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Year 3: Medicine Block CARDIORESPIRATORY year 5 > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

What is the pathophysiology of Pneumonia?

A
  • Defined as inflammation of substance
  • Caused by:
    • Bacteria usually
    • Viruses
    • Fungi
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2
Q

How is Pneumonia Classified?

A
  • Community acquired
  • Hospital acquired
  • Immunocompromised
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3
Q

Which organisms can causes infection?

A
  • Pneumococcus (most common)
  • Haemophilus Influenzae
  • Mycoplasma pneumoniae
  • Staphlycoccus Aurues
  • Legionella spp
  • Pseudomonas Aeruginosa
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4
Q

What are symptoms of Pneumonia?

A
  • Cough
  • Purulent sputum
  • Breathlessness
  • Fever
  • Chest Pain
  • Headache
  • Myocarditis and Pericarditis
  • Abdominal Pain
  • Diarrhoea and Vomiting
  • Myalgia, Arthralgia and malaise
  • Labial Herpes Simplex
  • Skin rashes such as erythema multiforme and erythema nodosum
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5
Q

How does the fever present in empyema?

A

Swing Fever

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6
Q

How is Pneumonia Assessed?

A

CURB-65

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7
Q

What are components of CURB-65?

A

CURB-65

  • C: Confusion present
  • U: Urea level >7mmol/L
  • R: Respiratory rate >30 breaths/min
  • B: Systolic blood pressure <90mmHg; diastolic <60mmHg
  • 65: Age >65
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8
Q

How is CURB-65 used to make decisions?

A

Score 0-1: Treat as Outpatient

Score 2: Admit

Score 3+: Require case in intensive treatment unit

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9
Q

What are investigations for Pneumonia?

A
  • Chest X-ray: Repeated 6 weeks later to rule out malignancy.
  • Blood Tests
  • Microbiological Tests: Sputum culture and Gram stain
  • Blood Culture
  • Pulse Oximetry and arterial blood gas analysis if oxygen sats is <94%
  • HIV Test should be offered
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10
Q

What are management steps for Pneumonia?

A
  • Oxygen to maintain oxygen between 94% and 98%. Should be given to maintain 88% and 92% for COPD
  • Intravenous fluid in hypotensive patients
  • Antibiotics: Amoxicillin and Doxycycline
  • Thromboprophylaxis: should be given if admitted for >12h and TED stockings should be fitted
  • Nutritional supplementation
  • Analgesia: to treat pleuritic pain
  • Physiotherapy: Chest physiotherapy not needed unless sputum retention is an issue
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11
Q

What are complications of pneumonia?

A
  • Parapneumonic pleural effusion (exudative) and Empyema
  • Lung abscess
  • Respiratory failure
  • Sepsis
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12
Q

Which criteria is used to differentiate between translate and exudate?

A

Light’s Criteria

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13
Q

How is the Parapneumonic pleural effusion and empyema managed?

A

Thoracentesis to make diagnosis.

Use Light’s criteria to assess whether its transudative or exudative.

Empyema should be drained instantly if it appears

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14
Q

What should fluid from thoracentesis be examined for?

A

Fluid should be sent for:

  • Gram Stain
  • Culture
  • Fluid protein
  • Glucose
  • LDH
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15
Q

What are clinical features of a lung abscess?

A
  • Persisting or worsening pneumonia with large quantities of sputum, swinging fever, malaise and weight loss.
  • Managed according to culture
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16
Q

What are causes of Lung abscesses?

A
  • Tuberculosis
  • Septic emboli containing Staphylococci
  • Inadequately treated CAP
  • Pneumonia from certain species
  • Spread from amoebic liver abscess
  • Bronchial obstruction by endoluminal cancer
  • Foreign body inhalation
17
Q

What are the causes of non-resolving pneumonia?

A

CHAOS

  • Complication: empyema, lung abscess
  • Host: immunocompromised
  • Antibiotic: inadequate dose, poor oral absorption
  • Organism: resistant or unexpected organism not covered by empirical antibiotics
  • Second diagnosis: PE, cancer, organising pneumonia
18
Q

What is Hospital Acquired Pneumonia?

A

New onset of cough with purulent sputum along with compatible X-ray demonstrating consolidation beyond 2 days of initial admisson to hospital or within 3 months of being in healthcare setting.

19
Q

Which organisms are implicated in Hospital Acquired Pneumonia?

A
  • Pseudomonas Spp.
  • Escherichia Spp.
  • Klebsiella spp.
  • Enterobacter spp.
  • Staphylococcus Aureus
  • MRSA
  • Acinetobacter spp.
20
Q

How is Hospital Acquired Pneumonia treated?

A
  • Ceftazidime/Avibactam
  • MRSA – Telavancin
21
Q

What is the pathophysiology of Aspiration Pneumonia?

A
  • Acute aspiration of gastric content into lungs can produce extremely severe and sometimes fatal illness due to intense destructiveness of gastric acid
  • Persistent pneumonia often due to anaerobes and progress to lung abscess or even bronchiectasis if protracted
22
Q

What is the most usual site for aspirated material?

A
  • Right Middle Lobe
  • Apical or Posterior segments of Right Lower Lobe
23
Q

What is the treatment for Aspiration Pneumonia?

A
  • Directed specification against positive culture if available
  • Co-amoxiclav covers gram negative and anaerobic bacteria if cultures not available
24
Q

What can lead to Pneumocystis Jiroveci Pneumonia?

A
  • Long-term corticosteroids
  • Monoclonal antibody therapy or methotrexate for autoimmune disease
  • Those on anti-rejection medication post solid organ transplantation
  • Stem cell transplantation
  • Those affected with HIV
25
Q

How does Pneumocystis Jiroveci Pneumonia arise?

A

Pneumocytis Jiroveci is found in air and pneumonia can arise from re-infection rather than reaction of persisting organism acquired in childhood

26
Q

What is the threshold for the CD4+ count to be harmful?

A

Individual with CD4+ counts of <200/mm3 are at particular risk

27
Q

What are clinical features of Pneumocystis Jiroveci Pneumonia?

A
  • High Fever
  • Breathlessness
  • Dry cough
  • Rapid desaturation on exercise or exertion
28
Q

What are imaging findings for Pneumocystis Jiroveci Pneumonia?

A
  • Diffuse bilateral alveolar and interstitial shadowing beginning in perihilar region and spreading out in a butter fly pattern.
  • Localized infiltration, nodules, cavitation or pneumothorax
29
Q

What is the management for Pneumocystis Jiroveci Pneumonia?

A
  • Diagnosis confirmed by indirect immune-flourescence on induced sputum or brochoalveolar lavage fluid
  • High-dose Co-Trimoxazole is 1st line.
30
Q

What is microbiology of Klebsiella Pneumoniae?

A
  • Gram-negative rod
  • Part of the normal gut flora.
  • Can cause a number of infections in humans including Pneumonia (typically following aspiration) and Urinary Tract Infections
31
Q

What are clinical features of Klebsiella Pneumonia?

A
  • Common among Alcoholics and Diabetics
  • Red Currant Jelly-like sputum
  • Implicated in many other disorders such as Ascending Cholangitis
  • May occur following Aspiration
32
Q

What are complication of Klebsiella Pneumoniae?

A

Commonly causes:

  • Lung Abscess formation
  • Empyema
33
Q

What is the difference between an abscess and empyema?

A
  • An abscess is a collection of pus inside a newly formed cavity. \
  • An empyema is a collection of pus in an already existing cavity such as the pleural space.

Year 3: Medicine Block CARDIORESPIRATORY year 5 (28 decks)

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