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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
Q

What is mortality like in pneumonia?

A

around 21% in hospital

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26
Q

What is an atypical organism associated with faulty air condition systems?

A

legionella pneumophilia

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27
Q

What is Streptoccocus pneumonaia (AKA pneumocoocous) associated with?

A

most common and associated with influenza

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28
Q

What are RF for haemophilius influenzae B?

A
  1. COPD

2. Bronchiectasis

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29
Q

What are RF for Staph aureus?

A

IV drug use

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30
Q

What is staph aureus assoicted with?

A

cavitating lesions and abscess

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31
Q

What is RF for klebsiella pneuomina and what is it associated with?

A
  • RF: Chronic alcoholics

- Assoicated with cavitating lesions

32
Q

What are the atypical organisms in pneumonia?

A
  1. Mycoplasma pneumonia
  2. Legionella pnuemophilia
  3. Chlamydia psittaci
  4. Chalmydia penumoniae
  5. Coxiella burnetild
  6. Pnuemocytsitici jirvecci (PCP)
33
Q

What are RF and associations for mycoplasma pneumonia?

A
  • Most common atypical
  • RF: young/close contact
  • Associated with: erythema multiforme, transverse myelitis
34
Q

What are RF and associations of Legionella pnuemophila?

A
  • RF: faulty AC/colling water towers/hot tubs

- Associated with hypoNa, abnormal increased LFTs

35
Q

What are RF and associations of Chlamydia psittaci?

A
  • RF: Birds to parrot fever

- Associated with HIV

36
Q

What are RF and associations for Coxiella burnetiid?

A
  • RF: farm animals

- Causes Q fever

37
Q

What are RF for Pneumocystitis jirvecii (PCP)?

A
  • RF: HIV (aids defining)

- Associated with Karposi Sarcoma (purple patch on nose)

38
Q

What are assoications of psudeomonas aeruginosa?

A

CF/Bronchictasis

39
Q

What are RF and associations of Staph Aureus?

A
  • RF: IV drug use

- Assoicated with cavitating lesions and abscess

40
Q

What are RF and associations of klebsiella?

A
  1. RF: chronic alcoholics

2. Associated with cavitating lesions

41
Q

What are RF for pneumoinia?

A
  1. Old age
  2. Chronic lung condition (asthma/COPD)
  3. Immunosuppresion
  4. Aspiration risk
  5. Smoking
  6. Travel
42
Q

What are symptoms for atypical pnuemonia?

A
  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
Q

What are the pneumonia inspection signs?

A
  1. Respiratory distress

2. Cyanosis (peripheral/central)

44
Q

What are the palpitation and percussion signs for pneumonia?

A
  1. Reduced chest expansion/asymmetrical)

2. Dull percussion (over consolidation)

45
Q

What are the auscultation signs of pneumonia?

A
  1. Basal creps (coarse) (fluid in alveoli)
  2. Bronchial breathing
  3. Increased vocal resonance
46
Q

What are the general causes of pleuritic chest pain?

A
  1. PE
  2. Pneumothorax
  3. Pleural effusion
  4. Pericarditis
  5. Pneumonia
47
Q

What imaging is done for pneumonia?

A

CXR

48
Q

What may you see on CXR?

A
  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
Q

What are air bronchograms?

A

bronchi being filled with air surrounded by alveoli that are filled with pus (consolidation)

50
Q

How would you do a pleural fluid aspirate and culture?

A

via thoracentesis

51
Q

What can urinary antigen testing show?

A
  1. Legionella

2. Pneumococcal (strep pneumoniae) urinary antigen testing

52
Q

What are possible causes for cavitating lung lesions on CXR?

A
  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
Q

What can you do for bacterial pneumonia?

A

gram staining +ve or -ve

54
Q

What is gram +ve bacteria?

A
  • cocci
    1. Streptococcus pneumoniae (usually diplococci can be isolated/ chain)
    2. Staphylococcus aureus (clusters)
55
Q

What is gram negative bacteria?

A
  • 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
Q

What tests are used and when for atypical pneumonia?

A
  1. PCR: mycoplasma + Chlamydophila
  2. Urinary antigens (legionella)
  3. Blood film (mycoplasma – cold agglutins)
  4. High LFTs (legionella)
  5. Serology (all)
57
Q

What is the scoring system in primary care/when urea not available?

A

Primary care/Urea unavailable to CRB65
0=no need for hospital Tx at home
>1 = hospitalisation recommended

58
Q

What antibiotics are used for CAP when pathogen unknown?

A
  1. Amoxicillin – typical cover
  2. Clarithromycin – atypical cover + if allergic to penicillin
  3. Doxycycline – allergic to penicillin
59
Q

What antibiotic is used for CRB65 0 or CURB65 0/1?

A

amoxicillin

60
Q

What antibiotic is used for CURB-65 2?

A

amoxicillin

61
Q

What antibiotic is used for CURB-65 3?

A

IV Co-amoxiclav (beta lactamase inhibitor) + clarithromycin

62
Q

Which antibiotic is used in pregnancy for pneumonia?

A

erythromycin

63
Q

What antibiotics are used in HAP?

A

1st line: Co amoxiclav
MRSA: IV Vancomycin
Pseudomonas: IV tazocin and gentamicin

64
Q

What antibiotics are used for aspiration pneumonia?

A

Amoxicillian + metronidazole

65
Q

What antibiotics are used for staph aureus?

A

flucloxacillin

66
Q

What antibiotics are used for PCP?

A

Co-trimoxazole

67
Q

What is the treatment for acute pneumonia (SOB/SEPSIS)?

A
  1. Oxygen + sit up patient)=
  2. IV fluids
  3. IV painkillers (pleuritic chest pain)
  4. IV antibiotics
  5. CPAP (if required)
68
Q

What is the most common CAP organism?

A

streptococcus pneumonia

69
Q

What atypical signs may be present with Mycoplasma pneumonia?

A
  1. Transverse myelitis (inflammation of spinal cord)
  2. Erythema multiforme (round lesions with bullseye appearance)
  3. Associated with autoimmune haemolytic anaemia
70
Q

What investigations are done for Mycoplasma pneumonia?

A

Blood film (red cell agglutination with cold agglutinin)

71
Q

What atypical signs may be with legionella?

A
  1. Hyponatraemia

2. Abnormal LFTs

72
Q

What investigations are done for legionella?

A
  • LFTs

- Urinary antigens

73
Q

If patient has penicillin allergy what do you give them?

A

docycyline

74
Q

What antibtioics do you give for Pneumocystis Jirovecii (PCP):pneumonia in HIV?

A

Co-trimoxazole (trimethoprim + sulfamethoxazole)

75
Q

What diff antibtioics are used in HAP?

A
  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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