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Z Year3 Resp Conditions > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

What is pneumonia?

A
  • Acute lower respiratory tract infection associated with fever, symptoms and signs on chest and abnormal CXR
  • Infection of lung parenchyma
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2
Q

What is the epid of pneumonia?

A

30% under 65

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3
Q

What is most common type of bacterial pneumonia?

A

pneumococcal pnuemonia/strep pneumoniae

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4
Q

What are different types of pneumonia?

A
  1. Community acquired (CAP)
  2. Hospital acquired
  3. Aspiration
  4. Immunocompromised treatment
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5
Q

When can you develop CAP?

A

primary or secondary to underlying disease

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6
Q

What are common causative organisms for CAP?-

A
  1. Streptoccocus pneumonaia
  2. Haemophilus influenzae B
  3. Staph aureus
  4. Moraxella cararrhalis
  5. Klebsiella pnuemonia
    Viruses account for 15%
    -Flu may be complicated with MSRA pneumonia
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7
Q

When is pneumonia classed as hospital acquired?

A

> 48h after hospital admission

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8
Q

What organisms usually cause hospital acquired pneumonia?

A
  1. Psedumonas aeruginosa
  2. Staph.aureus
  3. Klebsiella
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9
Q

When is aspiration pneumonia common?

A
  • stroke
  • myasthenia
  • bulbar palsies
  • decreased consciousness
  • oesophageal disease or poor dental hygiene risk aspirating oropharyngeal anaerobes
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10
Q

What organisms are common in immunocmprised pneumonia?

A
  1. Strep pneumonia
  2. H. infleunzae
    Staph aureus
  3. M, catarrhalis
  4. M penumonaie
  5. Gram -ve bacilli
  6. Fungi
  7. Viruses (CMV, HMB)
  8. Mycobacteria
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11
Q

What are symptoms of pneumonia?

A
  1. Fever
  2. Rigors Malaise
  3. Anorexia
  4. Dyspnoea
  5. Cough
  6. Green sputum
  7. Haemoptysis
  8. Pleuritic chest pain
  9. Confusion (elderly)
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12
Q

What are signs of pneumonia?

A
  1. Pyrexia
  2. Cyansosis
  3. Cpnfusion
  4. Tachypnoea
  5. Tachycardia
  6. Hypotension
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13
Q

How would signs of consolidation show in pneumonia?

A
  1. reduced expansion
  2. dull percussion
  3. increased tactile vocal fremitus
  4. bronchial breathing
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14
Q

What bloods are done in pneumonia?

A
  1. FBC: WCC high
  2. U+Es
  3. LFTs
  4. CRP: high
  5. ESR: high
  6. ABG: dyspnoea
  7. Culture: sepsis
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15
Q

What basic obs are done in pneumonia?

A
  1. HR high
  2. RR high
  3. BP low sepsis
  4. O2 sats low
  5. Temp high
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16
Q

What bedside tests are done for pneumonia?

A
  1. Sputum culture

2. Urinary antigen testing

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17
Q

What scoring system is used in pneumonia?

A

CURB-65

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18
Q

What does CURB-65 stand for?

A
  1. Confusion: (abbreviated mental test <8)
  2. Urea >7mmol/L
  3. Resp rate >30/min
  4. BP: <90 systolic and 60mmHg diastolic
  5. Age >65
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19
Q

What is the treatment for CURB-65 0-1?

A

antibitoic + home treatment

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20
Q

What is the treatment for CURB-65 2?

A

Hospital therapy

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21
Q

What is the treatment for CURB-65 >3?

A

severe pneumonia indicated mortality 15-40% consider ITU

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22
Q

What is the 1st line antibiotic used?

A

amoxicillin and them clarithromycin or doxycycline (if allergic to penicillin)

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23
Q

What is the treatment for staphococcal pnuemonia?

A

flucloxacillin

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24
Q

What are possible complications of pneumonia?

A
  1. Plural effusion
  2. Empyema
  3. Lung abscess
  4. Resp failure
  5. Septicaemia
  6. Brain abscess
  7. Pericarditis
  8. Myocarditis
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25
What is mortality like in pneumonia?
around 21% in hospital
26
What is an atypical organism associated with faulty air condition systems?
legionella pneumophilia
27
What is Streptoccocus pneumonaia (AKA pneumocoocous) associated with?
most common and associated with influenza
28
What are RF for haemophilius influenzae B?
1. COPD | 2. Bronchiectasis
29
What are RF for Staph aureus?
IV drug use
30
What is staph aureus assoicted with?
cavitating lesions and abscess
31
What is RF for klebsiella pneuomina and what is it associated with?
- RF: Chronic alcoholics | - Assoicated with cavitating lesions
32
What are the atypical organisms in pneumonia?
1. Mycoplasma pneumonia 2. Legionella pnuemophilia 3. Chlamydia psittaci 4. Chalmydia penumoniae 5. Coxiella burnetild 6. Pnuemocytsitici jirvecci (PCP)
33
What are RF and associations for mycoplasma pneumonia?
- Most common atypical - RF: young/close contact - Associated with: erythema multiforme, transverse myelitis
34
What are RF and associations of Legionella pnuemophila?
- RF: faulty AC/colling water towers/hot tubs | - Associated with hypoNa, abnormal increased LFTs
35
What are RF and associations of Chlamydia psittaci?
- RF: Birds to parrot fever | - Associated with HIV
36
What are RF and associations for Coxiella burnetiid?
- RF: farm animals | - Causes Q fever
37
What are RF for Pneumocystitis jirvecii (PCP)?
- RF: HIV (aids defining) | - Associated with Karposi Sarcoma (purple patch on nose)
38
What are assoications of psudeomonas aeruginosa?
CF/Bronchictasis
39
What are RF and associations of Staph Aureus?
- RF: IV drug use | - Assoicated with cavitating lesions and abscess
40
What are RF and associations of klebsiella?
1. RF: chronic alcoholics | 2. Associated with cavitating lesions
41
What are RF for pneumoinia?
1. Old age 2. Chronic lung condition (asthma/COPD) 3. Immunosuppresion 4. Aspiration risk 5. Smoking 6. Travel
42
What are symptoms for atypical pnuemonia?
1. Dry cough - because atypical pneumonia causes interstitial inflammation (spares alveoli) 2. Low grade fever 3. Headache 4. Diarrhoea 5. Myalgia 6. Hepatitis (extrapulmonary signs)
43
What are the pneumonia inspection signs?
1. Respiratory distress | 2. Cyanosis (peripheral/central)
44
What are the palpitation and percussion signs for pneumonia?
1. Reduced chest expansion/asymmetrical) | 2. Dull percussion (over consolidation)
45
What are the auscultation signs of pneumonia?
1. Basal creps (coarse) (fluid in alveoli) 2. Bronchial breathing 3. Increased vocal resonance
46
What are the general causes of pleuritic chest pain?
1. PE 2. Pneumothorax 3. Pleural effusion 4. Pericarditis 5. Pneumonia
47
What imaging is done for pneumonia?
CXR
48
What may you see on CXR?
1. Alveolar opacification 2. Air bronchograms 3. Consolidation 4. “diffuse patchy infiltrates bilaterally’: X ray looks worse than pts clinical symptoms characteristic of atypical e.g. PCP pneumonia
49
What are air bronchograms?
bronchi being filled with air surrounded by alveoli that are filled with pus (consolidation)
50
How would you do a pleural fluid aspirate and culture?
via thoracentesis
51
What can urinary antigen testing show?
1. Legionella | 2. Pneumococcal (strep pneumoniae) urinary antigen testing
52
What are possible causes for cavitating lung lesions on CXR?
1. Malignancy: esp squamous cell lung cancer 2. Autoimmune: Wegener’s granulmaotsis + RF 3. Vascular: Septic emboli 4. Infective: TB, abscess (staph aeureus/Klebsiella)
53
What can you do for bacterial pneumonia?
gram staining +ve or -ve
54
What is gram +ve bacteria?
- cocci 1. Streptococcus pneumoniae (usually diplococci can be isolated/ chain) 2. Staphylococcus aureus (clusters)
55
What is gram negative bacteria?
- bacillus 1. Haemophilus influenzae (can be coccobacilli) 2. Klebsiella pneumoniae 3. Psuedomonas aeruginosa 4. Legionella Pneuomophilia (does NOT graim stain well) 5. Moraxella catarrhalis (exception this is a diplococcus)
56
What tests are used and when for atypical pneumonia?
1. PCR: mycoplasma + Chlamydophila 2. Urinary antigens (legionella) 3. Blood film (mycoplasma – cold agglutins) 4. High LFTs (legionella) 5. Serology (all)
57
What is the scoring system in primary care/when urea not available?
Primary care/Urea unavailable to CRB65 0=no need for hospital Tx at home >1 = hospitalisation recommended
58
What antibiotics are used for CAP when pathogen unknown?
1. Amoxicillin – typical cover 2. Clarithromycin – atypical cover + if allergic to penicillin 3. Doxycycline – allergic to penicillin
59
What antibiotic is used for CRB65 0 or CURB65 0/1?
amoxicillin
60
What antibiotic is used for CURB-65 2?
amoxicillin
61
What antibiotic is used for CURB-65 3?
IV Co-amoxiclav (beta lactamase inhibitor) + clarithromycin
62
Which antibiotic is used in pregnancy for pneumonia?
erythromycin
63
What antibiotics are used in HAP?
1st line: Co amoxiclav MRSA: IV Vancomycin Pseudomonas: IV tazocin and gentamicin
64
What antibiotics are used for aspiration pneumonia?
Amoxicillian + metronidazole
65
What antibiotics are used for staph aureus?
flucloxacillin
66
What antibiotics are used for PCP?
Co-trimoxazole
67
What is the treatment for acute pneumonia (SOB/SEPSIS)?
1. Oxygen + sit up patient)= 2. IV fluids 3. IV painkillers (pleuritic chest pain) 4. IV antibiotics 5. CPAP (if required)
68
What is the most common CAP organism?
streptococcus pneumonia
69
What atypical signs may be present with Mycoplasma pneumonia?
1. Transverse myelitis (inflammation of spinal cord) 2. Erythema multiforme (round lesions with bullseye appearance) 3. Associated with autoimmune haemolytic anaemia
70
What investigations are done for Mycoplasma pneumonia?
Blood film (red cell agglutination with cold agglutinin)
71
What atypical signs may be with legionella?
1. Hyponatraemia | 2. Abnormal LFTs
72
What investigations are done for legionella?
- LFTs | - Urinary antigens
73
If patient has penicillin allergy what do you give them?
docycyline
74
What antibtioics do you give for Pneumocystis Jirovecii (PCP):pneumonia in HIV?
Co-trimoxazole (trimethoprim + sulfamethoxazole)
75
What diff antibtioics are used in HAP?
1. Staph aureus: flucloxacillin 2. . MRSA: vancomycin 3. Pseudomonas: tazocin + gentamicin (tazosin = tazobactam + piperacillin) 4. Anaerobes: metronidazole & amoxicillin

Z Year3 Resp Conditions (20 decks)

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