

A

Strep pneumoniae

39%

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14
Q

What are the most common causes of pneumonia? >5.2%

microorganisms
(in order)

A

Strep. pneumoniae - 39%

Chlamydophila. pneumoniae - 13.1%

All viruses - 13.1%

Mycoplasma. pneumoniae - 10.8%

H. influenzae - 5.2%

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15
Q

What is the common clinical name given to Strep. pneumoniae?

A

Pneumococcus

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16
Q

What is the appearance of pneumococcus under a microscope?

A

Chains of oval-ee shaped bacteria

gram positive so they’d stain purple

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17
Q

What is the scoring method for severity of pneumonia?

A

CURB 65

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18
Q

What are the parameters for CURB 65 scoring?

A

C - confusion?

U - Blood urea >7?

R - Respiratory rate >30?

B - diastolic blood pressure >60?

65 - Age>65?

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19
Q

What are the different score bands for CURB65?

A

0 = They’re chillybeans

1-2 = Hospital treatment usually required

3-5 = high risk of death and need for ITU

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20
Q

Treatment for CURB 0-1?

A

Amoxycillin or clarithromycin / doxycycline

+ ‘other treatments’

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21
Q

Treatment for CURB 2?

A

Amoxycillin and clarithromycin or levofloxacin

+ ‘other treatments’

22
Q

Treatment for CURB 3-5?

A

Co-amoxyclav and clarithromycin or levofloxacin

+ ‘other treatments’

23
Q

Why would levofloxacin be used instead of amoxycillin etc?

A

If the patient is allergic to penicillins

24
Q

What is the situation and treatment for aspiration pneumonia?

A

Amoxycillin and metronidazole

Metronidazole needed because aspiration pneumonia often has anaerobes

25
Q

Treatment for haematological malignancy / neutropenia?

A

Broad spectrum antibiotics

Consider anti-fungals

26
Q

Aside from normal treatment, what should be considered when a patient has legionnaires disease?

A

Consider involving public health

27
Q

If a patient has influenza

What would be expected to be seen on their bacterial culture?

A

High frequency of pneumococcus

28
Q

Some patients with pneumonia have been infected by MRSA

How is this treated?

A

Vancomycin or linezolid

29
Q

If someone has HIV, what is the most likely type of pneumonia they will have?

A

PJP

(aka PCP)

(Pneumocystis jiroveci Pneumonia)

30
Q

Aside from pure throwing drugs at them

What are the ‘other treatments’ for patients with pneumonia?

A

Oxygen

IV fluids

CPAP (ventilator)

Intubation + ventilation

31
Q

What are the main complications seen with pneumonia?

A 
Septicaemia 
Acute kidney injury 
Empyema 
Lung abscess 
Metastatic infection 
ARDS
32
Q

What is septicaemia?

A

Infection of blood

33
Q

What is empyema?

A

Collection of pus in the pleural cavity

34
Q

What is ARDS?

A

Acute resp. distress syndrome

Basically a rapid onset/spread of infection through the lungs

35
Q

Many patients presenting with respiratory problems show similar symptoms but for different diseases/conditions

What are important differential diagnoses to check?

A

Tuberculosis

Lung cancer

Pulm. embolism

Pulm. oedema

Pulm. vasculitis (Wegners granulomatosis)

36
Q

Both pneumonia and pulm. oedema involve fluid in the lungs…

How is pulmonary oedema different from pneumonia?

A

Causes: Pneumonia is infection based whereas PO is linked to heart failure

PO doesn’t really involve any microorganisms or infection so the lungs are still sterile

37
Q

How does empyema look on a CXR?

A

Large area of cloudy-ness across whole of the pleural cavity/lung

38
Q

What are the main causes of empyema?

A

Bacterial infection by:

  • Streptococcus 52%
  • Staph. aureus 11%
  • Anaerobes 20%

or Secondary to pneumonia infection

39
Q

What are the main symptoms/signs of empyema?

A

Pleuritic (chest) pain

High swinging fever

ABSENCE of cough

40
Q

What is the investigative/diagnostic route for empyema?

A

CT thorax & Pleural ultrasound

Diagnosed by Pleural aspiration (ph <7.2)

41
Q

How is empyema treated?

A

Chest drain

IV antibiotics (may be prolonged >6 weeks)

Intrapleural t-PA / DNase sometimes required

Surgery for patients not improving with above management.

42
Q

What organisms are most likely to be found in a lung abscess?

A

Staph. aureus

Pseudomonas

Anaerobes

43
Q

Why are lung abscesses sometimes hard to predict from patient’s presenting complaints?

A

Non-specific symptoms

Usually things like lethargy, weight loss, high swinging fever + normal resp disease symptoms

44
Q

What is the investigative route for lung abscess?

A

CT thorax

Sputum culture (including TB culture/microscopy)

45
Q

What is the treatment route for a lung abscess?

A

Prolonged antibiotics

Drainage via bronchial tree, but occasionally percutaneous drainage may be necessary

46
Q

What is bronchiectasis?

A

airways of the lungs become abnormally widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection

47
Q

What are the causes of bronchiectasis?

A

Idiopathic

Immotile Cilia Syndrome

Cystic fibrosis

Childhood infections such as measles

Hypogammaglobulinaemia

Allergic Bronchopulmonary Aspergillosis (ABPA)

48
Q

What are the symptoms of bronchiectasis?

A

Chronic cough

Daily sputum production (often shite tons)

Sometimes,

  • Wheeze
  • Dyspnoea
  • Tiredness
  • Flitting chest pains
  • Haemoptysis
49
Q

What are the main signs of bronchiectasis?

A

Finger clubbing

Course inspiratory crepitations (auscultation)

50
Q

How should bronchiectasis be investigated?

A

High resolution CT thorax

Sputum culture

Serum immunoglobulins

Total IgE and Aspergillus precipitins

CF genotyping

51
Q

What microorganisms are typical to bronchiectasis?

A

Haemophilus influenzae

Staph aureus

Pseudomonas aeruginosa

52
Q

How is bronchiectasis treated?

A

Appropriate antibiotics

May require inhaled beta2 agonist and inhaled corticosteroid

Chest physiotherapy

Respiratory (32 decks)

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