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Respiratory > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

Define pneumonia

A

Infection of the distal lung parenchyma

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2
Q

Categories of pneumonia

6

A 
community acquired
hospital acquired/nosocomial
aspiration 
pneumonia in the immunocompromised
typical
atypical (Mycoplasma, Chlamydia, Legionella)
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3
Q

Causes of community acquired pneumonia

10

A 
Streptococcus pneumoniae (70%)
Haemophilus influenzae
Moraxella catarrhalis (in COPD patients)
Chlamydia pneumonia
Chlamydia psittacosis (causes psittacosis)
Mycoplasma pneumonia
Legionella (anywhere w/ air conditioning)
Staphylococcus aureus
Coxiella burnetti (causes Q fever)
TB
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4
Q

Causes of hospital acquired pneumonia

2

A

Gram negative enterobacteria (Pseudomonas, Klebsiella)

Anaerobes (due to aspiration pneumonia)

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5
Q

Risk factors for pneumonia

6

A 
Age
Smoking
Alcohol
Pre existing lung disease (e.g. COPD)
Immunodeficiency
Contact w/ patients w/ pneumonia
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6
Q

Epidemiology of pneumonia

prevalence + deaths

A

5-11/1000

CAP is responsible for > 60,000 deaths per year in UK

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7
Q

Presenting symptoms of pneumonia

9

A 
Fever
Rigors
Sweating
Malaise
Cough
Sputum
Breathlessness
Pleuritic chest pain
Confusion (in severe cases or elderly)
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8
Q

Presenting symptoms of ATYPICAL pneumonia

4

A

Headache
Myalgia
Diarrhoea/abdominal pain
DRY cough

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9
Q

Signs of pneumonia on physical examination

12

A 
Pyrexia
Respiratory distress
Tachypnoea
Tachycardia
Hypotension
Cyanosis
Decreased chest expansion
Dull to percuss over affected area
Increased tactile vocal fremitus over affected area
Bronchial breathing over affected area
Coarse crepitations on affected side
Chronic suppurative lung disease (empyema, abscess) —> clubbing
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10
Q

Investigations for pneumonia

6 types

A 
Bloods
CXR
Sputum/pleural fluid
Urine
Atypical viral serology
Bronchoscopy & bronchoalveolar lavage
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11
Q

Investigations for pneumonia - bloods

6

A 
FBC - raised WCC
U&Es
LFTs
Blood cultures
ABG (assess pulmonary function)
Blood film - Mycoplasma causes red cell agglutination
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12
Q

Investigations for pneumonia - CXR

3

A

Lobar or patchy shadowing (Klebsiella often affects upper lobes)
Pleural effusion
May detect complications (e.g. lung abscess)

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13
Q

Investigations for pneumonia - sputum/pleural fluid

A

MC&S

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14
Q

Investigations for pneumonia - urine

A

Pneumococcus & Legionella antigens

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15
Q

Investigations for pneumonia - bronchoscopy & bronchoalveolar lavage

A

if Pneumocystis carinii pneumonia is suspected, or if it fails to resolve

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16
Q

Investigations for pneumonia

6 groups

A

Assess severity using British Thoracic Society Guidelines

Start empirical antibiotics

Supportive treatment

Discharge planning

Consider other causes if pneumonia not resolving

Prevention

17
Q

Investigations for pneumonia - start empirical antibiotics

5

A

Oral amoxicillin (0 markers)
Oral or IV amoxicillin + erythromycin (1 marker)
IV cefuroxime/cefotaxime/co-amoxiclav + erythromycin (>1 marker)
Add metronidazole if:
- aspiration
- lung abscess
- empyema
Switch to appropriate antibiotic based on sensitivity

18
Q

Investigations for pneumonia - supportive treatment

4

A

Oxygen
IV fluids
CPAP, BiPAP or ITU care for respiratory failure
Surgical drainage may be needed for lung abscesses & empyema

19
Q

Investigations for pneumonia - discharge planning

A

If 2 or more features of clinical instability are present there’s high risk of re admission & mortality

20
Q

Investigations for pneumonia - prevention

3

A

Pneumococcal vaccine
Haemophilus influenze type B vaccine
Usually only given to high risk groups (e.g. elderly, splenectomy)

21
Q

Complications of pneumonia

6

A 
Pleural effusion 
Empyema
Localised suppuration (e.g. access)
Septic shock
ARDS
Acute renal failure
22
Q

Complications of pneumonia - mycoplasma pneumonia

6

A 
Erythema multiforme
Myocarditis
Haemolytic anaemia
Meningoencephalitis
Transverse myelitis
Guillain-Barre syndrome
23
Q

Prognosis of pneumonia

3

A

Most resolve w/ treatment in 1-3 weeks
Severe pneumonia has high mortality
CURB-65 score used to assess severity

24
Q

Symptoms of abscesses

3

A

Swinging fever
Persistent pneumonia
Copious/foul smelling sputum

25
Q

CURB-65

A 
Confusion < 8 AMTS
Urea > 7mmol/L
Respiratory rate > 30/min
Blood pressure: systolic < 90mm Hg or diastolic < 60mm Hg
Age > 65 yrs
26
Q

Features of clinical instability

5

A 
high temperature
tachycardia
tachypnoea
hypotension
low oxygen sats

Respiratory (14 decks)

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