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Respiratory > Lung Infections > Flashcards

Lung Infections Flashcards

0
Q

Causes of community acquired pneumonia

A

Most common: Strep pneumoniae
Next: H. influenzae (old), M. pneumoniae (young)
Other: S. aureus (post viral), legionella, Moraxella catarrhalis, Chlamydia
Rare: gram negatives, Coxiella burnetii, anaerobes
Viruses: 15%

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1
Q

Causes of hospital acquired pneumonia

A

Most common: gram negative enterobacteria, S. aureus

Also : pseudomonas, klebsiella, bacteroides, clostridia

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2
Q

Those at risk of aspiration pneumonia

A

CNS: stroke, MG, bulbar palsy
Reduced consciousness (eg drunk, post ictal)
Oesophageal disease
Poor dental hygiene

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3
Q

Pneumonia in the immunocompromised

A 
S. pneumoniae
H. influenzae
S. aureus
M. catarrhalis
M. pneumoniae
Gram negatives 
Pneumocystis jiroveci
CMV/HSV
TB
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4
Q

Tests for patient with pneumonia

A

CXR, ABG if O2 <92%, FBC, U&E, LFT, CRP, blood cultures, sputum cultures, ? Fluid aspiration or bronchoscopy if severe

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5
Q

Treatment of mild CAP (S.pneumoniae, H.influenzae)

A 
Amoxicillin 500mg-1g/8h PO
Or
Clarithromycin 500mg/12h PO
Or
Doxycline 200mg loading then 100mg/day
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6
Q

CURB65 score

A

Confusion (amts 7), RR > 30,

BP (systolic <92%

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7
Q

Treatment of moderate CAP (S.pneumoniae, H.influenzae, M.pneumoniae)

A

Amoxicillin 500mg-1g/8h PO PLUS clarithromycin 500mg/12h PO (both can be IV at same dose)
OR
doxycycline 200mg loading then 100mg/12h PO

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8
Q

Treatment of severe pneumonia

A 
Co-amoxiclav 1.2g/8h IV
OR
Cefuroxime 1.5g/8h IV
Either PLUS
Clarithromycin 500mg/12h IV
ADD
flucloxicillin +/- rifampicin for staph
OR vancomycin for MRSA
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9
Q

Treatment of severe PVL Staph aureus

A

Seek urgent help. Treat as for severe plus IV linezolid, clindamycin and/or rifampicin

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10
Q

Treatment of Legionella pneumophilia

A

Fluoroquinine with clarithromycin or rifampicin for 2-3 weeks

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11
Q

Treatment of Chlamydia pneumonia

A

Doxycline or clarithromycin

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12
Q

Treatment of Pneumocystis jiroveci

A

High dose co-trimoxazole with prednisolone

Stabilise CD4 count

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13
Q

Treatment of hospital acquired pneumonia (gram negatives, pseudomonas, anaerobes) or neutropenic patients

A 
Aminoglycoside IV (eg gentamicin 5mg/kg/day) plus antipseudomonal penicillin IV (eg ticarcillin) or 3rd gen cephalosporin IV (eg cefotaxime 1-2g /6-12h). 
Consider antifungals after 48h
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14
Q

Treatment of aspiration pneumonia (Step pneumoniae, anaerobes)

A

Cephalosporin IV
PLUS
Metronidazole IV

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15
Q

Findings and treatment of staphylococcal pneumonia

A

Bilateral cavitating bronchopneumonia.

Treatment flucloxicillin +/- rifampicin

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16
Q

Findings and treatment of pneumococcus

A

Lobar consolidation - rust coloured sputum and poss haemoptosis
Treat with amoxicillin, benzylpenicillin or cephalosporin

17
Q

Findings and treatment of Klebsiella pneumonia

A

Cavitating pneumonia in upper lobes.
Treat with cefotaxime or imipenem.
Often drug resistant

18
Q

Findings and treatment of mycoplasma pneumoniae

A

Reticular nodular shadowing or patchy consolidation of lower lobe.
Treat with clarithromycin (500mg/12h) or doxycycline (200mg loading then 100mg OD) or fluroquinolone.
Beware meningitis, Stevens Johnson or Guillain Barré

19
Q

5 ways aspergillus affects the lungs

A
  1. Asthma
  2. Allergic bronchopulmonary aspergillosis
  3. Aspergilloma
  4. Invasive aspergillosis
  5. Extrinsic allergic alveolitis
20
Q

Asthma caused by aspergillus

A

Type 1 hypersensitivity to spores

21
Q

Allergic bronchopulmonary aspergillosis hypersensitivity reaction

A

Type 1 and 3.
Affects 1% asthmatics and 2-25% CF.
Causes mucus plugs of fungal hyphae and bronchiectasis.
Treat with prednisolone

22
Q

Cause of aspergilloma

A

Pre existing cavity from TB or sarcoidosis in which a fungus ball can lie.
Can cause massive haemoptysis

23
Q

Risk factors for invasive aspergillosis

A

Immunocompromised, AI disease, after broad spec Abx

25
Q

Treatment and prognosis of invasive aspergillosis

A

Voriconazole IV. Also miconazole or ketoconazole.

30% mortality

26
Q

URTIs

A

Common, usually short term and due to viruses - generally Coryza, acute pharyngitis or tracheobronchitis

27
Q

Coryza

A

The common cold due to rhinovirus infection leading to sore throat, malaise, sneezing, cough, rhinohorrea & hoarseness.
If complicated by tracheitis/bronchitis wheeze and chest tightness can occur.

28
Q

Whooping Cough

A

A very contagious cause of URTI which causes corzya and, rarely, severe bouts of ‘whooping coughs’
Diagnose by PCR of a NP swab and treat with macrolides.

29
Q

Rhinosinusitis

A

A combination of nasal congestion, blockage and discharge which can be followed by facial pain, pressure and anosmia. Exclude polyps and dental infection.
Treat with decongestants, nasal douching. Often bacterial but abx only necessary if symptoms persist for >5days.

30
Q

Definition of Pneumonia

A

An acute respiratory infection associated with recent radiographic changes. Can be ‘lobar’ - homogenous consolidation of one or more lobes, or ‘bronchopneumonia’ - patchy consolidation with bronchial inflammation and bilateral lower lobe involvement.

31
Q

Epidemiology of CAP

A

5-10/1000 adults/yr and accounts for 5-12% of LRTIs

Most common at extremes of age

32
Q

Viral causes of CAP

A

Influenza and parainfluenza
Measles
HSV and CMV
Adenovirus or Coronavirus

33
Q

Features of CAP

A 
Systemic = fever, rigors, malaise, anorexia, poss headache 
Pulmonary = cough (dry then productive - muco/mucopurulent), pleuritic chest pain (can refer to shoulder or upper abdo wall)
34
Q

Signs in patients with CAP

A

Systemic = low BP, high HR and RR, poss pyrexia, cyanosis/
desataturation
Chest = bronchial breathing, dullness to percussion, crackles, increased vocal resonance

35
Q

General management of CAP

A

Humidified oxygen up to CPAP
IV fluids for elderly or hypotensive patients
Analgesia for pleuritic pain

36
Q

Complications of Pneumonia

A

Para-pneumonia effusion or empyema
DVT or PE
Pneumothorax or abscess formation - staph aureus
Retention of sputum causing lobar collapse.

37
Q

Factors leading to HAP

A

Reduced host defences - reduced immunity or reduced cough reflex
Aspiration - reduced consciousness, vomiting, dysphagia or reflux
Introduction of bacteria into the LRT - Intubation, bronchoscopes, dental infectio
Bacteraemia - abdominal sepsis, Cannula infection, infected emboli

38
Q

Definition of HAP

A

Pneumonia developed at least 2 days after admission - early HAP is usually due to the same organisms as CAP, but later gram negatives or anerobes are more to blame

39
Q

Suppurative, aspiration and abscess forming pneumonia

A

Conditions characterized by destruction of lung parenchyma - these are most often due to inhalation of septic material.
More commonly in the apical segment of the lower lobe.

40
Q

Features of suppurative pneumonias

A

Cough with large amounts of sputum, can be fetid or blood-stained
pleural pain common
sudden expectoration of copious amounts of foul sputum if abscess ruptures into a bronchus

41
Q

Signs of suppurative pneumonias

A 
High remittent fever with profound systemic upset
Digital clubbing may develop over 1-2wks
Evidence of consolidation
Pleural rub is commmon 
Rapid weight loss can occur

Respiratory (11 decks)

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