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Respiratory System > LRTI and Pneumonia > Flashcards

LRTI and Pneumonia Flashcards

1
Q

What is pneuomnia?

A

General term denoting inflammation of the the lung parenchyma due to infection

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2
Q

What is pneumonitis?

A

Inflammation of the lung due to non-infective causes e.g. physcial damage or chemical damage

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3
Q

What is the common feature of pnemonias?

A

A cellular exudate in the alveolar spaces

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4
Q

What common microbiota exist in the respiratory tract?

A
  • Viridans streptococci
  • Neisseria species
  • Anaerobic candida species
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5
Q

Why aren’t the lungs sterile?

A
  • Have normal alveolar microbiota
  • Aspirate microbiomes from the URT
  • Microbiomes spread from blood stream
  • Direct spread of bacteria
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6
Q

What defences does the respiratory tract have to prevent infection?

A
  • Muco-ciliary clearance mechanisms: nasal hair, ciliated epithelium
  • Cough and sneezing reflex
  • Respiratory immune system from lymphoid follicles of the pharynx and tonsils
  • Alveolar macrophages
  • Secretory IgA and IgG
  • Alveolar microbiota prevent other organisms attaching and growing
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7
Q

What happens to the lungs in the course of a typical infection?

A
  1. Alveolar macrophages fail to stop pathogen
  2. Cytokines recruit more macrophages
  3. Inflammation causes increased permability
  4. More WBC/ proteins recruited to aid macrophages
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8
Q

What happens outside the lungs in a typical respiratory tract infection?

A
  • Inflammatory mediators (cytokines and chemokines) released into systemic circulation
  • Activates bones marrow to produce more neutrophils
  • Cardiac output increased to deliver more blood to the lungs
  • Raised body temperature to fight infection
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9
Q

What host factors make it harder to deal with a respiratory tract infection?

A
  • Age >65
  • Lifestyle: smoking, alcohol, drugs
  • Chornic lung diseases
  • Aspiration
  • Immunocompromised
  • Metabolic problems
  • Co-infection with other viruses
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10
Q

What kind of drugs can pre-dispose to respiratory tract infections?

A
  • Antacids (PPI/ H2 antagonists)
  • Antiphyschotics
  • ACE inhibitors
  • Glucocorticoids
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11
Q

What symptoms do you get with a upper resiratory tract infection?

A
  • Rhinitis
  • Pharyngitis
  • Epiglottis
  • Laryngitis
  • Sinusitis
  • Trachetitis
  • Otitis media
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12
Q

What is the difference between chronic and acute bronchitis

A

Acute bronchitis - usually and infective cause that causes inflammation of the medium sized airways

  • CXR normal
  • Can be managed with bronchodilation and antibiotics

Chronic bronchitis - is not due to an infective cause

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13
Q

What is the main way to classify pneumonias? Give the main categories

A

Classified based on the source of infection

  • Community Aquired
  • Hospital Aquired
  • Aspiration Pneumonia
  • Pneumonia in the immunocompromised patient
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14
Q

What is the difference between lobar pneumonia and bronchpneumonia?

A

Lobar = affects 1 lobe of the lung

Bronchopneumonia = patchier infection

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15
Q

What can you see microscopically in pneumonia?

A
  • exudate- fibrin rich fluid
  • neutrophil infiltration
  • macrophage infiltration
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16
Q

What is the most common caustative organisms in community aquired pneumonia?

A

Streptococcus Pneumonia (most common)

17
Q

What other organisms can cause community aquired pneumonia?

A
  • Haemophillus influenzae
  • Moraxella Catarrahalis
  • Klebsiella Pneumonia
  • Staphylociccus aureus
18
Q

Which ‘atypical’ organisms can cause community aquired pneumonia?

A
  • Mycoplasma pneumoniae (most common)
  • Chlamydia pneumoniae
  • Legionella Pneumonphila
19
Q

How do you diagnose community aquired pneumonia?

A

Clinical findings: Cough (+/- sputum), dyspnoea, pleurisy, fever, tachycardia, crackles

Imaging: must see changes on CXR consolidations, inflitrates, cavitations

20
Q

How do you define hospital aquired pneumonia?

A

Infection of lower respiratory tract in hospitalised patients occuring >48 hours afer admission

21
Q

What are the causative organisms of hospital aquired pneumonia?

A
  • Gram Negative bacteria
  • Staphylococcus Aureus (including MRSA)
22
Q

How do you assess the severity of pneumonia?

A

CURB 65

  • Confusion
  • Urea >7 mmol/L
  • Resp Rate >30
  • Blood Pressure <90 Systolic, <60 diastolic
  • >65 years old

Score of 2-5 managed as severe

23
Q

What investigations would you do if you suspected pneumonia?

A
  • FBC
  • U&Es
  • CRP
  • Arterial Blood Gas
  • CXR
24
Q

What microbiological investigations would you order for suspected pneumonia?

A
  • sputum test
  • blood culture
  • broncho alveolar lavage fluid (BAL)
  • Nose and throat swabs
  • Urine (testing for legionella/ pneumococcus)
  • Serum antibodies
25
Q

What is aspirational pneumonia?

A

Aspiration of food, drink, saliva or bomit can cause pneumonia

More likely in those with altered conciousness (anaesthesia, alcohol/ drug abuse, dysphagia)

Causative organisms oral flora and anaerobes

26
Q

What are the causative organisms in pneumonia in the immunocompromised patient?

A
  • Pneumocystis jiroveci
  • Aspergillus species
  • Cytomegalovirus
27
Q

What is the prognosis of pneumonia?

A

In previously well individuals: good prognosis (mortality of 5%)

Prognosis gets worse in older patients or in high CURB65 score

28
Q

How long do you treat pneumonia with antibitoics for?

A

Mild CAP= 5-7 days

Severe CAP = 7-10 days

29
Q

What general measures fo you take in treating pneumonia?

A
  • good oral fluid intake
  • antipyretics to reduce fever and malaise
  • analgestics for pleural pain
  • IV fluids and O2 for more severe cases
30
Q

What antibiotics would you use to treat pneumonia?

A

Mild- moderate= amoxicillin or doxycylcine/ erythryomycin/ clarithromycin

Moderate- Severe = needs hospital admission co-amoxiclav and clarithromycin/ doxycline

31
Q

What complications can arise as a consequence of pneumonia?

A
  • Pleural effusion
  • Empyema
  • Lung abscess formation

Respiratory System (20 decks)

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