Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CR3 > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

What are the signs and symptoms of pneumonia

A

Symptoms -

  • Fever >38 degrees
  • Malaise
  • Cough (purulent - rust coloured sputum)
  • Dyspnoea
  • Pleuritic pain (may hear pleuritic rub)

Sign-

  • Dull percussion note
  • Reduced breath sounds
  • Bronchial breathing (transmission of bronchial sounds to peripheries due to consolidation)
  • Coarse crepitations
  • Increased vocal fremitus (increased transmission of ’99’ through consolidated lung)
  • Tachycardia
  • Hypotension
  • Confusion
  • Cyanosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe 3 main respiratory defence mechanisms against infection?

A
  • Mucus layer - traps pathogens
  • Cilia - sweeps mucus and pathogens out of airway
  • Alveolar macrophages -bind and ingest pathogens and particles
  • Recruitment of additional white blood cells in times of sever infection e.g neutrophils
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is empyema and what are its key clinical features?

A

Collection of puss (abscess) in the lung tissue.

Features -
Failure to fully recover from antibiotic therapy

swinging fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is pneumonia?

A

inflammation of the parenchyma of the lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What can cause pneumonia?

A

most common cause of pneumonia is infection and the majority of these are bacterial in nature. Viruses, fungi and parasites may also cause pneumonia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Bacteria can reach the lungs in which 3 routes?

A

Inhalation
Aspiration
Haematogenous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Community acquired pneumonia is split into 2 categories, what are they?

A

Typical and Atypical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the common causes of typical community acquired pneumonia?

A
  • Streptococcus pneumoniae (most common)
  • Haemophilus influenzae
  • Moraxella catarrhalis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the common causes of Atypical community acquired pneumonia?

A

Non-zoonotic -

  • Mycoplasma pneumoniae,
  • Legionella pneumophila, - Chlamydophila pneumoniae

Zoonotic -

  • Chlamydophila psittaci (psittacosis)
  • Coxiella burnetii (Q fever),
  • Francisella tularensis (tularemia).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the difference between typical and atypical pneumonia?

A

Typical - presents with usual symptoms - a productive cough, fever and pleuritic chest pain

Atypical - present with a combination of pulmonary and extrapulmonary symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is hospital acquired pneumonia?

A

pneumonia contracted > 48 hrs after hospital admission that was not incubating at the time of admission.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which bacteria are known to cause hospital acquired pneumonia?

A
  • Gram-negative bacilli (e.g. Pseudomonas aeruginosa)
  • Staphylococcus aureus
  • Legionella pneumophila
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which types of patients are most at risk of aspiration pneumonia?

A

Reduced conscious level

Neuromuscular disorders

Oesophageal conditions

Mechanical interventions such as endotracheal tubes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which bacteria are often associated with aspiration pneumonia?

A
  • Streptococcus pneumoniae,
  • Staphylococcus aureus,
  • Haemophilus influenzae,
  • Enterobacteriaceae, in

the hospital Gram-negative bacilli (e.g. pseudomonas aeruginosa)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which test can be used to diagnose pneumococcal pneumoniae and legionella pneumophilia. What should be done is the test is positive?

A

Urinary antigen tests - then PCR

If positive - need to do a specific spot culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

State specific features of Streptococcus pneumoniae

A
  • Gram-positive alpha-haemolytic streptococci
  • causes a significant leucocytosis (high WBC) and a raised CRP
  • Gives rust coloured sputum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which extrapulmonary symptoms are associated with atypical pneumonia?

A 
Erythema multiforme and erythema nodosum (Mycoplasma pneumonia.)
Arthralgia, myalgia, malaise
Myocarditis, pericarditis
Haemolytic anaemia
Headache

Abdominal pain, diarrhoea and vomiting (Hepatitis can be a feature of Legionella pneumonia)

Labial herpes simplex (reactivation is relatively common in pneumococcal pneumonia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

State specific features of Mycoplasma pneumoniae?

A
  • Rod-shaped gram negative
  • affect a younger demographic and occurs in cyclical epidemics.
  • presents with flue like symptoms (arthralgia, myalgia, dry cough and headache)

Can present with following extrapulmonary symptoms

  • can cause cold autoimmune haemolytic anaemia
  • Erythema multiforme
  • Arthralgia
  • Myocarditis, pericarditis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

State specific features of Legionella pneumophila?

A
  • gram-negative coccobacillus
  • encountered in those exposed to contaminated cooling systems, humidifiers and showers.
  • chest symptoms may present after several days of myalgia, headache and fever.
  • 50% associated related to foreign
    travel – Especially Mediterranean
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How is Legionella pneumophila often contracted?

A

It is encountered in those exposed to contaminated cooling systems, humidifiers and showers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which extrapulmonary features is Legionella pneumophila associated with?

A

myalgia, headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which biochemical and blood test abnormalities are associated with Legionella pneumophila?

A
  • Hyponatraemia (secondry to SIADH)
  • hypophosphataemia
  • raised serum ferritin.
  • Lymphopenia (low lymphocytes)
23
Q

Which organisms causes pneumonia in immunocompromised people?

A

Pseudomonas aeruginosa

Pneumocystis jirovecii (aids defining illness)

Candidiasis

Cytolomegalovirus

S. aureus

Gram negative bacteria

24
Q

Which bacteria causes characteristic green sputum in pneumonia?

A

Pseudomonas aeruginosa

25
Q

What type of sputum is associated with Klebsiella pneumophila? Which other clinical features are associated with this type of pneumonia?

A
  • red-currant jelly like sputum
  • Mainly effects upper lobes
  • Associated with people who have a weak immune system (alcoholics, diabetics
  • Gram negative anaerobic rod (baccilus) bacteria)
  • ## Symptoms include a cough, fever and flu-like features
26
Q

What are the pulmonary complications of pneumonia? (4)

A 
Parapneumonic effusion
Pneumothorax
Abscess
Empyema
acute respiratory failure
27
Q

What are the systemic extrapulmonary complications of pneumonia? (2)

A

Sepsis

Atrial fibrillation

28
Q

In somone you suspect may have pneumonia, which investigation would you obtain? (bedside, blood, imaging)

A 
Bedside -
- Observations 
- sputum sampling (bronchoalveolar lavage)
Urinary sampling - Urinary antigen tests
- ECG (for atrial fibrillation)

Blood -
- FBC
- U and E
- CRP
- Blood cultures (moderate to sever case- take before antibiotics)
HIV test- pneumonia is a common initial presenting illness in patients undiagnosed HIV infection

Imaging
- Chest X ray

29
Q

Which x-ray findings are associated with pneumonia?

A

Consolidation

parapneumonic effusions, pneumothorax, abscess and empyema.

30
Q

Which scoring system is used to assess mortality in pneumonia patients? Describe the score.

A

CURB-65

  • Confusion
  • Urea >7
  • Respiratory rate >30
  • Blood pressure <90 systolic and <60 diastolic
  • Age >65
0-1 = low mortality 
2 = intermediate mortality 
3-5 = high mortality

5 is maximum

31
Q

How is low severity community acquired pneumonia treated?

A

Oral therapy with a broad spectrum beta-lactam (e.g. amoxicillin).

A tetracycline or macrolide may be used in those with a penicillin allergy (doxycycline or clarithromycin).

Alternative: Levofloxacin 500mg PO OD

A typical antibiotic course would be 5-7 days.

32
Q

How is intermediate severity community acquired pneumonia treated?

A

Most can be treated adequately with oral therapy.

Dual therapy with a beta-lactam (e.g. amoxicillin) and a macrolide (e.g. clarithromycin).

Doxycycline may be used as an alternative in those with a penicillin allergy.

A typical antibiotic course would be 7-10 days.

33
Q

How is high severity community acquired pneumonia treated?

A

IV beta-lactamase stable beta-lactam (e.g co-amoxiclav) and a macrolide (e.g. clarithromycin).

Alter - Benzylpenicillin IV plus either levofloxacin or ciproflaxcin

Alt - Cefuroxime IV or cefotaxime or ceftriaxone plus clarythromycine

Use levofloxacin if legionella strongly suspected

An antibiotic course of 7-10 days may be extended to 14 or 21 days depending on clinical circumstance.

34
Q

How is hospital acquired pneumonia treated?

A

Should follow local guidelines based upon local microbial knowledge.

Co-amoxiclav 625mg TDS may be used in mild infections.

Tazocin (piperacillin/tazobactam) 4.5g IV TDS may be used in severe infections.

35
Q

How are smokers with pneumonia followed up?

A

A CXR at 6-8 weeks post-event should be used to screen for underlying lung cancers in this age group.

11% of smokers over the age of 50 who have pneumonia have lung cancer.

36
Q

List 7 markers for sever community acquired pneumonia

A

Chest X-ray – more than one lobe involved

PaO2 – <8 kPa

Low albumin – <35 g/L

White cell count – <4 × 109/L or >20 × 109/L

Blood culture – positive

Other co-morbidities

Absence of fever in the elderly

37
Q

State specific features of Pseudomonas aeruginosa

A
  • gram-negative bacillus
  • opportunistic - effects those who are immunosuppressed or with chronic lung disease
  • can effect many body systems and cause bacteraemia
  • cause the symptoms classically associated with pneumonia
  • green sputum
  • Treatment often involves a cephalosporin and aminoglycoside. Aerosolised antibiotics may be used in patients with cystic fibrosis.
38
Q

State specific features of Pneumocystis jirovecii

A
  • A fungi
  • Associated with aids
  • causes fever, cough (frequently non-productive) and exertional dyspnoea
  • Hypoxia and a raised LDH are also common findings.
  • Does not respond to antifungals and is instead treated with co-trimoxazole (trimethoprim-sulfamethoxazole).
39
Q

COPD predisposes individuals to pneumonia from which microorganisms?

A

H.influenzae & M.catarrhalis

40
Q

For target therapy to be successful the bacteria must be identified. How is this conducted for the different causes of pneumonia?

A

Most - Blood and sputum cultures
Pneumococcal- urinary antigen if positive specific sputum culture
Legionella - urinary antigen and sputum collection
-Mycoplasma - PCR (sputum/throat)
Chlamydophilia (PCR/complement fixation)
VIRAL PCR (nose and throat swab)

41
Q

What might cause a patient to fail to recover?

A 
Incorrect diagnosis or complicating condition
–
 Unexpected/resistant pathogen
–
 Impaired local or systemic immunity
–
 Local or distant complications of CAP
42
Q

How often should a patients X ray be followed up? What should be done if the x ray does not improve?

A

Follow up s and 52 days

Consider bronchoscopy
and (CT)

43
Q

Which infections can be caused by antibiotic use?

A

Clostridium difficile

MRSA

44
Q

Which antibiotic types has S.pneumoniae developed resistance to?

A

Penicillin Resistance

Macrolides Resitance

45
Q

When prescribing antibiotics - which dates must you always include?

A

Start and stop date

46
Q

What are the indications for someone to be vaccinated against influenza?

A 
Influenza- 
All >65 yo + 2-4
 >6 months in at risk groups:
- Asthma 
- COPD
- Chronic respiratory, heart, kidney, liver or neurological disease
- Immunosuppression
- Pregnant

Health care workers

47
Q

What are the indications for someone to be vaccinated against pneumococcus?

A
  • All >65
  • > 2 year olds in at risk groups
  • asplenia/ splenic dysfunction
  • cochlear implants
  • CSF leaks
Revaccinate every 5 years 
-  Asplenia/ splenic dysfunction
- CKD
otherwise only once
Reduces septicaemia
Poorly protective
48
Q

Which class of antibiotics are atypical pathogens

A

B lactams

49
Q

State specific features of C.psittaci

A

Acquired from birds but only 20% have bird contact

50
Q

State specific features of C.burnetii

A

Younger males, dry cough & high fever

51
Q

What are the signs and symptoms of cold autoimmune haemolytic anaemia?

A 
Symptoms of anaemia -
Pallor 
fatigue
Shortness of breath 
Dizziness 
Palpitations

Symptoms of brisk and sever haemolysis
Chest pain
Lethargy
Confusion
Transient loss of consciousness (syncope),
Deregulation of heart rate and blood pressure (hemodynamic instability)
Dark pigmented urine (haemoglobin in urine)
Jaundice (degraded haemoglobin forming bilirubin)

Circulatory symptoms

  • coldness of the fingers and/or toes (digits)
  • Painful bluish or reddish discoloration of the skin of the digits, ankles, and wrists (acrocyanosis or Raynaud phenomenon).
  • Severe cases, ulcers may develop on the extremities of digits.
52
Q

How is erythema multiform described?

A

Round lesions with bulls eye

53
Q

Which bacteria can cause caviting pneumonia?

A

klebsiella and pseudamonas (aeruginosa)

CR3 (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions