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M103 T4 > M103 T4 L11 > Flashcards

M103 T4 L11 Flashcards

1
Q

What are two examples of exacerbated chronic airway disease?

A

COPD

Bronchiectasis

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2
Q

What is the only hospital criteria that can be used to diagnose penumonia?

A

abnormal CXR changes with evidence of infection

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3
Q

What are the two main types of pneumonia classifications?

A

anatomical

setting

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4
Q

What are the three types of anatomical pneumoias?

A

lobar
broncho-pneumonia
diffuse

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5
Q

What are the three types of setting pneumoias?

A

community acquired
hospital acquired
ventilator related

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6
Q

In what age groups is pneumonia very common?

A

the very young

the very old

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7
Q

What test should all patients who present with pneumonia get?

A

HIV test

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8
Q

What are the signs of pneumonia when assessing the chest?

A

Reduced Air Entry /PN
Bronchial Breathing
Increased Vocal resonance
Crackles

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9
Q

What information relevant to pneumonia is taken from a blood test?

A 
any evidence of infection / inflammation
renal function
liver function
blood cultures
HIV test
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10
Q

What tests are done for patients presenting with pnemonia?

A 
sputum
Viral throat swab/ Mycoplasma 
Urine –legionella Ag
Arterial blood gas
blood test
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11
Q

What might the blood look like from a patient presenting with pnemonia?

A

high WBC count

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12
Q

Why is renal function assesed?

A

to identify if there is an associated acute kidney injury

this an important complication of pneumonia

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13
Q

When might sputum be tested?

A

if there is a pneumonia in the context of chronic lung disease

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14
Q

When might arterial blood gas be tested?

A

if the patient is requiring oxygen
if the patient has the toxin saturations
if the patient is metabolically unwell

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15
Q

How is the severity of pneumonia assessed?

A

the CURB 65 score

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16
Q

What does the CURB 65 score assess?

A 
Confusion
raised blood Urea
raised Respiratory rate
hypotension
age
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17
Q

What is a positive score for raised blood urea in the CURB 65 test?

A

> 7 mmol/L

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18
Q

What is a positive score for raised Respiratory rate in the CURB 65 test?

A

> 30 breaths / min

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19
Q

What is a positive score for hypotension in the CURB 65 test?

A

bp less than 95 / 60 when they reach A&E

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20
Q

What is a positive score for age in the CURB 65 test?

A

age > 65 years

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21
Q

What does a CURB score of zero or one mean?

A

patient has a low risk of dying

can consider all antibiotics and treatment at home

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22
Q

What does a CURB score of two or three mean?

A

their risk of dying increases up to 14 percent
patient offered a short hospitalisation
24 - 48 hours of IV antibiotics to ensure ongoing improvement

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23
Q

What does a CURB score of four or five mean?

A

chances of dying in hospital are significant

could be admitted into ICU

24
Q

What is the mortality rate for a patient with a CURB score of four or five?

A

27.8%

25
Q

For a patient with no risk factors, how is pneumonia managed in the community?

A 
Rest
Push fluids
Analgesics
Antibiotic
Safety net
Refer if no improvement in 48 hrs
26
Q

How is pneumonia managed in a hospital? (FOAC)

A

Fluid replacement
Oxygen
Antibiotics
Critical care management

27
Q

When is oxygen given to patients with pneumonia?

A

if the patient has respiratory failure

28
Q

When is fluid replacement administered to patients with pneumonia?

A

if required to treat one any acute kidney injury and to support system circulation and cardiovascular function

29
Q

What is the most common cause for Community Acquired Pneumonia?

A

Streptococcus pneumoniae

30
Q

Which factors will determine the antibiotics administered to a pnemonia patient?

A 
the setting
the severity
any co-morbidities (esp resp disease)
epidemiology
any patient allergies
31
Q

Which antibiotic is used to treat a Community Acquired Pneumonia?

A

Doxycyline if not sever
Amoxicillin if severe
both if more severe

32
Q

Which antibiotic is used to treat mild hospital acquired pneumonia?

A

Amoxicillin

Doxycycline

33
Q

Which antibiotic is used to treat severe hospital acquired pneumonia?

A

Amoxicillin or Ceftriaxone /Levofloxacin

AND temocillin

34
Q

Why is a six week gap left between chest xrays when checking for progress?

A

X-ray change is always significantly lag behind a clinical response

35
Q

When would a six week gap NOT be left between chest xrays while the patient is still being treated?

A

only if the patient is excellently deteriorated

36
Q

Which factors will increase the time taken for pneumonia to clear?

A

increased comorbidity
bacteremia
multilobar involvement
enteric gram-negative bacilli pneumonia

37
Q

What does a MET call involve?

A

when an emergency patient that is rapidly detiorating has a senior group of doctors arrive to try and quickly to help him get through the next couple of hrs

38
Q

How can oxygen be delivered?

A

Nasal cannulae
Controlled (fixed percentage - venturi) masks
Uncontrolled masks

39
Q

What are two examples of Uncontrolled masks?

A

Hudson

Reservoir mask

40
Q

What are the two ways in which oxygen reaching the patient is measured?

A

litres per minute

percentage inspired oxygen

41
Q

How is pneumonia treated in critical care?

A 
Nasal HiFlow
CPAP 
NIV (BiPAP)
Intubation and invasive Ventilation 
If everything fails consider ECMO
42
Q

What are the local complications of pneumonia?

A

pleural effusion
empyema
lung abscess
organising pneumonia

43
Q

How does CPAP (continuous positive airway pressure) work?

A

it stops the airways closing

splints the airways open so that worker breathing becomes less work

44
Q

When is BiPAP used?

A

type 2 respiratory failure

45
Q

When is intubation and invasive ventilation used on pneumonia patients?

A

when non-invasive methods of ventillation don’t work

46
Q

What are advs of Nasal HiFlow?

A

can give higher oxygen concentration, positive pressure and reduce work of breathing

47
Q

When is ECMO used?

A

when the lungs are poorly compliant

when the lungs are hard to ventilate

48
Q

How is organising pneumonia treated?

A

with steroids

49
Q

What might the causes be when a pneumonia patient is failing to respond to treatment?

A 
Wrong or incomplete diagnosis
Antibiotic problem
Complication developing
Underlying bronchial obstruction (cancer)
Pleural parapneumonic Effusion
50
Q

What problems with antibiotics might patients have which might affect their response to treatment?

A

might not be taking their antibiotics
drug chart might not be done
might have absorption issues
might be dealing with a resistant organism - might need to change antibiotics to a greater spectrum

51
Q

How can a sample of a parapneumonic effusion be obtained?

A

use an ultrasound probe
put a needle through the side if there’s significant amounts of fluid
put the chest drain in
let it drain out

52
Q

How will a pneumonia patient with Pleural parapneumonic Effusion or lung abscesses have a different treatment to usual?

A

same treatment of antibiotics but for a longer course, up to six weeks by IV

53
Q

What does a sample of an empyema look like?

A

visibly purulent effusion

54
Q

Pus with a pH of less than pH 7.2 is what?

A

an empyema

55
Q

If a pneumonia patient isn’t responding to treatment, what are the three common differential diagnoses that they might have?

A

LRTI and lung cancer
LRTI and heart failure
pulmonary emboli / infarction

56
Q

What are some unusual reasons pneumonia patients might not be responding to treatment?

A

if they have specific infections, eg TB

if they have complicating chronic bronchial suppuration, eg. Cystic Fibrosis

57
Q

What are some rare reasons pneumonia patients might not be responding to treatment?

A

vasculitis
pulmonary eosinophilia
cryptogenic organising pneumonia

M103 T4 (19 decks)

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