PBL 6

Question 1

what does malaise mean

Answer 1

this is a general feeling of discomfort, illness, or unease whose exact cause is difficult to identify

Question 2

define crackles

Answer 2

this is a sound that is often associated with inflammation or infection of the small bronchi, bronchioles and alveoli

Question 3

define amoxicillin

Answer 3

– antibiotic from the penicillin family, it is used to treat a number of bacterial infections, it attaches to the cell wall and causes the death of the bacteria

Question 4

define macrolide

Answer 4

they have an antibacterial spectrum that is similar but not identfical to that of penicillin, it is protein synthesis inhibitor, it prevents the peptidyltransferase from adding the growing peptide attached to tRNA to the next amino acid, also can cause the premature dissociation of the peptidyl tRNA from the ribosome

Question 5

define effusion

Answer 5

this is excess fluid that accumulates in the pleural cavity

Question 6

define congestive heart failure

Answer 6

Heart failure, sometimes known as congestive heart failure, occurs when your heart muscle doesn’t pump blood as well as it should

Question 7

what pathogens cause pneumonia

Answer 7

bacteria or virus

Question 8

is pneumonia and upper or lower respiratory tract infection

Answer 8

lower

Question 9

what is the most frequent cause of pneumonia

Answer 9

• Most frequent cause is the streptococcus pneumoniae (antibiotic resistance in penicillin and macrolides)

Question 10

describe the damage done to pneumonia

Answer 10

• Pneumonia (direct injury) → Inflammation → Innate immunity →Alveolar injury/dysfunction
• Invasion & overgrowth of a pathogenic microorganism in the lung parenchyma → intra-alveolar exudates → Pneumonia
• If there is enough repetitive injury to the alveoli then they cross into the systemic circulation, the neutrophils will then start to modulate this

Question 11

define pneumonia

Answer 11

• Pneumonia is a bacterial, viral or fungal infection that can effect on or both sides of the lungs, it causes the air sacs, alveoli of the lungs to fill up with fluid or pus

Question 12

name the different types of pneumonia

Answer 12

• Bacterial pneumonia – caused by various bacteria
• Viral pneumonia – type is caused by various viruses including the flu (influenza)
• Mycoplasma pneumonia – caused by bacteria mycoplasma pneumoniae
• Hospital acquired pneumonia
• Community acquired pneumonia
• Walking pneumonia – feel well enough to go about regular activities
• Fungal pneumonia – more likely to get it if your immune system is weakened from an organ transplant, chemotherapy for cancer, medicines to treat an autoimmune disease like rheumatoid arthritis
• Aspiration pneumonia – inhale food drink vomit or saliva into your lungs

Question 13

what are the signs and symptoms of pneumonia

Answer 13

• Commonly resolve spontaneously withint 4-7 days
• Headache
• Fever
• Weakenss
• Dry cough
• Nasal congestion
• Chills
• Sore throat
• Sweating
• Muscle aches
• Symptoms commonly last for 3-4 weeks
• Daily activities are impaired for a further 3 weeks on average

Question 14

how do you diagnose pneumonia

Answer 14

• Physical exam
• Complete blood count
• Sputum culture
• Urine test
• PCR
• CT scan
• Chest radiograph to allow accurate diagnosis.- consolidation in the lower zones

Question 15

what are the microbiological investigations for pneumonia

Answer 15

• Urea and electrolytes to inform severity assessment.
• C-reactive protein to aid diagnosis and as a baseline measure.
• Full blood count and Liver function tests

Question 16

describe how CRB65 works

Answer 16

• Confusion
• Respiration rate greater than or equal to 30 min
• Blood pressure – hypotensive
• Over the age of 65
• • if 0 - dutiable for home treatment and given antibiotics
• • if 1-2 moderate severity should consider a hospital referral
• • if 3-4 high severity - urgent hospital admission, empirical antibiotics if life threatening

Question 17

what is the treatment of pneumonia

Answer 17

CRB65 of 0 
- amoxicillin 500mg
or
- doxycycline 200mg loading then 100mg 
or
- clarithromycin 500mg BD
for 5-7 days

CRB65 of 1-2
- amoxicillin 500mg plus, clarithromycin 500mg dual therapy
or
- doxycycline monotherapy 200mg loading then 100mg

CRB65 of 3 or more
- bezylpencillin 1-2g IV or amoxicillin 1g

Question 18

what is the treatment for children with pneumonia

Answer 18

• cough and cold means they have no pneumonia so home care advice
• fast breathing and or chestt undraping pneumonia - oral amoxicillin and home care advice
• general danger signs - severe pneumonia or very severe disease - first dose antibiotic and referral to facility for injectable antibiotic/supportive therapy

Question 19

what other treatments for pneumonia are there

Answer 19

• Pain killers such as paracetmol or ibuprofen

- Drink plently of fluids

Question 20

explain her symptoms

Answer 20

• 40 degrees – tyring to kill of the bacteria and pathogen
• Cough – excess mucus secretion to trap the bacteria and pathogen, irritation of the alveoli due to excess fluid
• Backpain
• Malaise
• 130 bpm – lack of oxygen getting to cells therefore increases beats per minute
• RR 33 per minute – breathing is harder, alveoli filled with fluid therefore less surface area for exchange of oxygen, this can cause hyperventilation as lack of oxygen
• 95/65 bp
• SpO2 94%- due to inefficient oxygen diffusion across the alveoli
• Crackles – excess fluid in the lungs
• Sharp pain in right base – consolidation

Question 21

what is a preventive measure of pneumonia

Answer 21

• pneumococcal vaccine

Question 22

what groups of people should have a pneumococcal vaccine

Answer 22

• Elderly over 65 and young should be targeted
• Children and adults with certain long term health conditions such as serious heart of kidney conditions
• Those with respiratory conditions such as asthma and COPD
• Anyone at occupational risk such as welders
• Had spleen removed or doesn’t work properly
• Chronic liver disease
• A cochlear implant
• Immune system supressed such as if you are on chemotherapy

Question 23

what vaccine to babies receive

Answer 23

• Babies receive 3 doses – 8 weeks, 16 weeks, 1 year – offered pneumococcal conjugate vaccine PCV

Question 24

what vaccines do adults aged over 65 and those aged from 2-64 receive

Answer 24

• Adults over 65 – offered pneumococall polysaccharide vaccine PPV
• PPV from children from aged 2 to 64

Question 25

what is the follow up procedure for pneumonia a

Answer 25

• Chest x ray
• Flu vaccination
• Pneumoccoal vaccination

Question 26

what are the risk factors for pneumonia

Answer 26

• Being 2 years and younger
• 65 and older
• Being hospitalized
• Chronic disease
• Smoking
• Weakened or supressed immune system

Question 27

describe the severity assessment of pneumonia if aged younger 2 months

Answer 27

Severe pneumonia

• RR is greater or equal to 60l/min
• Lower chest wall in drawing
• But no signs of very severe pneumonia

Very severe pneumonia

• Central cyanosis
• Not able to drink
• Head nodding

Question 28

describe the severity assessment of pneumonia if aged between 2 and 60 months

Answer 28

Pneumonia

• Respirator rate is greater than or equal to l/min (2-11 months of age)
• Respiratory rate greater than or equal to 40l/min (for 12-60 months of age
• But no signs of severe or very sever pneumonia

Severe pneumonia

• Low chest wall in drawing
• But no sings of very severe pneumonia

Very severe pneumonia

• Central cyanosis
• Unable to drink
• Head nodding