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Medicine: Respiratory > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

What is pneumonia?

A

Inflammation of the alveolar space with consolidation, usually due to acute LRTI.

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2
Q

What are the commonest causes of community acquired pneumonia?

A
  1. Streptococcus pneumoniae

2. H. influenzae, M. catarrhalis

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3
Q

What are the commonest causes of hospital acquired pneumonia?

A
  1. Gram -ve enterobacteria (e.g. E. coli)

2. Pseudomonas (common in ITU and ventilated)

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4
Q

What is aspiration pneumonia and what are the risk factors?

A
  1. Inhalation of oropharyngeal contents into lower airways.

2. Low GCS, swallowing dysfunction, stroke, intubation, feeding tube, oesophageal disease.

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5
Q

What are the organisms that cause atypical pneumonia?

A

Mycoplasma pneumoniae, chlamydophila pneumoniae, legionella pneumophila, klebsiella, chlamydophila psittac, pneumocystis pneumoniae.

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6
Q

What is ventilator associated pneumonia?

A

Pneumonia >48hrs after endotracheal intubation.

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7
Q

What is the difference between bronchopneumonia and lobar pneumonia on autopsy?

A
  1. Broncho - widespread patchy inflammation centred on airways, often bilateral.
  2. Lobar - diffuse inflammation affecting entire lobe/lobes.
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8
Q

What is consolidation and what is it in a pneumonia?

A
  1. Replacement of air in alveoli by fluid or other material.

2. Acute inflammatory exudate

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9
Q

What is the pathophysiology of pneumonia?

A
  1. Develops subsequent to invasion and overgrowth of pathogenic microorganisms in lungs (overwhelms host defences and produces intra-alveolar exudates.
  2. Pathogens reach lower respiratory tract by - inhalation, aspiration, haematogenous spread, direct extension from adjacent infected foci.
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10
Q

What is this a presentation of?
Fever, rigors, malaise, anorexia, dyspnoea, cough, purulent sputum, haemoptysis, pleuritic chest pain. Pyrexia, cyanosis, confusion, hypothermia, tachypnoea, tachycardia, hypotension, reduced expansion, dull to percussion, increased fremitus, crackles on auscultation.

A

Pneumonia

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11
Q

What are the risk factors for community-acquired pneumonia?

A

> 65, COPD, exposure to cigarette smoke, alcohol abuse, poor oral hygiene, contact with children, PPI use.

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12
Q

What are the risk factors for hospital-acquired pneumonia?

A

Poor infection control, intubation, mechanical ventilation.

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13
Q

Which pathogen is causing this atypical pneumonia and what is the treatment?
Flu-like symptoms followed by dry cough. CXR patchy consolidation in one lower lobe. Young patient treated with antibiotics prior to presentation.

A
  1. Mycoplasma pneumoniae

2. Clarithromycin/doxycycline/ciprofloxacin

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14
Q

Which pathogen is causing this atypical pneumonia and what is the treatment?
Biphasic illness: pharyngitis, hoarseness, otitis, followed by pneumonia.

A
  1. Chlamydophila pneumoniae

2. Doxycycline/clarithromycin

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15
Q

Which pathogen is causing this atypical pneumonia and what is the treatment?
Hotel, jacuzzi, cooling tower. Flu symptoms then dry cough and dyspnoea. Anorexia, D&V, renal failure, hyponatraemia, hepatitis, confusion. CXR bilateral consolidation, urinary antigen.

A
  1. Legionella pneumophila

2. Ciprofloxacin for 3 weeks or clarithromycin

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16
Q

Which pathogen is causing this atypical pneumonia and what is the treatment?
May complicate influenza infection or occur in the young, elderly, IVDU, patients with cancer or cystic fibrosis.

A
  1. Staphylococcal pneumonia

2. Flucloxacillin +/- rifampicin

17
Q

Which pathogen is causing this atypical pneumonia and what is the treatment?
Rare. Occurs in elderly, diabetics, and alcoholics. Cavitating pneumonia especially in upper lobes and causes pleural empyema. Current jam sputum.

A
  1. Klebsiella

2. Often drug resistant - cefotaxime or imipenem

18
Q

Which pathogen is causing this atypical pneumonia and what is the treatment?
From infected birds (typically parrots). Diagnose on serology.

A
  1. Chlamydophila psittaci

2. Doxycycline or clarithromycin

19
Q

Which pathogen is causing this atypical pneumonia and what is the treatment?
Common in immunosuppressed (HIV). Dry cough, exertional dyspnoea, fever. Diagnose on sputum.

A
  1. Pneumocystis pneumonia

2. Co-trimoxazole (prophylactically in low CD4 count), steroids if hypoxaemia.

20
Q

How is a suspected pneumonia investigated?

A
  1. CXR - air bronchograms hallmark of consolidation, silhouette sign.
  2. FBC - neutrophil dominance (bacterial)
  3. CRP - monitor disease course
  4. U&Es - high urea = increased severity, hyponatraemia in legionella, monitor for dehydration.
  5. ABG/sats
  6. Blood culture - all hospitalised patients
  7. Urinary antigen testing - legionella and pneumococcal
  8. Sputum culture - before Abx, not in outpatient setting
21
Q

How is the severity of a pneumonia assessed?

A 
CURB-65:
C - confusion (8 or less on abbreviated mental test)
U - urea (>7mmol/L)
R - respiratory rate (>30/min)
B - BP (<90 SYS and/or <60 DIA)
65 - age 65 or older

0-1: PO Abx/home treatment
2: IV Abx/hospital therapy
3+: severe pneumonia, 15-40% mortality, consider ITU

22
Q

What is the management for pneumonia?

A
  1. A-E, aim sats >92%, CXR, bloods, ABG
  2. Analgesia
  3. Fluids
  4. Calculate CURB-65
  5. Antibiotics - IV if severe, anaerobic cover in aspiration, 5-7 days uncomplicated, 10 days severe, 14-21 if staphylococcal/legionella/gram -ve, switch to oral ASAP.
23
Q

What should you check for if suspecting a pneumonia?

A
  1. Type 1 respiratory failure
  2. Hypotension due to dehydration and sepsis
  3. Empyema if 5 days Abx but persistent fever and WCC.
  4. AF - may need BBs short term
  5. Lung abscess
  6. Jaundice - secondary to sepsis/Abx treatment
24
Q

Which antibiotics are recommended in this pneumonia first line and if allergic to first line?
CAP with CURB-65 of 0-1

A
  1. Doxycycline PO

2. Amoxicillin PO

25
Q

Which antibiotics are recommended in this pneumonia first line and if allergic to first line?
CAP with CURB-65 of 2-5

A
  1. Ben Pen IV + doxycycline PO (add flucloxacillin for staph and vancomycin for MRSA)
  2. Seek advice - levofloxacin IV
26
Q

Which antibiotics are recommended in this pneumonia first line and if allergic to first line?
HAP with CURB-65 of 0-1

A
  1. Doxycycline PO

2. Seek advice - levofloxacin PO/IV

27
Q

Which antibiotics are recommended in this pneumonia first line and if allergic to first line?
HAP with CURB-65 of 2-5

A
  1. Ben Pen IV + gentamicin IV

2. Seek advice - levofloxacin IV

28
Q

Which antibiotics are recommended in this pneumonia first line and if allergic to first line?
Aspiration pneumonia with low severity

A
  1. Doxycycline PO + metronidazole PO

2. Levofloxacin IV + metronidazole IV

29
Q

Which antibiotics are recommended in this pneumonia first line and if allergic to first line?
Aspiration pneumonia, severe or not for PO therapy

A
  1. Ben Pen IV + metronidazole IV

2. Levofloxacin IV + metronidazole IV

30
Q

Which antibiotics are recommended in a chlamydophila pneumonia?

A

Doxycycline or clarithromycin

31
Q

Which antibiotics are recommended in a legionella pneumonia?

A

Ciprofloxacin + clarithromycin

32
Q

What are the risk factors for antibiotic resistance?

A
  1. Abx in past 3 months
  2. Current admission in hospital for 5 or more days
  3. Hospitalisation in last 3 months
  4. Previous episodes of pneumonia in past year
  5. Age <5 or >65
  6. COPD
33
Q

What is the progression of pneumonia up to 6 months after and what is offered as follow-up?

A
  1. 1 week - fever should have resolved
  2. 4 weeks - chest pain and sputum production reduced
  3. 6 weeks - cough and breathlessness reduced (offer vaccine and CXR)
  4. 3 months - most symptoms resolved, some fatigue
  5. 6 months - back to normal
34
Q

Who is the influenza vaccine offered to?

A
  1. 65 years and over, children 2-9.
  2. Pregnant women
  3. Chronic heart, liver, renal or lung conditions.
  4. Diabetes mellitus
  5. Immunosuppressed
  6. Carers
35
Q

Who is the pneumococcus vaccine offered to?

A
  1. All adults 65 or older
  2. Chronic heart, liver, renal or lung conditions.
  3. Diabetes mellitus not controlled by diet
  4. Immunosuppression (poor spleen, AIDS, chemo, prednisolone >20mg/day)
  5. Smoking/alcohol/IVDU
36
Q

Who is the mycobacterium tuberculosis vaccine offered to?

A
  1. Babies born in areas with high TB incidence
  2. Babies born with grandparents/parents from endemic areas
  3. Working in close contact with patients with TB
37
Q

What are the complications of pneumonia?

A

Pleural effusion, empyema, lung abscess, DVT, sepsis, post-infective bronchiectasis, pre-renal AKI.

Medicine: Respiratory (29 decks)

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